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不明原发灶肿瘤(cancer of unknown primary,CUP)是一群异源发生的肿瘤,指转移灶经穿刺细胞学或组织病理学已得到确认而通过其他检查(包括详细的病史回顾、体格检查、实验室检查和常规影像学检查)尚未发现原发灶的肿瘤,占所有恶性肿瘤的3%~10%[1-2]。该类患者预后差,3年生存率为11%,5年生存率为6%,平均中位生存期只有2~10个月[3]。所以明确原发灶有助于指导临床医师合理治疗及改善患者预后。目前对于18F-FDG PET/CT诊断CUP患者原发灶的效能尚存争议,Kole等[4]研究了29例CUP 18F-FDG PET全身显像的结果,18F-FDG PET仅发现7例(24%)CUP原发灶,CUP患者的临床生存期并未因原发灶发现而得以改善,所以他们认为18F-FDG PET所提供信息的临床意义有限;据国内外相关研究报道,18F-FDG PET对CUP原发灶的检出率约为54%[5];另有多位学者支持18F-FDG PET可有效检出CUP原发灶的观点[6]。本研究旨在进一步探讨18F-FDG PET/CT全身显像对CUP原发灶的诊断价值。
18F-FDG PET/CT在不明原发灶肿瘤中的临床应用价值
Clinical value of 18F-FDG PET/CT in cancer of unknown primary
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摘要:
目的探讨18F-FDG PET/CT全身显像在不明原发灶肿瘤(CUP)诊断中的临床应用价值。 方法回顾分析46例于2015年2月至2016年6月在我院行常规检查未能发现肿瘤原发灶而进一步行18F-FDG PET/CT全身显像查找肿瘤原发灶的转移性肿瘤患者的资料。PET/CT图像分析采用视觉及半定量分析方法。通过病理活检和(或)临床综合诊断、临床随访对结果进行评价。 结果46例患者中,18F-FDG PET/CT显像找到原发肿瘤33例,均经过病理活检及临床随访证实;13例未发现原发病灶。18F-FDG PET/CT对不明肿瘤原发灶的检出率为71.7%(33/46),其中阳性患者中淋巴瘤3例、胃癌2例、食管癌4例、卵巢癌3例、肺癌14例、肝癌2例、尿路上皮癌1例、鼻咽癌2例、多发性骨髓瘤1例、降结肠癌1例。转移方式主要有淋巴结转移32例、骨转移20例、肝转移13例、肺转移9例、胸膜腹膜转移5例、肾上腺转移3例、脑转移4例、皮下转移3例、心包膜转移1例。 结论18F-FDG PET/CT全身显像对CUP的检出率显著优于一般常规检查,对临床指导治疗有着重要意义。 -
关键词:
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术, X线计算机 /
- 不明原发灶肿瘤
Abstract:ObjectiveTo evaluate the clinical value of 18F-FDG PET/CT whole-body imaging in the manage-ment of cancer of unknown primary(CUP). MethodsFrom February 2015 to June 2016, 46 CUP patients were analyzed retrospectively in Taizhou People's Hospital. They underwent 18F-FDG PET/CT imaging to detect their primary tumors that had not been detected through routine examinations. Visual and semiquantitative analyses were then employed to analyze the PET/CT images. The results were assessed on the basis of the pathological results, comprehensive clinical diagnoses, and clinical follow-ups. ResultsOf the 46 patients, 33 had primary tumors, which were detected through 18F-FDG PET/CT imaging and further confirmed by pathology or clinical follow-up. Meanwhile, the primary tumors in 13 patients were not characterized. The CUP detection rate of the 18F-FDG PET/CT was 71.7%(33/46). Of the 33 patients with detected CUPs, 3 had lymphoma, 2 had gastric cancer, 4 had esophageal cancer, 3 had oophoroma, 14 had lung cancer, 2 had liver cancer, 1 had urinary tract epithelial cancer, 2 had nasopharyngeal carcinoma, 1 had multiple myeloma, and 1 had colon cancer. The modes of tumor metastasis included lymphatic metastasis in 32 cases, bone metastasis in 20 cases, liver metastasis in 13 cases, lung metastasis in 9 cases, pleural and peritoneal metastasis in 5 cases, adrenal metastasis in 3 cases, brain metastasis in 4 cases, subcutaneous metastasis in 3 cases, and pericardium metastasis in 1 case. ConclusionsThe 18F-FDG PET/CT outperforms ordinary routine examinations in terms of CUP detection. Thus, 18F-FDG PET/CT possesses significant importance to clinical management. -
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