骨扫描在初诊食管癌骨转移筛查中的临床应用

Clinical application of bone scanning in preoperative screening of osseous metastasis for patients with esophageal carcinoma

目的探讨99mTc-MDP骨扫描在食管癌术前筛查中的临床应用价值。方法回顾性分析2015年3月—2017年5月初诊食管鳞状细胞癌患者359例,常规行99mTc-MDP骨扫描检查,骨显像阳性者再经3.0MRI、CT以及随访最终确诊有无骨转移。结果 30例患者共计68个部位证实为骨转移,食管癌骨转移率为8.4%(30/359)。基于患者分析,99mTc-MDP骨扫描诊断食管癌骨转移准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为74.3%(267/359)、93.3%(28/30)、72.6%(239/329)、23.7%(28/118)、99.2%(239/241),基于病灶分析,99mTc-MDP骨扫描诊断食管癌骨转移灶的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为77.4%(182/235)、91.2%(62/68)、71.9%(120/167)、56.9%(62/109)、95.2%(120/126)。将其诊断结果与诊断标准相比,Kappa检验一致性较差(Kappa值0.283)。结论99mTc-MDP骨扫描灵敏度高,可作为食管鳞状细胞癌骨转移筛查手段,但特异性较差,不能单独用于骨转移诊断。

Objective To investigate the clinical application value of 99 m Tc-MDP bone scintigraphy in preoperative screening for patients with esophageal carcinoma. Methods Retrospectively analyzed the clinical data of in 359 patients with esophageal squamous carcinoma those who primarily diagnosed during Mar 2015 and May 2017,all of them received99 mTc-MDP bone scintigrapy. MRI,CT and follow-up results were used to confirm whether the positive cases with bone metastasis. Results A total of 68 lesions were diagnosed in 30 patients,the rate of bone metastasis was 8. 4%（ 30/359）. In term of patients,the accuracy,sensitivity,specificity,PPV,NPV of99 mTc-MDP bone scintigraphy for detecting bone metastasis were 74. 3%（ 267/359）,93.3%（ 28/30）,72.6%（ 239/329）,23.7%（ 28/118）,99.2%（ 239/241） respectively. In term of lesions,the accuracy,sensitivity,specificity,PPV,NPV of99 mTc-MDP bone scintigraphy for detecting bone metastasis were77.4%（ 182/235）,91.2%（ 62/68）,71.9%（ 120/167）,56.9%（ 62/109）,95.2%（ 120/126）. When comparing with diagnostic criteria,Kappa consistency test is poor（ Kappa value 0. 283）. Conclusions99 mTc-MDP bone scanning is a good method for preoperative screening in diagnosis osseous metastasis in the patients with esophageal squamous cancer,which the sensitivity was high,but with poor specificity,it can ＇ t be used to diagnose metastases alone.