18F-FDG PET/CT显像在上皮性卵巢癌术后随访中的应用价值及对临床决策的影响

摘要

目的 探讨PET/CT显像在上皮性卵巢癌术后和(或)综合治疗后随访中的应用价值及对临床治疗决策影响.方法 回顾性分析52例上皮性卵巢癌术后,接受18F-FDG PET/CT显像及常规影像学方法检查患者的随访及临床评价资料,与临床随访的金标准[再次术后病理和(或)长期随访观察]进行对比,并分析PET/CT显像对临床决策的影响.结果 52例患者中,33例经临床随访确诊为复发和(或)转移,19例无明显复发和(或)转移.PET/CT显像以视觉分析法结合标准摄取值(SUVmax≥2.5作为阳性诊断标准),34例诊断为复发和(或)转移(真阳性30例,假阳性4例),阴性结果18例(其中3例为假阴性).PET/CT在随访中诊断复发和(或)转移的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为90.91%(30/33)、78.95%(15/19)、86.54%(45/52)、88.24%(30/34)和83.33%(15/18);而常规影像学分别为70.00%(28/40)、58.33%(7/12)、67.31%(35/52)、84.85%(28/33)和36.84%(7/19).基于PET/CT结果,16例(16/52,30.77%)患者的治疗方案发生改变.结论 应用18F-FDG PET/CT检查对卵巢癌综合治疗后患者进行随访,在监测复发和(或)转移的诊断价值明显高于常规影像学检查.%Objective To investigate the role of PET/CT imaging on the follow-up and therapeutic decision-making in epithelial ovarian cancer patients after surgery and (or) combined therapies. Methods Fifty-two patients were enrolled, all underwent surgical operation, radiotherapy and (or) chemotherapy before PET/CT scans. PET/CT images were retrospectively observed, and compared with the conventional imaging and clinical golden standard (postoperative pathology and [or] long-term clinical follow-up). The role of PET/CT in therapeutic decision-making was then investigated. Results In 52 patients, 33 were final diagnosed as recurrence and (or) metastasis, the other 19 as disease-free survival after long-term clinical follow-up. According to PET/CT, 34 patients were diagnosed as metastasis and (or) recurrence (including 30 true-positive and 4 false-positive), and 18 were negative (including 3 false-negative). Compared with the golden standard, the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT was 90. 91 ％ (30/33), 78. 95％ (15/19), 86. 54％ (45/52), 88. 24％ (30/34) and 83.33％ (15/18) for PET/CT imaging, respectively, while was 70.00％ (28/40), 58. 33％ (7/12), 67. 31％ (35/52), 84.85％ (28/33) and 36. 84％ (7/19) respectively of conventional imaging. The therapeutic decision changed in 16 patients (16/52, 30. 77 ％) based on PET/CT results. Conclusion 18F-FDG PET/CT imaging could be used for the follow-up of ovarian cancer patients after treatment. The diagnostic value of PET/CT in monitoring metastasis and (or) recurrence was much higher than that of conventional imaging.