99m Tc-MDP 骨扫描在乳腺癌骨转移诊断中的应用

摘要

目的：观察99m Tc-MDP骨扫描在乳腺癌骨转移诊断中的应用效果。方法对317例乳腺癌患者进行99m Tc-MDP全身骨扫描；在99m Tc-MDP全身骨扫描前1周内空腹采集患者静脉血3．0 mL，采用电化学发光法检测血清癌胚抗原（CEA）、糖链抗原125（CA125）、糖链抗原15-3（CA15-3）；利用ROC曲线分析血清CEA、CA125、CA15-3与骨扫描的关系，计算CEA、CA125、CA15-3诊断乳腺癌骨转移的CUT-OFF值。结果99m Tc-MDP骨扫描显示，无骨转移（阴性）者245例，有骨转移（阳性）者72例（Ⅰ级52例、Ⅱ级及以上20例）。与骨扫描阴性者比较，骨扫描Ⅰ级、Ⅱ级及以上者CEA、CA125、CA15-3水平升高（ P均＜0．05）；与骨扫描Ⅰ级者比较，骨扫描Ⅱ级者CEA、CA125、CA15-3水平升高（P均＜0．05）。99mTc-MDP骨扫描显示，在骨扫描分级达Ⅱ级及以上时，血清CEA、CA125、CA15-3的ROC曲线下面积分别为0．80、0．98、0．88，CEA、CA125、CA15-3诊断乳腺癌骨转移的CUT-OFF值分别为22．35、38．71、41．96 U／mL。结论99m Tc-MDP骨扫描可作为诊断乳腺癌骨转移的筛选手段，血清CEA、CA125、CA15-3水平高于22．35、38．71、41．96 U／mL时，应高度警惕多发骨转移的发生，需行99m Tc-MDP骨扫描筛查。%Objective To observe application effect of 99m Tc-MDP bone scanning in the diagnosis of breast cancer with bone metastasis.Methods 99mTc-MDP bone scanning of the whole body was performed in 317 cases of patients with breast cancer.A week before 99mTc-MDP bone scanning, fasting venous blood was collected (3.0 mL), and then, the serum carci-noembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and carbohydrate antigen 15-3 (CA15-3) was detected by using the ECL assay .The relationships between serum CEA , CA125, CA15-3 and bone scanning were analyzed by ROC curve, and we calculated CUT-OFF value of CEA, CA125, CA15-3 in diagnosis of breast cancer with bone metastasis .Re-sults 99mTc-MDP bone scanning showed there were 245 cases of patients without bone metastasis (negative), and 72 cases of bone metastasis (positive, 52 cases of gradeⅠ, 20 cases of gradeⅡand above).Compared with the negative bone scanning , the levels of CEA, CA125 and CA15-3 were increased in the patients of bone scanning gradeⅠ,Ⅱand above (all P<0.05);compared with gradeⅠbone scanning , the levels of CEA , CA125 and CA15-3 were increased in patients of bone scanning gradeⅡ(all P<0.05).99mTc-MDP bone scanning showed when the bone scanning reached grade Ⅱand above, the area under the ROC curve of serum CEA , CA125 and CA15-3 was 0.80, 0.98 and 0.88, respectively .The CUT-OFF values of CEA , CA125 and CA15-3 in diagnosis of breast cancer with bone metastasis were 22.35, 38.71 and 41.96 U/mL.Conclusions 99m Tc-MDP bone scanning can be used as a diagnostic tool in the breast cancer with bone metastases screening .When the serum CEA, CA125 and CA15-3 levels are above 22.35, 38.71 and 41.96 U/mL, we should be more vigilant about the oc-currence of multiple bone metastases, which needs for the 99mTc-MDP bone scanning.