正电子发射计算机断层显像/计算机断层扫描在乳腺癌放疗靶区勾画中的作用及对淋巴结转移的预测价值

Value of position emission tomography/computed tomography in breast cancer radiotherapy target delineation and predicting of lymph node metastasis

目的探讨正电子发射计算机断层显像(PET)/CT在乳腺癌放疗靶区勾画中的作用及对淋巴结转移的预测价值。方法选取68例乳腺癌患者,依据放疗时影像学定位技术的不同分为观察组(n=37)和对照组(n=31),对照组患者采用64层螺旋CT定位扫描,观察组患者采用PET/CT定位扫描。比较两组患者的大体肿瘤体积(GTV)、计划靶区(PTV)、放疗疗效、放疗相关不良反应和预后情况。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估最大标准摄取值(SUV_(max))对乳腺癌患者淋巴结转移的预测价值。结果两组患者GTV无明显差异(P﹥0.05),观察组患者的PTV小于对照组,差异有统计学意义(P﹤0.05)。观察组患者的放疗总有效率为75.68%,与对照组患者的70.97%无明显差异(P﹥0.05)。观察组放疗不良反应总发生率为2.70%,低于对照组患者的22.58%,差异有统计学意义(P﹤0.05)。PET/CT检查显示,37例乳腺癌患者中,发生淋巴结转移15例,未发生淋巴结转移22例,淋巴结转移患者的SUV_(max)为(7.39±1.08),高于无淋巴结转移患者的(5.78±1.22),差异有统计学意义(P﹤0.05)。ROC曲线显示,SUV_(max)诊断乳腺癌患者淋巴结转移的AUC为0.845(95%CI:0.720~0.970),最佳截断值为6.34,此时的灵敏度为0.800,特异度为0.773。随访结束,观察组患者的总生存率为75.68%,与对照组患者的61.29%无明显差异(P﹥0.05)。结论PET/CT检查能更准确地指导临床乳腺癌靶区勾画和调整放疗方案,减轻放疗相关不良反应,对乳腺癌患者淋巴结转移具有较高的诊断价值。

Objective To investigate the value of positron emission tomography(PET)/CT in breast cancer radiotherapy target delineation and predicting of lymph node metastasis.Method A total of 68 breast cancer patients were selected and divided into observation group(n=37)and control group(n=31)according to the different imaging localization techniques during radiotherapy.The patients in the control group were scanned by 64-slice spiral CT,and the patients in the observation group were scanned by PET/CT.The gross tumor volume(GTV),planned target volume(PTV),radiotherapy efficacy,radiotherapy-related adverse reactions and prognosis were compared between the two groups.The receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated,and the predictive value of the maximum standard uptake value(SUV_(max))for lymph node metastasis in breast cancer patients was evaluated.Result There was no significant difference in GTV between the two groups(P>0.05),but the PTV of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).The total effective rate of radiotherapy in the observation group was 75.68%,which was not significantly different from 70.97%in the control group(P>0.05).The total incidence of radiotherapy adverse reactions in the observation group was 2.70%,which was lower than 22.58%in the control group,and the difference was statistically significant(P<0.05).PET/CT examination showed that 15 of 37 breast cancer patients had lymph node metastasis,and 22 had no lymph node metastasis.The SUV_(max)of patients with lymph node metastasis was(7.39±1.08),which was higher than that of patients without lymph node metastasis(5.78±1.22),and the difference was statistically significant(P<0.05).The ROC curve showed that the AUC of SUV_(max)for the diagnosis of lymph node metastasis in breast cancer patients was 0.845(95%CI:0.720-0.970),the best cut-off value was 6.34,the sensitivity was 0.800,and the specificity was 0.773.At the end of the follow-up,the overall survival rate of the observation group was 75.68%,which was not significantly different from 61.29%of the control group(P>0.05).Conclusion PET/CT examination can more accurately guide the delineation of the clinical breast cancer target area and adjust the radiotherapy plan,reduce the adverse reactions related to radiotherapy,and have a high diagnostic value for lymph node metastasis in breast cancer patients.