18F-FDG PET/CT评价鼻咽癌治疗后的肿瘤残留或复发

摘要

Objective:To investigate the diagnostic potential of 18F-FDG PET-CT for the detection of residual/recurrent nasopharyngeal carcinoma(NPC). Methods:Fifty-five NPC patients after therapy underwent follow-up with PET-CT. In 55 NPC, thirty-eight NPC patients were performed with both PET-CT and NPS, and thirty-one NPC patients with both PET-CT and MRI. The diagnosis standards were based on histopathological findings or clinical and imaging follow-up above 6 months. The sensitivity, specificity, and accuracy of PET-CT were analyzed, and an optimal cut-off of SUVmax was determined. PET-CT, NPS and MRI were compared for local residual or recurrent nasopharygeal carcinoma with receiver operating characteristic curves (ROC). The detection of neck lymph node metastasis, distant metastasis and second primary carcinoma were analyzed with PET-CT. Results:The sensitivity, specificity and accuracy of PET-CT were 100%, 87.9%, 92.7%for local residual/recurrent nasopharygeal carcinoma. The optimal cut-off of SUVmax was 4.2 for local tumor residual/recurrence. PET-CT showed better diagnostic accuracy than NPS(P<0.05), and similar accuracy to MRI (P>0.05). The detection of neck lymph node metastasis, distant metastasis and second primary carcinoma in NPC was 14.5%, 10.9%and 5.5%with PET-CT. Conclusion:PET-CT had a high accuracy of local residual/recurrent NPC at the primary tumor site and detection of neck lymph node metastasis, distant metastasis and second primary carcinomas. PET-CT would more comprehensive for tumor restaging and therapy strategy.%目的：探讨18F-FDG PET/CT在诊断鼻咽癌治疗后有无肿瘤残留或复发方面的应用价值。方法：55例鼻咽癌治疗结束后行18F-FDG PET/CT检查，其中38例纤维鼻咽镜(NPS)检查，31例磁共振成像(MRI)检查。以组织病理学或6个月以上临床和影像学随访结果作为诊断病灶性质的标准。计算PET/CT判断鼻咽局部肿瘤残留或复发的敏感性、特异性和准确性，并确定最大标准化摄取值(SUVmax)判断肿瘤残存或复发的界值。用ROC曲线分析比较PET/CT与NPS、MRI判断鼻咽局部肿瘤残留或复发的诊断效能。分析PET/CT对颈部淋巴结转移、远处转移以及第二原发癌的检出率。结果：PET/CT判断鼻咽局部肿瘤残留或复发的灵敏度、特异度和准确率分别为100%、87.9%和92.7%。SUVmax判断鼻咽局部肿瘤残留或复发的界值为4.2。PET/CT判断鼻咽局部肿瘤残留或复发的诊断准确率高于NPS(x2=7.11，P＜0.05)，与MRI相仿(x2＝2.79，P＞0.05)。PET/CT对颈部淋巴结转移的检出率为14.5%，远处转移检出率为10.9%，第二原发癌检出率为5.5%。结论：PET/CT不仅在判断鼻咽局部肿瘤残留或复发方面具有很高的准确性，而且PET/CT扫描有助于颈部淋巴结转移、远处转移和第二原发癌的检出，从而为鼻咽癌治疗后的再分期及治疗计划提供更全面的信息。