18F-FDG PET/CT不同诊断方法对乳腺癌及其淋巴结转移的应用价值

摘要

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在诊断乳腺癌及其区域淋巴结转移中的临床价值.方法 对27例疑原发性乳腺癌及经临床随访(＞12个月)证实的12例单发乳腺良性病变患者行18F-FDG PET/CT显像,患者均为女性.对显像结果分别行定性、半定量分析.27例疑乳腺癌患者均行手术治疗.结果 疑乳腺癌患者术后病理检查示24例为乳腺癌,共25个病灶;良性病灶7个.18F-FDG PET/CT显像定性分析诊断乳腺癌的灵敏度为76.0%(19/25),特异性为94.7%(18/19);以最大标准摄取值(SUVmax)＞2.5为界值,18F-FDG PET/CT诊断乳腺癌的灵敏度为72.0%(18/25),特异性为63.2%(12/19);以病灶SUVmax大于对侧正常乳腺腺体SUVmax的-x+2s为界值,PET/CT诊断乳腺癌的灵敏度为96.0%(24/25),特异性为63.2%(12/19),其灵敏度明显高于前2种分析方法(X2=4.15,4.14;P均＜0.05).定性方法的特异性明显高于半定量分析(X2值均为5.7,P均＜0.05).23例行区域淋巴结廓清术的患者病理检查示10例有淋巴结转移.18F-FDGPET/CT定性诊断乳腺癌区域淋巴结转移的灵敏度为60.0%(6/10),特异性为84.6%(11/13);以SUVmax＞2.5为界值,18F-FDG PET/CT诊断淋巴结转移的灵敏度为60.0%(6/10),特异性为92.3%(12/13).结论 在18F-FDG PET/CT诊断乳腺癌中,以病灶SUVmax大于正常乳腺腺体sUVmax的-x+2s为界值的半定量分析有较好的灵敏度;定性分析的诊断特异性优于半定量分析.%Objective The purpose of this study was to assess the diagnostic efficiency of the qualitative and semi-quantitative analyses of 18F-fluorodeoxyglucose(FDG)PET/CT for staging primary breast cancer.Methods This prospective study included 39 patients.Of the 39 cases,24 were primary breast cancer,15 were benign breast lesions.Patients underwent regional FDG PET/CT scanning covering bilateral breasts and axilla.All primary breast cancer lesions were confirmed by pathologic results of surgery.Twenty-four cases with benign lesions were established according to the results of surgery or clinical follow up for at least 12 months.The qualitative and semi-quantitative 18F-FDG uptake results were used fbr T staging and N staging of breast cancer.SPSS 11.5 was used for data analysis.Results When using SUVmax＞4.5 as the cutoff value or SUVmax＞x+2s of contra-lateral normal breast SUVmax as the cutoff value combined CT malignant signs for initial diagnosis,the sensitivity,specificity of diagnosing breast malignant lesion were 96.0%(24/25),63.2%(12/19),respectively.By using threshold of SUVmax＞2.5,the sensitivity,specificity were 60%(6/10),92.3%(12/13)respectively for staging regional lymphadenopathy.Conclusion For staging primary breast carcinoma with FDG PET/CT,higher sensitivity could be acquired when using SUVmax＞4.5 or SUVmax＞-x+2s of contra-lateral normal breast SUVmax as the cutoff value combined with CT malignant signs.