【摘要】 目的:探讨以18F-氟代脱氧葡萄糖(18F-FDG)作为示踪剂的正电子发射断层与X线计算机断层成像(18F-FDG PET/CT)对常见妇科恶性肿瘤腹膜后淋巴结转移的诊断及临床意义。方法:选择拟行手术治疗的妇科恶性肿瘤患者30例,所有患者术前均行18F-FDG PET/CT检查,然后行根治性手术。以手术病理结果作为对照,分别在患者水平和区域淋巴结水平计算18F-FDG PET/CT诊断妇科恶性肿瘤腹膜后淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果:30例患者术后病理证实原发灶均为妇科恶性肿瘤,12例患者存在腹膜后淋巴结转移,18F-FDG PET/CT正确诊断7例;在切除的199个区域淋巴结组中,经病理确认30个腹膜后淋巴结组发生转移,18F-FDG PET/CT正确诊断16个区域淋巴结组。在患者水平分析,18F-FDG PET/CT诊断腹膜后淋巴结转移的敏感性为58.3%,特异性为100.0%,阳性预测值为100.0%,阴性预测值为78.3%,准确性为83.3%;在区域淋巴结水平,上述指标分别为53.3%、98.8%、88.9%、92.3%和92.0%。发生淋巴结转移时,原发肿瘤的最大标准摄取值(SUVmax)要高于未发生淋巴结转移时,但两者差异无统计学意义(P=0.586)。结论:术前18F-FDG PET/CT显像诊断腹膜后淋巴结转移具有中度敏感性,不能代替全面手术病理分期;18F-FDG PET/CT诊断腹膜后淋巴结转移的高阳性预测值对是否进行全面手术分期有提示意义;较高的阴性预测值在选择不需要腹膜后淋巴结切除的患者时,也有一定的临床价值。更多还原

【Abstract】 Objective: The aim of this study was to evaluate the diagnostic value of positron emission tomography with computed tomography( PET / CT) using18F-fluor-Ddeoxyglucose( FDG) in detecting retroperitoneal lymph node metastasis in patients with gynecological malignancies. M ethods: This was a prospective study involving 30 patients with gynecological malignant tumors. They underwent radical hysterectomy after18F-FDG PETCT,and the imaging findings were compared with pathological results. Calculating the sensitivity,specificity,positive predictive value( PPV),negative predictive value( NPV) and accuracy of18F-FDG PET-CT for lymph node metastasis on region node-based and patient-based respectively. Results: All thirty patients were confirmed gynecological malignancies pathologically. According to the pathological results,12 patients had lymph node metastasis,7 of whom were correctly identified by18F-FDG PET / CT. 30 pathologically positive node regions were found in199 dissected node regions,16 of which were accurately identified on the18F-FDG PET / CT imagings. The overall patient-based sensitivity,specificity,PPV,NPV and accuracy of18F-FDG PET / CT for detecting nodal metastases were 58. 3%( 7 /12),100. 0%( 18 /18),100. 0%( 7 /7),78. 3%( 18 /23) and 83. 3%( 25 /30) respectively. The overall regional node-based sensitivity,specificity,PPV,NPV and accuracy were 53. 3%( 16 /30),98. 8%( 167 /169),88. 9%( 16 /18),92. 3%( 167 /181) and 92. 0%( 183 /199) respectively. Although the difference has no statistically significant in our finding( P = 0. 586),primary tumor with lymph node metastasis tended to have a larger SUVmax than that without lymph node metastasis. Conclusions: Integrated18F-FDG PET / CT may not have enough sensitivity to predict all metastatic lymph nodes preoperatively in patients with gynecological malignancies.Combined18F-FDG PET / CT demonstrates high positive value in identifying retroperitoneal lymph nodes,suggest that regional lymphadenectomy may be necessary for radical surgery. The high negative value may help selecting patients who could refrain from retroperitoneal lymphadenectomy.更多还原