PET/CT对早期宫颈癌后腹膜淋巴结转移的诊断价值

The value of PET/CT in the diagnosis of early cervical cancer with retroperitoneal lymph node metastasis

目的探讨正电子发射计算机断层成像(PET/CT)对早期宫颈癌后腹膜淋巴结转移的诊断价值。方法回顾性选取2019年5月5日至2020年8月31日在上海交通大学医学院附属仁济医院妇科肿瘤科因宫颈癌行手术治疗的105例患者,分析术前PET/CT检查结果、术后病理结果及临床特征,探讨影响PET/CT诊断后腹膜淋巴结转移的高危因素。结果 PET/CT诊断后腹膜淋巴结转移的准确度为75.2%,灵敏度为60.0%,特异度为81.3%,曲线下面积(AUC)为0.707。单因素分析显示,2009 FIGO(国际妇产科联盟)分期、肿瘤直径>4 cm、淋巴脉管间隙浸润(LVSI)阳性、浸润深度、鳞状细胞癌抗原(SCC-Ag)升高及细胞学分级是PET/CT诊断后腹膜淋巴结转移重要因素(P<0.05);多因素logistic回归分析显示肿瘤直径>4 cm是PET/CT诊断后腹膜淋巴结转移的独立危险因素(P=0.015)。结论 PET/CT对早期宫颈癌后腹膜淋巴结转移的评估有一定的诊断价值,但不能完全反映淋巴结转移的真实性;肿瘤直径>4 cm是PET/CT诊断后腹膜淋巴结转移的独立危险因素。

Objective To investigate the value of positron emission tomography/computed tomography(PET/CT)in diagnosis of retroperitoneal lymph node metastasis for early cervical cancer.Methods Retrospectively analyze the preoperative PEI/CT examination results and postoperative pathological results of patients with early cervical cancer who underwent surgical treatment from May 5,2019 to August 31,2020,and analyze the clinical characteristics,so as to explore the high risk factors of PET/CT in the diagnosis of retroperitoneal lymph node metastasis.Results The accuracy,sensitivity,specificity and area under the curve(AUC)of PET/CT in the diagnosis of retroperitoneal lymph node metastasis were 75.2%,60.0%,81.3%and 0.707,respectively.Univariate analysis showed that 2009 International Federation of Gynecology and Obstetrics(FIGO)stage,tumor diameter>4 cm,lymphovascular space involvement(LVSI)positive,depth of invasion,high squamous cell carcinoma antigen(SCC-Ag)level and cytological grade were important factors for PET/CT in the diagnosis of retroperitoneal lymph node metastasis(P<0.05);Multivariate analysis showed that tumor diameter>4 cm was an independent risk factor for PET/CT diagnosis of retroperitoneal lymph node metastasis(P=0.015).Conclusions PET/CT has a certain diagnostic value in the evaluation of retroperitoneal lymph node metastasis,but it can not fully reflect the facticity of lymph node metastasis;tumor diameter>4cm is an independent risk factor for PET/CT in the diagnosis of retroperitoneal lymph node metastasis.