氟标记氟代脱氧葡萄糖正电子发射断层扫描用于卵巢癌术后监测的探讨

^(18)F-FDG PET in post-operative monitoring patients with ovarian cancer

目的 评价^(18)F-FDG(18氟标记氟代脱氧葡萄糖)PET(正电子发射断层扫描)在卵巢癌术后病情监测中的临床应用价值。方法 1999年6月至2002年3月对21例卵巢癌术后随访的患者行^(18)F-FDG PET检查,结果判定采用目测法和半定量分析法(标准化摄取值,SUV)。结果 9例临床完全缓解的卵巢癌Ⅰ期患者于术后12～15个月进行了全身PET检查,未发现病灶,继续随访观察12～21个月,临床无复发征象。12例临床检查疑为复发者,11例PET检查为阳性,1例为阴性,6例PET结果阳性者及1例阴性者进行了手术探查,手术病理证实7例均为复发,PET、B超与病理结果符合率分别为85.7％、71.4％。21例患者中,2例CA_(125)升高而B超结果为阴性者,PET显像除见局部复发灶外,还同时探测到横结肠和(或)乙状结肠转移灶,均经病理证实为复发灶,病灶最小直径约0.8cm;1例PET检查结果为阴性者,B超及CT检查均为阳性,病理证实为透明细胞癌复发。结论 ^(18)F-FDG PET检查对卵巢癌术后随访、确认肿瘤复发以及探测全身各部位尤其肠道转移灶有良好的临床应用价值,对肠道转移病灶的定性和定位诊断优于B超,对透明细胞癌的诊断缺乏准确性。

Objective To explore the clinical value of post-operational surveillance of ovary cancer by 18F-FDG. Meth-ods From June 1999 to March 2002 21 patients with ovarian cancer were examined with 18F-FDG PET during the follow-up period after operation,and the results were evaluated by eyes and semi-quantity analysis(by standardized up-take value, SUV). Results Nine patients with total remission( I stage) were examined with whole-body PET after 12 - 15 months of operation, with no focus being found. The follow-up was carried out for another 12-21 months, no clin -ical recurrence being detected. Among 12 patients with suspicious recurrence, 11 were positive with PET examination, and l negative.These 6 positive cases and l negative case were treated by surgical detection, all of them being proved to be with recurrence, The rates of consistency of PET, B-ultrasound and pathological examination were 85.7% and 71.4% ,respectively. Among 21 cases,there were 2 negative cases by B-ultrasound,but with increased CA125,but PET showed local recurrent focus. In addition,the metastatic focuses were found in both transverse colon and (or) sigmoid, which was confirmed by surgical pathology,the diameter of the smallest focus being 0.8cm. One case was negative by PET but positive by B-ultrasound and CT examination,and the pathology revealed ovarian clear cell carcinoma recurrence. Conclusion 18F-FDG PET is clinically valuable for post-operational follow-up of ovarian cancer in confirming the recurrence,detecting metastasis to the whole body, especially metastasis in the colon. It is better than B-ultrasound for detecting whole-body metastasis focuses, especially for characterization and location; but it is less accurate in diagnosing clear cell carcinoma.