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宫颈癌发病率较高,在女性肿瘤疾病中处于第二位[1],而分期为Ib期及以上的患者大约有1/3在治疗后会复发[2-3]。早期的局部复发可以通过放疗或盆腔廓清术等方法提高患者的生存率,甚至可使部分患者获得治愈的机会,但是当患者出现远处转移时,以上的治疗是无效的,因此,宫颈癌复发和(或)转移的早期及准确诊断非常重要。传统的影像学检查如超声、CT、MRI等在宫颈癌复发的诊断中有局限性,包括难以鉴别复发性肿瘤与手术或放疗所致的纤维化、难以发现正常大小的转移淋巴结及盆腔以外的远处转移等[4]。因此,寻找一种以代谢功能改变为基础的显像方法,成为临床肿瘤学研究的新趋势[5]。我们回顾性分析我院2007年1月至2008年12月为评估宫颈癌是否复发而行18F-FDG SPECT-CT的62例患者的临床资料,探讨其在监测宫颈癌复发和(或)转移中的临床价值。
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62例患者临床最终确诊为宫颈癌复发和(或)转移者36例,其中18F-FDG SPECT-CT检查结果为真阳性34例、假阴性2例,2例假阴性中,1例为骨转移、1例为腹膜后淋巴结转移,骨转移患者18F-FDG SPECT-CT 2周后出现臀部疼痛,全身骨扫描发现左坐骨转移,另一例假阴性患者18F-FDG SPECT-CT 2周后经外院PET-CT示腹膜后淋巴结转移。62例患者临床最终排除复发和(或)转移者26例,其中18F-FDG SPECT-CT结果为真阴性24例、假阳性2例,2例假阳性中,1例为阴道残端炎症、1例为纵隔淋巴结非特异性摄取。
CT检查结果为真阳性25例,假阴性11例,真阴性21例,假阳性5例。假阴性中,2例为阴道残端复发、3例为盆腔淋巴结转移、2例为锁骨上淋巴结转移、1例为肺转移、1例为肝脏转移、2例为骨转移;假阳性中,3例为阴道残端术后纤维瘢痕组织形成、2例为盆腔非特异性淋巴结肿大。
62例患者中,血清SCCA水平升高者38例(2.7~37.9 ng/ml),SCCA水平在正常范围者24例(< 2.0 ng/ml)。SCCA检查结果中,真阳性24例,假阴性12例,真阴性12例,假阳性14例。
18F-FDG SPECT-CT与CT、SCCA检查对宫颈癌复发和(或)转移的诊断效能比较分别见表 1、表 2。其中,18F-FDG SPECT-CT与CT相比,两者的灵敏度、阴性预测值及准确率差异具有统计学意义,18F-FDG SPECT-CT的特异度、阳性预测值均高于CT,但二者差异无统计学意义;18F-FDG SPECT-CT与SCCA检查相比,两者的灵敏度、特异度、阳性预测值、阴性预测值和准确率的差异均有统计学意义(表 2)。
灵敏度 特异度 阳性预测值 阴性预测值 准确率 SPECT-CT 94.4(34/36) 92.3(24/26) 94.4(34/36) 92.3(24/26) 93.5(58/62) CT 69.4(25/36) 80.8(21/26) 813(25/30) 65.6(21/32) 74, 2(46/62) χ2 7.604 1.486 2.131 5.873 8.585 P < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 表 1 18F-FDG SPECT-CT与CT对宫颈癌复发和(或)转移诊断效能比较(%)
灵敏度 特异度 阳性预测值 阴性预测值 准确率 SPECT-CT 94.4(34/36) 92.3(24/26) 94.4(34/36) 92.3(24/26) 93.5(58/62) SCCA检査 66.7(24/36) 46.2(12/26) 63.2(24/38) 50.0(12/24) 58.1(36/62) χ2 8.867 13.000 10.678 11.081 21.282 P < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 注:表中,SCCA为鳞状细胞癌抗原。 表 2 18F-FDG SPECT-CT与SCCA检查对宫颈癌复发和(或)转移诊断效能比较(%)
18F-FDG SPECT-CT在宫颈癌监测中的价值
The value of 18F-FDG SPECT-CT in detecting recurrence or metastasis of cervical cancer
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摘要:
目的 评价18F-FDG SPECT-CT在监测宫颈癌复发和(或)转移中的价值。 方法 回顾性分析为评估宫颈癌是否复发和(或)转移而行18F-FDG SPECT-CT的62例患者的临床资料,以二次手术或局部活检病理或临床随访为最终结果,并与同期CT和鳞状细胞癌抗原(SCCA) 检查结果对比。 结果 经病理或临床随访证实,62例患者中有36例复发和(或)转移。18F-FDG SPECT-CT对宫颈癌复发和(或)转移监测的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为94.4%、92.3%、94.4%、92.3%、93.5%;CT分别为69.4%、80.8%、83.3%、65.6%、74.2%;SCCA检查分别为66.7%、46.2%、63.2%、50.0%、58.1%。 结论 18F-FDG SPECT-CT监测宫颈癌复发和(或)转移有较大临床价值。 -
关键词:
- 宫颈肿瘤 /
- 肿瘤复发,局部 /
- 肿瘤转移 /
- 体层摄影术,发射型计算机,单光子 /
- 体层摄影术,X线计算机 /
- 氟脱氧葡萄糖F18
