^(18)F-FDG PET/CT在妇科常见恶性肿瘤诊断及预后中的应用探讨

Application of ^(18)F-FDG PET/CT in the diagnosis and prognosis of gynecologic malignancies

目的比较PET/CT显像、常规影像学检查(B超、CT、MRI)及肿瘤标志物对宫颈癌、卵巢癌、子宫内膜癌三大妇科恶性肿瘤的早期诊断及复发转移评估效果。方法回顾性分析2014年2月-2017年1月于无锡市第四人民医院就诊并临床怀疑妇科肿瘤而行PET/CT扫描的患者121例,收集其PET/CT检查报告197份,经确诊有79例患者为妇科恶性肿瘤;收集所有患者彩超、CT、MIR及血清学等辅助检测结果,并做相应回访。分别分析PET/CT、常规影像学检查及肿瘤标志物对卵巢癌、宫颈癌、子宫内膜癌诊断的灵敏度、特异度、诊出率;通过COX回归分析评估三种检测方法对妇科恶性肿瘤复发及转移的预测价值。结果 PET/CT对子宫内膜癌的诊断符合率最高(97.0%),对卵巢癌的漏诊率最高(9.7%),对宫颈癌的误诊率较高(11.1%);此外,PET/CT对肿瘤的复发及转移的预测较常规影像学(B超、CT、MRI)、肿瘤标志物的预测效果更好(COX回归分析:HR=149.67,95%CI 14.42-1553.54,P<0.01)。结论 PET/CT对妇科恶性肿瘤的复发及转移的预测较常规影像学、肿瘤标志物的预测价值更高;此外,PET/CT对子宫内膜癌的诊断符合率较高,但对卵巢癌及宫颈癌的漏诊率、误诊率也较高。

Objective To evaluate the early diagnosis and recurrence and metastasis of cervical cancer,ovarian cancer and endometrial cancer in three gynecologic malignancies by PET/CT imaging and routine imaging examination（ B ultrasound,CT,MRI） and tumor markers. Methods A retrospective analysis of 121 patients who suspected gynecological tumor clinically and underwent PET/CT scanning at the Fourth People＇s Hospital of Wuxi City between February 2014 and January2017 were analysed and 197 PET/CT examination reports were collected. 79 cases were diagnosed as gynecologic malignancies later. All patients were collected color Doppler ultrasound,CT,MIR and serology and other auxiliary test results,and make the appropriate return visit. The sensitivity,specificity and diagnosis rate of PET/CT,routine imaging examination and tumor markers in the diagnosis of ovarian cancer,cervical cancer and endometrial cancer were analyzed respectively. The predictive value of three detection methods for the recurrence and metastasis of gynecologic malignancies was evaluated by COX regression analysis. Results The highest rate with PET/CT in the diagnosis of endometrial carcinoma（ 97. 0%）,the misdiagnosis rate of ovarian cancer was highest（ 9. 7%）,the higher rate of misdiagnosis of cervical cancer（ 11. 1%）; in addition,the prediction of recurrence and metastasis of PET/CT tumor than conventional imaging（ Bultrasound,CT,MRI）,tumor marker the better prediction effect（ COX regression analysis： HR = 149. 67,95% CI 14. 42-1553. 54,P 0. 01）. Conclusion ： the predictive value of PET/CT for the recurrence and metastasis of gynecologic malignancies is higher than that of conventional imaging and tumor markers. In addition,PET/CT has a high coincidence rate of diagnosis of endometrial cancer. However,the rate of misdiagnosis for ovarian cancer and cervical cancer is also higher.