^(18)F-FDG PET对睾丸生殖细胞肿瘤化疗后肿瘤残留的准确性判断

The ^(18)F-fluorodeoxyglucose positron emission tomograhy in predicting residual retroperitoneal tumor after chemotherapy of testis germ cell tumors

目的:探讨睾丸生殖细胞肿瘤化疗后^(18)F-FDG PET对腹膜后残留病灶的准确性判断。方法:回顾性分析2014年2月至2016年12月北京大学肿瘤医院泌尿外科16例睾丸生殖肿瘤伴腹膜后淋巴结转移患者的资料,4~6个疗程的博来霉素+顺铂+依托泊苷(BEP)化疗后行腹部CT检查,所有患者的腹膜后肿块直径>2 cm。^(18)F-FDG PET检查后行腹膜后淋巴结清扫术,并进行术后病理与术前^(18)F-FDG PET结果比较。结果:16例患者中10例^(18)F-FDG PET结果阳性,其中5例术后病理存在肿瘤残留、5例无肿瘤残留组织;6例^(18)F-FDG PET结果为阴性,2例术后病理肿瘤残留患者均为成熟畸胎瘤、4例无肿瘤组织残留。^(18)F-FDG PET的准确率为56.25%(9/16),灵敏度为71.42%(5/7),特异度为44.44%(4/9),阳性预测率为50.00%(5/10),阴性预测率为66.67%(4/6)。结论:^(18)F-FDG PET灵敏度较高,但多种因素会影响^(18)F-FDG PET结果的准确性,成熟畸胎瘤易造成^(18)F-FDG PET的假阴性,大量炎性组织易造成^(18)F-FDG PET假阳性,需结合多种检查提高结果准确性。

Objective：To determine the value of 18F-fluorodeoxyglucose positron emission tomography （18F-FDG PET） scans in identify-ing the residual retroperitoneal tumor after chemotherapy of testis germ cell tumors. Methods：Sixteen testis germ cell tumor patients with metastasis of retroperitoneal lymph nodes who were treated in our hospital from February 2014 to December 2016 were select-ed for the study from February 2014 to December 2016. After 4-6 cycles of chemotherapy, their CT scans showed residual masses with diameters greater than 2 cm. The retroperitoneal lymph nodes were dissected after the 18F-FDG PET exam. The post-surgery pathology results were compared with the results of the 18F-FDG PET exam. Results：Residual tumors were found in 5 of 10 patients with 18F-FDG PET positive. Residual tumor was absent in 4 of 6 patients with 18F-FDG PET negative, while residual mature teratoma tumors were found in two patients. The accuracy rate, sensitivity, specificity, positive predictive value （PPV）, and negative predictive value （NPV） of the 18F-FDG PET exam were 56.25%（9/16）, 71.42%（5/7）, 44.44%（4/9）, 50.00%（5/10）, and 66.67%（4/6）, respectively. Conclusion： 18F-FDG PET is highly sensitive. However, many factors influence the result of 18F-FDG PET. Mature teratoma leads to a false negative re-sult, whereas massive tissue inflammation leads to a false positive result. Therefore, more clinical examinations should be made.