PET-CT在乳腺癌保乳微创治疗中的应用研究

STUDY OF PET- CT IN THE APPLICATION OF MINIMAL INVASIVE BREAST CONSERVED THERAPY

目的:探讨PET蛳CT在早期乳腺癌保乳微创治疗中的可行性及其临床意义。方法:选取2002年12月—2004年3月行PET蛳CT检查的乳腺肿瘤或腋窝肿物患者40例(包括1例男性患者),给予常规检查及PET蛳CT扫描,根据疾病性质及患者情况给予相应手术治疗,根据术后病理结果评价PET蛳CT对于原发肿瘤及转移灶诊断的准确性,及其判断腋窝淋巴结转移情况的可行性,并与SLNB或ALND进行比较。结果:PET蛳CT诊断原发肿瘤的敏感性、特异性、准确率为95.2 %、50 %、88 %;在切检术后病例中,PET蛳CT诊断肿瘤是否残留的敏感性、特异性及准确率为25 %、83.3 %、60 %;肿瘤病理大小与PET蛳CT诊断大小相关性最为显著(Pearson系数=0.786,P=0.000);以SLNB和/或ALND作为金标准,PET蛳CT诊断腋窝淋巴结状况的敏感性、特异性及准确率是72.2 %、94.4 %、83.3 %,诊断转移淋巴结数目与病理诊断数目的符合率为41.2 %。结论:PET蛳CT与原发肿瘤病理诊断基本符合,两者诊断原发肿瘤大小一致性最佳,PET蛳CT有望成为准确判断肿瘤范围的可靠方法;但对于腋窝淋巴结,PET蛳CT尚没有足够的敏感性及准确率成为SLNB以外的准确诊断腋窝淋巴结状况的方法。

Objective: To evaluate the feasibility and clinical significance of PET- CT scan in minimal invasive breast conserved therapy of early stage breast cancer. Methods: From December 2002 to March 2004, PET- CT was performed for 40 cases with breast tumor before surgery. Accuracy of PET- CT was evaluated on pathological results and compared with SLNB or ALND. Results: The sensitivity, speciality, and accuracy of PET- CT on primary tumor were 95.2 %, 50 %, and 88 % respectively; and 72.2 %, 94.4 %, and 83.3 %, respectively for axillary lymph nodes. The pathological size of primary tumor remarkably correlated with that of PET- CT (Pearson coefficient is 0.786;P=0.000). Conclusion: PET- CT is expected to be a new method for the correct diagnosis of both primary tumor and axillary lymph nodes. With its low sensitivity and accuracy comparing with SLNB, PET- CT could not substitute SLNB for the minimal invasive therapy of axillary lymph nodes.