Abstract:Objective To evaluate the value of 18F-fluorodeoxyglucose(18F-FDG)SPECT-CT in detecting recurrence and(or) metastasis of cervical cancer. Methods Retrospective analysis of 62 patients who underwent 18F-FDG SPECT-CT to evaluate recurrence and/or metastasis of cervical cancer at Fujian Tumor Hospital. The diagnostic results were confirmed by second surgery, biopsy or clinical follow-up, and also compared with the coincidence images obtained by CT scan and the serum squamous cell carcinoma related antigen(SCCA) levels. Results It is confirmed that 36 of 62 patients had recurrence and(or) meta-stasis of cervical cancer by biopsy or clinical follow-up. The sensitivity, specificity, positivity predicitive value (PPV), negative predictive value (NPV), and accuracy of 18F-FDG SPECT-CT were 94.4%, 92.3, 94.4%, 92.3%and 93.5%. Those of CT scan were 69.4%, 80.8%, 83.3%, 65.6% and 74.2%. Those of SCCA measurement were 66.7%, 46.2%, 63.2%, 50.0% and 58.1%. Conclusions 18F-FDG SPECT-CT has greater clinical value to monitor recurrence and(or) metastasis of cervical cancer. -
表 1 18F-FDG SPECT-CT与CT对宫颈癌复发和(或)转移诊断效能比较(%)
灵敏度 特异度 阳性预测值 阴性预测值 准确率 SPECT-CT 94.4(34/36) 92.3(24/26) 94.4(34/36) 92.3(24/26) 93.5(58/62) CT 69.4(25/36) 80.8(21/26) 813(25/30) 65.6(21/32) 74, 2(46/62) χ2 7.604 1.486 2.131 5.873 8.585 P < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 表 2 18F-FDG SPECT-CT与SCCA检查对宫颈癌复发和(或)转移诊断效能比较(%)
灵敏度 特异度 阳性预测值 阴性预测值 准确率 SPECT-CT 94.4(34/36) 92.3(24/26) 94.4(34/36) 92.3(24/26) 93.5(58/62) SCCA检査 66.7(24/36) 46.2(12/26) 63.2(24/38) 50.0(12/24) 58.1(36/62) χ2 8.867 13.000 10.678 11.081 21.282 P < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 注:表中,SCCA为鳞状细胞癌抗原。 -
[1] Jemal A, Murray T, Samuels A, et al. Cancer statistics, 2003. CA Cancer J Clin, 2003, 53(1): 5-26. doi: 10.3322/canjclin.53.1.5 [2] Friedlander M, Grogan M. Guidelines for the treatment of recurrent and metastatic cervical cancer. Oncologist, 2002, 7(4): 342-347. doi: 10.1634/theoncologist.2002-0342 [3] Waggoner SE. Cervical cancer. Lancet, 2003, 36(9376): 2217-2225. [4] Park DH, Kim KH, Park SY, et al. Diagnosis of recurrent uterine cervical cancer: computed tomography versus positron emission tomography. Korean J Radiol, 2000, 1(1): 51-55. doi: 10.3348/kjr.2000.1.1.51 [5] Schiepers C, Penninckx F, De Vadder N, et al. Contribution of PET in the diagnosis of recurrent colorectal cancer: comparison with conventional imaging. Eur J Surg Oncol, 1995, 21(5): 517-522. doi: 10.1016/S0748-7983(95)97046-0 [6] Grisaru D, Almog B, Levine C, et al. The diagnostic accuracy of 18F- Fluorodexyglucose PET/CT in patients with gynecological malignancies. Gynecol Oncol, 2004, 94(3): 680-684. doi: 10.1016/j.ygyno.2004.05.053 [7] Rose PG, Adler LP, Rodriguez M, et al. Positron emission tomography for evaluating paraaortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study. J Clin Oncol, 1999, 17(1): 41-45. doi: 10.1200/JCO.1999.17.1.41 [8] Chung HH, Jo H, Kang WJ, et al. Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence. Gynecol Oncol, 2007, 104(3): 529-534. doi: 10.1016/j.ygyno.2006.09.009 [9] 王珍芳, 万卫星, 郁春景, 等. 18F-FDG符合线路显像在结肠癌术后复发和(或)转移监测中的应用. 中华核医学杂志, 2009, 29(1): 27-30.