~(18)F-FDG PET/CT在胆道系统恶性肿瘤中的应用
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摘要
目的探讨~(18)F-FDG PET/CT诊断胆道系统恶性肿瘤的价值。方法回顾性分析34例临床疑似胆道恶性肿瘤患者的PET/CT影像资料,均获得术后病理结果,其中12例经手术切除淋巴结或淋巴结穿刺活检对18枚淋巴结获得病理诊断;与病理结果对照,计算PET/CT对胆道恶性病变原发灶、淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值及准确率。结果 34例中,31例为恶性病变,3例为良性病变。PET/CT诊断胆道恶性肿瘤原发灶的灵敏度100%(31/31),特异度66.67%(2/3),阳性预测值96.88%(31/32),阴性预测值100%(2/2),准确率97.06%(33/34)。胆道恶性病变原发灶最大标准摄取值(SUV_(max))为8.42±4.27;3例胆道良性疾病SUV_(max)分别为12.90、2.00及1.90。共18枚淋巴结获得病理结果,包括转移性淋巴结13枚,良性增生5枚。PET/CT诊断淋巴结转移的灵敏度76.92%(10/13),特异度60.00%(3/5),阳性预测值83.33%(10/12),阴性预测值50.00%(3/6),准确率72.22%(13/18)。结论 PET/CT对胆道系统恶性肿瘤的诊断具有重要价值。
Objective To observe the value of ~(18)F-FDG PET/CT in diagnosis of malignant tumors in biliary system.Methods A retrospective study of ~(18)F-FDG PET/CT imaging feature was performed on 34 patients with clinical suspicion of biliary system malignancy.Pathological results of 18 lymph nodes were obtained in 12 patients after surgical operation or needle biopsy.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy of ~(18)F-FDG PET/CT for detecting primary focus of malignant tumor and lymph node metastasis were obtained.Lymph nodes in 12 patients were examined by surgical or biopsy pathology.Results In 34 patients,there were 31 with malignant lesions and 3 with benign lesions.The sensitivity,specificity,PPV,NPV and accuracy of ~(18)F-FDG PET/CT for detecting primary focus was 100%(31/31),66.67%(2/3),96.88%(31/32),100%(2/2)and 97.06%(33/34),respectively.The maximum standardized uptake value (SUV_(max))of primary focus of malignant tumors was 8.42±4.27,while of 3 cases with benign lesions was 12.90,2.00 and 1.90,respectively.Pathological results were obtained in 18 lymph nodes,including 13 benign nodes and 5 malignant nodes.The sensitivity,specificity,PPV,NPV and accuracy of ~(18)F-FDG PET/CT for diagnosing lymph node metastasis was 76.92%(10/13),60.00%(3/5),83.33%(10/12),50.00%(3/6)and72.22%(13/18),respectively.Conclusion PET/CT has important value in diagnosis of malignant tumors in biliary system.
Objective To observe the value of ~(18)F-FDG PET/CT in diagnosis of malignant tumors in biliary system.Methods A retrospective study of ~(18)F-FDG PET/CT imaging feature was performed on 34 patients with clinical suspicion of biliary system malignancy.Pathological results of 18 lymph nodes were obtained in 12 patients after surgical operation or needle biopsy.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy of ~(18)F-FDG PET/CT for detecting primary focus of malignant tumor and lymph node metastasis were obtained.Lymph nodes in 12 patients were examined by surgical or biopsy pathology.Results In 34 patients,there were 31 with malignant lesions and 3 with benign lesions.The sensitivity,specificity,PPV,NPV and accuracy of ~(18)F-FDG PET/CT for detecting primary focus was 100%(31/31),66.67%(2/3),96.88%(31/32),100%(2/2)and 97.06%(33/34),respectively.The maximum standardized uptake value (SUV_(max))of primary focus of malignant tumors was 8.42±4.27,while of 3 cases with benign lesions was 12.90,2.00 and 1.90,respectively.Pathological results were obtained in 18 lymph nodes,including 13 benign nodes and 5 malignant nodes.The sensitivity,specificity,PPV,NPV and accuracy of ~(18)F-FDG PET/CT for diagnosing lymph node metastasis was 76.92%(10/13),60.00%(3/5),83.33%(10/12),50.00%(3/6)and72.22%(13/18),respectively.Conclusion PET/CT has important value in diagnosis of malignant tumors in biliary system.
引文
[1] Hu JH, Tang JH, Lin CH, et al. Preoperative staging of cholangiocarcinoma and biliary carcinoma using 18F-fluorodeoxyglucose positron emission tomography: A meta-analysis. J Investig Med, 2018,66(1):52-61.
[2] Hennedige TP, Neo WT, Venkatesh SK. Imaging of malignancies of the biliary tract-an update. Cancer Imaging, 2014,14:14.
[3] Elias Y, Mariano AT Jr, Lu Y. Detection of primary malignancy and metastases with FDG PET/CT in patients with cholangiocarcinomas: Lesion-based comparison with contrast enhanced CT. World J Nucl Med, 2016,15(3):161-166.
