原发性子宫内膜癌患者浸润与转移的18F-FDG PET/CT影像学诊断价值

Diagnostic value of18F-FDG PET/CT imaging in detecting invasion and metastasis of primary endometrial carcinoma

目的探讨原发性子宫内膜癌患者浸润与转移的18F-FDG PET/CT影像研究。方法回顾性分析2015年1月至2018年1月期间温州市中心医院、温州医科大学附属第一医院收治的204例确诊及疑似子宫内膜癌患者的临床资料,所有患者均经18F-FDG PET/CT检查,172例患者经术后病理诊断为子宫内膜癌,32例患者为子宫良性肿瘤。比较原发灶不同病理情况SUVmax水平,淋巴结数量分析18F-FDG PET/CT影像诊断情况,并分析18F-FDG PET/CT影像对转移病灶的诊断价值。结果原发灶不同病理情况SUVmax比较后发现恶性肿瘤SUVmax显著高于良性肿瘤(t=1.996,P<0.05),肿瘤≥4cm者SUVmax显著高于肿瘤<4cm者(t=2.059,P<0.05),肌层侵犯≥1/2者SUVmax显著高于肌层侵犯<1/2(t=2.793,P<0.05),SUVmax随着病理分级提高而显著降低(F=2.537,P<0.05)。而宫颈基质是否累及、FIGO分期、病理类型之间SUVmax比较无显著性差异(t值分别为1.683、1.813、1.924,均P>0.05)。172例恶性肿瘤患者中132例行盆腔淋巴结清扫,共切除1 188枚淋巴结,由淋巴结数量分析18F-FDG PET/CT影像诊断,显示其诊断敏感度为85.71%(72/84)、特异度为98.18%(1 084/1 104)、准确性为97.30%(1 156/1 188)、阴性预测值为98.90%(1 084/1 096)、阳性预测值为78.26%(72/92)。172例恶性肿瘤患者中,经病理证实70例出现远处转移,18F-FDG PET/CT影像对转移病灶的诊断灵敏度为90.00%(63/70)、特异度为91.17%(93/102)、准确性为90.69%(156/172)、阴性预测值为93.00%(93/100)、阳性预测值为87.50%(63/72)。结论 18F-FDG PET/CT影像能清晰显示原发性子宫内膜癌患者病灶情况,且对于远处转移病灶具有较高的诊断特异度和预测值,对于临床治疗具有较好的指导意义。

Objective To investigate the diagnostic value of 18F-FDG PET/CT imaging in detecting the infiltration and metastasis of primary endometrial carcinoma.Methods We retrospectively analyzed the clinical data of 204 patients,with confirmed and suspected endometrial cancer,who were admitted to Wenzhou Central Hospital and the First Affiliated Hospital of Wenzhou Medical University during the period from January 2015 to January 2018.All patients underwent 18F-FDG PET/CT imaging,and 172 of them underwent postoperative pathological diagnosis and were diagnosed to have endometrial cancer and 32 of them were confirmed to have benign tumors of the uterus.The levels of SUVmax in different pathological conditions of the primary lesions were compared,and the number of lymph nodes was analyzed by 18F-FDG PET/CT imaging.The diagnosis of metastatic lesions by 18F-FDG PET/CT images was analyzed.Results The SUVmax of malignant tumor was significantly higher than that of benign tumor(t=1.996,P<0.05),SUVmax of tumor≥4 cm was significantly higher than that of tumor<4 cm(t=2.059,P<0.05),SUVmax of muscular invasion≥1/2 was significantly higher than that of muscular invasion<1/2(t=2.793,P<0.05),and SUVmax decreased significantly with the improvement of pathological grade(F=2.537,P<0.05).However,there was no significant difference in SUVmax between cervical stroma involvement,FIGO stage and pathological type(t=1.683,1.813,1.924 respectively,P>0.05 for all).In 132 of 172 patients with pelvic lymph node cleaning of malignant tumor cells,a total of 1,188 lymph nodes were excised;and the results of the analysis of 18F-FDG PET/CT imaging diagnosis through the number of lymph nodes showed that their diagnostic sensitivity was 85.71%(72/84),specificity 98.18%(1,084/1,104),accuracy 97.30%(1,156/1,188),negative predictive value was 98.90%(1,084/1,096),positive predictive value was 78.26%(72/92).Among 172 patients with malignant tumors,70 of them were pathologically confirmed to have distant metastasis.The diagnostic sensitivity of 18F-FDG PET/CT imaging for metastatic lesions was 90.00%(63/70),specificity 91.17%(93/102),accuracy 90.69%(156/172),negative predictive value was 93.00%(93/100),and positive predictive value was 87.50%(63/72).Conclusion The 18F-FDG PET/CT imaging can clearly show the lesions of patients with primary endometrial carcinoma,and have higher diagnostic specificity and predictive value for distant metastatic lesions.It has good guiding significance for clinical treatment.