18F-氟脱氧葡萄糖PET/CT与鳞状细胞癌抗原在宫颈鳞癌治疗后随访中的应用价值

doi:10.3969/j.issn.1007-9572.2016.27.011

摘要/Abstract

摘要： 目的　探讨18F-氟脱氧葡萄糖（18F-FDG）PET/CT及鳞状细胞癌（SCC）抗原诊断宫颈鳞癌初步治疗后是否存在残余、复发或转移的价值。方法　回顾性分析2008年1月—2014年4月河北医科大学第四医院155例宫颈鳞癌患者资料，所有患者治疗后随访中怀疑出现残余、复发或转移并进行了18F-FDG PET/CT检查和血清SCC 抗原测定，以病理及随访结果为诊断标准，计算18F-FDG PET/CT、SCC抗原及联合指标在宫颈鳞癌治疗后随访中的诊断效能。结果　155例患者经病理及随访证实存在残余、复发或转移128例，无恶性病变存在27例。18F-FDG PET/CT正确诊断150例，诊断灵敏度为99.2%，特异度为85.2%，正确率为96.8%，阳性预测值为96.9%，阴性预测值为95.8%。SCC抗原正确诊断122例，诊断灵敏度为80.5%，特异度为70.4%，正确率为78.7%，阳性预测值为92.8%，阴性预测值为43.2%。4例18F-FDG PET/CT假阳性患者中3例SCC抗原阴性。1例18F-FDG PET/CT假阴性患者中SCC抗原阳性。8例SCC抗原假阳性患者中7例18F-FDG PET/CT 阴性，25例SCC抗原假阴性患者均18F-FDG PET/CT阳性。联合指标正确诊断144例，诊断灵敏度为100.0%，特异度为59.3%，正确率为92.9%，阳性预测值为92.1%，阴性预测值为100.0%。18F-FDG PET/CT、SCC抗原及联合指标诊断宫颈癌治疗后存在残余、复发或转移的ROC曲线下面积分别为0.918〔95%CI（0.838,0.998）〕、0.754〔95%CI（0.646,0.862）〕、0.796〔95%CI（0.678,0.914）〕。结论　18F-FDG PET/CT辅以血清SCC抗原在宫颈鳞癌治疗后评估是否存在残余、复发或转移中具有良好的诊断效能，具有重要应用价值。

关键词: 宫颈肿瘤, 断层摄影术,螺旋计算机, 氟脱氧葡萄糖F18, 癌,鳞状细胞

Abstract: Objective　To assess the value of 18F-FDG PET/CT and serum squamous cell carcinoma （SCC） antigen in the detection of residual,recurrent or metastasis in patients with cervical squamous cancer after treatment.Methods　From January 2008 to April 2014,155 patients with cervical squamous cancer suspected residual,recurrent or metastasis after treatment,which had undergone 18F-FDG PET/CT scans and SCC antigen measurement in Fourth Hospital of Hebei Medical University were retrospectively analyzed.Diagnostic efficiency of 18F-FDG PET/CT and SCC antigen were analyzed according to pathology and follow-up results.Results　Of the 155 patients included in this study,128 patients were malignant,while 27 were benign.The overall patient-based sensitivity,specificity,accuracy,positive predictive value （PPV） and negative predictive value （NPV） of 18F-FDG PET/CT for the detection of malignancy were 99.2%,85.2%,96.8%,96.9% and 95.8%,while SCC antigen were 80.5%,70.4%,78.7%,92.8% and 43.2%,respectively.All the 4 false-positive 18F-FDG PET/CT results were associated with negative SCC antigen except one,and 1 false-negative PET/CT results was positive SCC antigen，8 false-positive SCC antigen were associated with 7 negative on 18F-FDG PET/CT，while 25 false-negative SCC antigen were all positive 18F-FDG PET/CT results.The sensitivity,specificity,accuracy,PPV and NPV of combination index for the detection of malignancy were 100.0%,59.3%，92.9%,92.1% and 100.0%,respectively.The area under ROC curve of 18F-FDG PET/CT，SCC antigen and combination index were 0.918〔95%CI（0.838,0.998）〕，0.754〔95%CI（0.646,0.862）〕 and 0.796〔95%CI（0.678,0.914）〕.Conclusion　18F-FDG PET/CT imaging and Serum SCC antigen,which have important value in cervical squamous cancer,can be complementary method in cases of suspected malignant focus exist after treatment.

Key words: Uterine cervical neoplasms, Tomography,helical computed, Fluorodeoxyglucose F18, Carcinoma,squamous cell

张召奇, 赵新明, 王建方, 张敬勉, 王颖晨, 和玲燕. 18F-氟脱氧葡萄糖PET/CT与鳞状细胞癌抗原在宫颈鳞癌治疗后随访中的应用价值[J]. 中国全科医学, 2016, 19(27): 3311-3316.

ZHANG Zhao-qi, ZHAO Xin-ming, WANG Jian-fang, ZHANG Jing-mian, WANG Ying-chen, HE Ling-yan. Value of 18F-FDG PET/CT and SCC Antigen in the Detection of Cervical Cancer after Treatment[J]. Chinese General Practice, 2016, 19(27): 3311-3316.

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