18F-FDG PET/CT显像在乳腺外Paget病中的临床应用

Clinical application of 18F-FDG PET/CT in extramammary Paget’s disease

目的:探讨18F-FDG PET/CT在乳腺外Paget病(Extramammary Paget’s disease,EMPD)诊断、分期和随访中的作用。方法:回顾性分析13例新诊断或可疑复发的EMPD患者全身18F-FDG PET/CT图像。18F-FDG摄取增加的病灶为阳性,测量最大标准摄取值(SUVmax)。结果:13例EMPD患者中,11例术前接受18F-FDG PET/CT检查,2例术后接受18F-FDG PET/CT检查。13例患者中有11例存在皮肤病变,所有皮肤病变18F-FDG摄取均可见不同程度增高,SUVmax介于1.4~15.9之间。其中,皮肤病变的厚度≥1 cm的有4例(4/11),SUVmax介于4.6~15.9之间;<1 cm的有7例(7/11),SUVmax介于1.4~3.9之间。采用独立样本t检验对两组皮肤病变的SUVmax进行统计学比较,结果显示t=2.821,P=0.064,差异无统计学意义。13例EMPD患者发现淋巴结转移7例(7/13),SUVmax介于3.4~15.1之间,其中包含1例EMPD术后及放疗后疑似复发的患者。13例EMPD患者发现远处转移2例(1例为单发骨转移,1例为肺、肝、骨多发转移),所有病灶均表现为18F-FDG不同程度摄取增高,SUVmax介于3.8~14.0之间。同时发现2例EMPD患者合并有肺癌或结肠癌。结论:18F-FDG PET/CT对EMPD的诊断主要依赖于病变的厚度,对转移的诊断更为敏感,因此有助于EMPD的术前分期及临床随访。

Objective:To investigate the role of 18F-FDG PET/CT in the diagnosis,staging and follow-up of extramammary Paget’s disease(EMPD).Methods:Whole-body 18F-FDG PET/CT images of 13 patients with newly diagnosed or suspected recurrent EMPD were retrospectively analyzed.The lesions with increased uptake of 18F-FDG were positive and were measured with maximum standard uptake(SUVmax).Results:Among the 13 patients with EMPD,11 received 18F-FDG PET/CT before surgery and 2 received 18F-FDG PET/CT after surgery.Eleven patients had skin lesions,18F-FDG uptake of all skin lesions was increased in varying degrees,SUVmax ranged from 1.4 to 15.9.The skin lesions thickness was more than or equal to 1 cm in 4 cases(4/11),and SUVmax ranged from 4.6 to 15.9,the thickness was less than 1 cm in 7 cases(7/11),and SUVmax ranged from 1.4 to 3.9.The SUVmax of skin lesions between two groups was compared by independent sample t-test and the results showed that t=2.821,P=0.064,without statistical significance.Lymph node metastasis was found in 7(7/13),and SUVmax ranged from 3.4 to 15.1,and one of them(1/7)was suspected recurrence after EMPD surgery and radiotherapy.In 13 EMPD patients,distant metastasis was found in 2 cases(1 case with single bony metastasis,1 case with multiple lung,liver and bone metastases),all lesions showed increased FDG uptake in varying degrees and SUVmax ranged from 3.8 to 14.0.Two cases(2/13)of EMPD with lung cancer or colon cancer were found.Conclusion:18F-FDG PET/CT diagnosis of EMPD mainly depends on the thickness of the lesion,which is more sensitive to the diagnosis of metastasis.Therefore,18F-FDG PET/CT is very useful for the diagnosis,staging and follow-up of EMPD.