18 F-NaF PET/CT与99m Tc-MDP骨显像诊断乳腺癌骨转移瘤的对比研究

Comparison between 18 F-NaF PET/CT and 99m Tc-MDP bone scintigraphy to detect bone metastases in patients with breast cancer

目的对比分析18 F标记的氟化钠(18 F-Fluoride,18 F-NaF)PET/CT骨显像与99m Tc标记的亚甲基二膦酸盐(99m Tc-MDP)骨显像(bone scintigraphy,BS)对诊断乳腺癌骨转移的临床价值。方法回顾性分析经病理证实为乳腺癌且临床怀疑骨转移的48例女性患者,在1周内分别行18 F-NaF PET/CT骨显像与BS检查,以病理学或临床随访结果为诊断依据,分别在病例和病灶水平上比较两种检查方法的诊断效能。结果48例乳腺癌患者经证实38例、147个病灶为骨转移瘤。在病例水平上,18 F-NaF PET/CT与BS显示骨转移瘤的检出率及特异度间的差异无统计学意义(P=0.210,P=0.582),18 F-NaF PET/CT显示骨转移瘤的灵敏度高于BS(P<0.01),18 F-NaF PET/CT发现乳腺癌骨转移瘤的效能与标准组高度一致(Kappa=0.934,μ=14.369,P<0.01),而BS发现乳腺癌骨转移瘤的效能与标准组中等一致(Kappa=0.413,μ=2.888,P<0.05)。在病灶水平上,18 F-NaF PET/CT发现骨转移灶的检出率、灵敏度、特异度和符合率均高于BS(χ^2=9.892,χ^2=23.263,χ^2=9.028,χ^2=30.897,P<0.01),18 F-NaF PET/CT发现乳腺癌骨转移灶的效能与标准组高度一致(Kappa=0.881,μ=16.942,P<0.01),而BS发现乳腺癌骨转移灶的效能与标准组一致性差(Kappa=0.238,μ=2.674,P<0.05)。结论18 F-NaF PET/CT骨显像对乳腺癌骨转移的诊断效能总体优于BS,具有一定的临床指导意义和应用价值。

Objective To compare and analyze the clinical value of 18 F-NaF PET/CT and 99m Tc-MDP bone scintigraphy(BS)in the diagnosis of breast cancer with bone metastasis.Methods 48 female patients with breast cancer confirmed in pathology and clinically suspected bone metastasis were retrospectively analyzed.18 F-NaF PET/CT bone imaging and BS examination were performed within one week respectively.Based on pathology or clinical follow-up results,the diagnostic efficacy of the two methods was compared at the level of cases and lesions.Results A total of 38 patients and 147 lesions were detected to have bone metastases.At the case level,there was no statistically significant difference between 18 F-NaF PET/CT and BS in the detection rate and specificity of bone metastases(P=0.210,P=0.582).18 F-NaF PET/CT showed a sensitivity of bone metastases higher than that by BS(P<0.01);18 F-NaF PET/CT showed the efficacy in diagnosing bone metastases in breast cancer highly consistent with the standard group(Kappa=0.934,μ=14.369,P<0.01),while BS showed an efficacy moderately consistent with standard group(Kappa=0.413,μ=2.888,P<0.05).At the lesion level,the detection rate,sensitivity,specificity and coincidence rate of bone metastases were higher in 18 F-NaF PET/CT than in BS(χ^2=9.892,χ^2=23.263,χ^2=9.028,χ^2=30.897,P<0.01);the efficacy of 18 F-NaF PET/CT in detecting bone metastases was highly consistent with the standard group(Kappa=0.881,μ=16.942,P<0.01),while BS showed a poor consistence(Kappa=0.238,μ=2.674,P<0.05).Conclusion 18 F-NaF PET/CT bone imaging is,on the whole,superior to BS in the diagnosis of breast cancer with bone metasta sis,and thus has certain clinical guiding significance and application value.