18F-FDG PET/CT显像联合血清学肿瘤标志物检测对直肠癌的诊断价值

Diagnostic value of 18F-FDG PET/CT combined with serological tumor markers for rectal cancer

目的探讨18氟-氟代脱氧葡萄糖(18F-FDG)计算机正电子发射断层扫描/计算机断层显像(PET/CT)联合肿瘤标志物诊断直肠癌的价值。方法选取2017年1月至2020年5月本院收治的95例直肠占位患者作为直肠占位组,记录患者接受18F-FDG PET/CT显像检查的病灶最大标准化摄取值(SUV_(max))、血清肿瘤标志物癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原242(CA242)水平,并选取同期以健康体检为诉求行18F-FDG PET/CT显像检查及外周肿瘤标志物筛查且经证实身体健康的30名健康者作为对照组,比较两组筛查结果,评估18FFDG PET/CT、肿瘤标志物诊断直肠癌效能,分析SUV_(max)与血清肿瘤标志物相关性。结果直肠占位组SUV_(max)、平均标准化摄取值(SUVmean)高于对照组,代谢体积(MTV)、病灶糖酵解总量(TLG)大于对照组(P<0.05);经病理确诊为直肠癌76例,直肠良性病变19例;18F-FDG PET/CT检出阳性直肠结节75例,阴性20例,其中确诊直肠癌73例;阳性直肠结节患者SUV_(max)、SUVmean、MTV及TLG均高于阴性直肠结节患者(P<0.05);直肠占位组血清CEA、CA19-9、CA242水平均高于对照组(P<0.05)。18F-FDG PET/CT单独诊断直肠癌的灵敏度、准确率、阳性预测值均高于肿瘤标志物,Kappa值为0.838,与病理结果一致性极强;联合诊断灵敏度、准确率、阴性预测值均高于单独肿瘤标志物诊断,Kappa值为0.903,与病理结果一致性Kappa值极强。CEA、CA19-9、CA242阳性患者SUV_(max)值均高于阴性患者(P<0.05);CEA、CA19-9、CA242均与SUV_(max)呈正相关(r>0,P<0.05)。结论推测18F-FDG PET/CT SUV_(max)与肿瘤标志物联合可提高直肠癌诊断效能。

Objective To investigate the diagnostic value of fluorine-18 fluorodeoxyglucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)combined with serological tumor markers for rectal cancer.Methods A total of 95 patients with rectal neoplasms admitted to the hospital from January 2017 to May 2020 were selected as the rectal neoplasms group,the maximum standard intake(SUV_(max))of the lesion,serum tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and carbohydrate antigen 242(CA242)in patients undergoing 18F-FDG PET/CT were recorded.30 healthy people who underwent 18F-FDG PET/CT imaging and screening of peripheral blood tumor markers for health examination in the same period were selected as the control group.Screening results of the two groups were comparatively analyzed,the efficacy of 18F-FDG PET/CT and tumor markers in the diagnosis of rectal cancer was evaluated,the correlation between SUV_(max) and serum tumor markers was analyzed.Results SUV_(max),mean standardized uptake(SUVmean)in rectal neoplasms group were higher than those in control group,metabolic timor volume(MTV)and total lesion glycolysis(TLG)in rectal neoplasms group were larger than those in control group(P<0.05).76 cases of rectal cancer and 19 cases of rectal benign lesions were confirmed by pathology;the results of 18F-FDG PET/CT showed positive rectal nodules in 75 cases and negative rectal nodules in 20 cases,among which 73 cases were diagnosed with rectal cancer;SUV_(max) and SUVmean in positive rectal nodules were higher than those in negative rectal nodules,MTV and TLG in positive rectal nodules were larger than those in negative rectal nodules(P<0.05);the levels of CEA,CA19-9 and CA242 in rectal neoplasms group were higher than those in control group(P<0.05).The sensitivity,accuracy and positive predictive value of 18F-FDG PET/CT alone in the diagnosis of rectal cancer were higher than those of tumor markers,and the Kappa value was 0.838,which was highly consistent with the pathological results.The sensitivity,accuracy and negative predictive value of combined diagnosis were higher than those of single tumor marker diagnosis,and the Kappa value was 0.903,which was highly consistent with pathological results.The SUV_(max) values of CEA,CA19-9 and CA242 positive patients were higher than those of negative patients(P<0.05);CEA,CA19-9 and CA242 were positively correlated with SUV_(max)(r>0,P<0.05).Conclusion It is speculated that 18F-FDG PET/CT SUV_(max) combined with serum tumor markers can improve the diagnostic efficiency for rectal cancer.