[4] Li X, Zhang Y, Zhang Y. 18F -FDG PET/CT may be a suitable method for preoperative diagnosis and evaluation of Chinese older patients with hilar cholangiocarcinoma. BMC Geriatr, 2018,18(1):150.
[5] 杨晖,关志伟,富丽萍,等.18F-FDG PET/CT在肝外胆管细胞癌术前诊断及分期中的价值.中华核医学与分子影像杂志,2017,37(2):65-69.
[6] 张建,吴仪仪,左长京,等.18F-FDG PET/CT对肝内胆管癌的诊断价值研究.影像诊断与介入放射学,2016,25(2):161-166.
[7] 王珍,吴湖炳,王全师,等.18F-FDG PET/CT在胆囊癌鉴别诊断及分期中的应用价值.中华核医学与分子影像杂志,2016,36(5):402-407.
[8] Annunziata S, Pizzuto DA, Caldarella C, et al. Diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography in gallbladder cancer: A meta-analysis. World J Gastroenterol, 2015,21(40):11481-11488.
[9] Ramos-Font C, Gomez-Rio M, Rodriguez-Fernandez A, et al. Ability of FDG-PET/CT in the detection of gallbladder cancer. J Surg Oncol, 2014,109(3):218-224.
[10] 张晨波,庞丽芳,薄晓波,等.氟代脱氧葡萄糖PET/CT在胆囊癌术前评估中的价值.中国临床医学,2017,24(2):210-213.
[11] 郎宁,刘剑羽,王永进,等.多排螺旋CT鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌.中国医学影像技术,2011,27(2):333-336.
[12] Zhao F, Lu PX, Yan SX, et al. CT and MR features of xanthogranulomatous cholecystitis: An analysis of consecutive 49 cases. Eur J Radiol, 2013,82(9):1391-1397.
[13] Kang TW, Kim SH, Park HJ, et al. Differentiating xanthogranulomatous cholecystitis from wall-thickening type of gallbladder cancer: Added value of diffusion-weighted MRI. Clin Radiol, 2013,68(10):992-1001.
[14] 张潇月,唐少珊.超声造影鉴别诊断胆囊良恶性病变Meta分析.中国医学影像技术,2015,31(9):1340-1343.
[15] Ruys AT, Kate FJ, Busch OR, et al. Metastatic lymph nodes in hilar cholangiocarcinoma: Does size matter? HPB (Oxford), 2011,13(12):881-886.
[2] Hennedige TP, Neo WT, Venkatesh SK. Imaging of malignancies of the biliary tract-an update. Cancer Imaging, 2014,14:14.
[3] Elias Y, Mariano AT Jr, Lu Y. Detection of primary malignancy and metastases with FDG PET/CT in patients with cholangiocarcinomas: Lesion-based comparison with contrast enhanced CT. World J Nucl Med, 2016,15(3):161-166.
[4] Li X, Zhang Y, Zhang Y. 18F -FDG PET/CT may be a suitable method for preoperative diagnosis and evaluation of Chinese older patients with hilar cholangiocarcinoma. BMC Geriatr, 2018,18(1):150.
[5] 杨晖,关志伟,富丽萍,等.18F-FDG PET/CT在肝外胆管细胞癌术前诊断及分期中的价值.中华核医学与分子影像杂志,2017,37(2):65-69.
[6] 张建,吴仪仪,左长京,等.18F-FDG PET/CT对肝内胆管癌的诊断价值研究.影像诊断与介入放射学,2016,25(2):161-166.
[7] 王珍,吴湖炳,王全师,等.18F-FDG PET/CT在胆囊癌鉴别诊断及分期中的应用价值.中华核医学与分子影像杂志,2016,36(5):402-407.
[8] Annunziata S, Pizzuto DA, Caldarella C, et al. Diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography in gallbladder cancer: A meta-analysis. World J Gastroenterol, 2015,21(40):11481-11488.
[9] Ramos-Font C, Gomez-Rio M, Rodriguez-Fernandez A, et al. Ability of FDG-PET/CT in the detection of gallbladder cancer. J Surg Oncol, 2014,109(3):218-224.
[10] 张晨波,庞丽芳,薄晓波,等.氟代脱氧葡萄糖PET/CT在胆囊癌术前评估中的价值.中国临床医学,2017,24(2):210-213.
[11] 郎宁,刘剑羽,王永进,等.多排螺旋CT鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌.中国医学影像技术,2011,27(2):333-336.
[12] Zhao F, Lu PX, Yan SX, et al. CT and MR features of xanthogranulomatous cholecystitis: An analysis of consecutive 49 cases. Eur J Radiol, 2013,82(9):1391-1397.
[13] Kang TW, Kim SH, Park HJ, et al. Differentiating xanthogranulomatous cholecystitis from wall-thickening type of gallbladder cancer: Added value of diffusion-weighted MRI. Clin Radiol, 2013,68(10):992-1001.
[14] 张潇月,唐少珊.超声造影鉴别诊断胆囊良恶性病变Meta分析.中国医学影像技术,2015,31(9):1340-1343.
[15] Ruys AT, Kate FJ, Busch OR, et al. Metastatic lymph nodes in hilar cholangiocarcinoma: Does size matter? HPB (Oxford), 2011,13(12):881-886.