目的：探讨18F-氟代脱氧葡萄糖（18F-FDG）符合线路PET/CT联合钼靶、B超在乳腺癌诊断中的临床应用价值。方法回顾性分析36例乳腺癌手术后患者，根据病灶大小分为3组（＜1.0 cm组，1.0~2.0 cm组，＞2.0 cm组），术前均进行B超、钼靶X线乳腺摄影和符合线路正电子发射计算机断层显像（PET）/CT检查。结合术后病理，比较符合线路PET/CT、B超、钼靶X线乳腺摄影诊断乳腺癌的结果。结果6例肿瘤直径＜1 cm中，18F-FDG符合线路PET/CT未发现病灶，钼靶诊断4例，B超诊断2例。19例1．0~2．0 cm患者中，符合线路PET/CT、B超、钼靶X线、三者联合敏感性分别为：52．61％、78．95％）、47．37％、94．74％，B超、钼靶与联合检查的敏感性差异无统计学意义（χ2＝1．12，P＞0．05）；B超、钼靶与PET/CT比较差异无统计学意义（χ2＝4．94，P＜0．05）。病灶直径＞2．0 cm，检查敏感性分别为钼靶81．82％、B超90．91％、PET/CT 90．91％、联合检查100％；3种检查与联合检查的检出率差异无统计学意义。在判断腋窝淋巴结转移中，各种检查的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为18F-FDG符合线路PET/CT 86．67％，80．95％，83．33％，76．47％，89．47％，B超66．67％，61．90％，63．89％，55．56％，72．22％，钼靶20.0％，90．48％，61．11％，60.0％，61．29％。结论乳腺肿瘤直径＜2.0 cm时，B超结合钼靶的敏感性较18F-FDG符合线路PET/CT高，且经济适用；当肿瘤＞2.0 cm时，三者敏感性相近。乳腺癌不同病理分型中对18F-FDG摄取不尽相同。在淋巴结转移及临床分期上，18F-FDG符合线路PET/CT有明显优势。%Objective To explore the clinical value of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in combination of mammography and ultrasound in diagnosing breast cancer. Methods A retrospective analysis of 36 patients with breast cancer after surgery was performed. The patients were divided into 3 groups (<1.0 cm, 1.0-2.0 cm and>2.0 cm). They had undergone preoperative ultrasound, molybdenum target X-ray mammography and PET/CT. We com-pared the diagnostic performance of these modalities. Results In the 6 patients with <1.0 cm tumor size, 18F-FDG PET/CT failed in all cases, while mammography and ultrasound detected the lesions in 4 and 2 cases, respectively. In the 19 patients with 1.0-2.0 cm tumor size, sensitivity of the PET/CT, ultrasound, mammography, alone and combina-tion of the three was 52.61%), 78.95%, 47.37% and 94.74%, respectively. There was no difference among the sen-sitivity of ultrasound, mammography and combined detection, while the PET/CT differed from the ultrasound and mam-mography in detection sensitivity ( χ2=4.94, P<0.05). For the cases with > 2.0 cm tumor size, the sensitivity was 81.82% with the X-ray mammography, 90.91% with the ultrasound, 90.91% with the PET/CT, and the 100% with combination of the three. In judgment of axillary lymph node metastasis of the breast cancer, the sensitivity, specifici-ty, accuracy, positive predictive value and negative predictive value were as follows: PET/CT (86.67%, 80.95%, 83.33%, 76.47%, 89.47%), ultrasound (66.67%, 61.90%, 63.89%, 55.56%, 72.22%), and molybde-num target (20.0%, 90.48%, 61.11%, 60.0%, 61.29%). Conclusion In diagnosis of <2 cm breast cancer, ultra-sound combined with mammography is more sensitive and affordable than PET/CT. When the tumor is greater than 2 cm, the three diag-nostic modalities offer similar sensitivity. Breast cancer of different pathological types show differ-ent 18F-FDG uptake.PET/CT appears to have evident advantages which justify it as reference for clinical purpose.
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