~(18)F-脱氧葡萄糖PET/CT对低分化胃腺癌的诊断价值
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摘要
目的18F-脱氧葡萄糖(18F fluorodeoxyglucose,18FDG)PET/CT对胃癌的诊断敏感性及特异性不佳。文中旨在探讨18F PET/CT对低分化胃腺癌的诊断价值。方法回顾性分析第二军医大学附属长征医院2012年4月至2014年7月经手术或胃镜病理证实为低分化胃腺癌的34例患者18FDG PET/CT征象,记录肿瘤大小、位置、胃壁浸润深度及最大标准摄取值(maximum standardized uptake values,SUVmax)。分析18FDG摄取阳性与各个临床病理参数关系。结果 34例患者低分化胃腺癌诊断阳性率仅为67.6%(23/34)。肿瘤大小、胃壁浸润深度与18FDG摄取阳性率差异有统计学意义(P<0.05)。性别、肿瘤位置、肿瘤病理亚型、淋巴结转移、远处转移与18FDG摄取阳性差异无统计学意义(P>0.05)。根据二项分类Logistic回归分析表明肿瘤大小是低分化腺癌18FDG摄取的独立影响因素[OR=0.37,95%CI(0.154,0.920),P=0.03]。结论18FDG PET/CT对低分化胃腺癌的诊断价值有限,诊断时应警惕假阴性结果的出现。
Objective The sensitivity and specificity of18 FDG PET / CT are poor in the diagnosis of gastric cancer. Gastric signet ring cell carcinoma and Mucinous gastric carcinoma is known to have low fluorodeoxyglucose(18FDG) uptake,but not known for poorly differentiated gastric adenocarcinoma. This study was to investigate the value of18 FDG PET / CT in the diagnosis of poorly differentiated gastric adenocarcinoma. Methods We retrospectively analyzed the results of18 FDG PET / CT of 34 cases of histologically confirmed poorly differentiated gastric adenocarcinoma. We recorded the volume,location,and gastric wall invasion depth,and maximum standardized uptake value( SUVmax) of the tumors and analyzed the relationship of18 FDG uptake with the clinicopathologic parameters. Results By18FDG-PET / CT,poorly differentiated gastric adenocarcinoma was diagnosed in only 67. 6% of the patients( 23 /34). SUVmax was found to be significantly correlated with age,gastric wall invasion,and tumor size( P < 0. 05),but not with gender,tumor location,tumor pathologic subtype,lymph node metastasis,and distant metastasis( P > 0. 05). Logistic regression analysis showed the tumor size to be the sole factor influencing the18 FDG uptake of poorly differentiated gastric adenocarcinoma( OR =0. 37,95% CI 0. 154- 0. 920,P = 0. 03). Conclusion The diagnostic value of18FDG-PET / CT is but limited for poorly differentiated gastric adenocarcinoma,and attention should be paid to its falsenegative results.
Objective The sensitivity and specificity of18 FDG PET / CT are poor in the diagnosis of gastric cancer. Gastric signet ring cell carcinoma and Mucinous gastric carcinoma is known to have low fluorodeoxyglucose(18FDG) uptake,but not known for poorly differentiated gastric adenocarcinoma. This study was to investigate the value of18 FDG PET / CT in the diagnosis of poorly differentiated gastric adenocarcinoma. Methods We retrospectively analyzed the results of18 FDG PET / CT of 34 cases of histologically confirmed poorly differentiated gastric adenocarcinoma. We recorded the volume,location,and gastric wall invasion depth,and maximum standardized uptake value( SUVmax) of the tumors and analyzed the relationship of18 FDG uptake with the clinicopathologic parameters. Results By18FDG-PET / CT,poorly differentiated gastric adenocarcinoma was diagnosed in only 67. 6% of the patients( 23 /34). SUVmax was found to be significantly correlated with age,gastric wall invasion,and tumor size( P < 0. 05),but not with gender,tumor location,tumor pathologic subtype,lymph node metastasis,and distant metastasis( P > 0. 05). Logistic regression analysis showed the tumor size to be the sole factor influencing the18 FDG uptake of poorly differentiated gastric adenocarcinoma( OR =0. 37,95% CI 0. 154- 0. 920,P = 0. 03). Conclusion The diagnostic value of18FDG-PET / CT is but limited for poorly differentiated gastric adenocarcinoma,and attention should be paid to its falsenegative results.
引文
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[11]Kawamura T,Kusakabe T,Sugino T,et al.Expression of glucose transporter-1 in human gastric carcinoma:association with tumor aggressiveness,metastasis,and patient survival[J].Cancer,2001,92(3):634-641.
[12]Yamada A,Oguchi K,Fukushima M,et al.Evaluation of 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography in gastric carcinoma:relation to histological subtypes,depth of tumor invasion,and glucose transporter-1 expression[J].Ann Nucl Med,2006,20(9):597-604.
[13]Zhu Z,Li F,Mao Y,et al.Improving evaluation of primary gastric malignancies by distending the stomach with milk immediately before18F-FDG PET scanning[J].J Nucl Med Technol,2008,36(1):25-29.
[14]Kamimura K,Nagamachi S,Wakamatsu H,et al.Role of gastric distention with additional water in differentiating locally advanced gastric carcinomas from physiological uptake in the stomach on18F-fluoro-2-deoxy-D-glucose PET[J].Nucl Med Commun,2009,30(6):431-439.
[15]丁勇,张书文,田嘉禾,等.18FDG-PET诊断胃癌及影响因素[J].中国医学影像学杂志,2003,11(5):335-337.
[16]Namikawa T,Okabayshi T,Nogami M,et al.Assessment of18Ffluorodeoxyglucose positron emission tomography combined with computed tomography in the preoperative management of patients with gastric cancer[J].Int J Clin Oncol,2014,19(4):649-655.
[17]Takebayashi R,Izuishi K,Yamamoto Y,et al.18F-fluorodeoxyglucose accumulation as a biological marker of hypoxic status but not glucose transport ability in gastric cancer[J].J Exp Clin Cancer Res,2013,32:34.
[18]Choi BH,Song HS,an YS,et al.relation between fluorodeoxyglucose uptake and glucose transporter-1 expression in gastric signet ring cell carcinoma[J].Nucl Med Mol Imaging,2011,45(1):30-35.
[19]Kim SK,Kang KW,lee JS,et al.Assessment of lymph node metastases using18F-FDG PET in patients with advanced gastric cancer[J].Eur J Nucl Med Mol Imaging,2006,33(2):148-155.
[20]Mochiki E,Kuwano H,Katoh H,et al.Evaluation of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography for gastric cancer[J].World J Surg,2004,28(3):247-253.
[2]耿海云,陈映霞,秦叔逵,等.重组人血管内皮抑素联合紫杉醇对高侵袭性胃癌细胞增殖和侵袭作用的影响[J].医学研究生学报,2014,27(6):587-591.
[3]闫美凤,张永胜.p53与Gadd45a蛋白在胃癌组织中的表达及临床病理学意义[J].医学研究生学报,2014,27(3):282-285.
[4]Bar-Shalom R,Yefremov N,Guralnik L,et al.Clinical performance of PET/CT in evaluation of cancer:additional value for diagnostic imaging and patient management[J].J Nucl Med,2003,44(8):1200-1209.
[5]Shimada H,Okazumi S,Koyama M,et al.Japanese gastric Cancer association task force for research promotion:clinical utility of18f-fluoro-2-deoxyglucose positron emission tomography in gastric cancer:a systematic review of the literature[J].Gastric Cancer,2011,14(1):13-21.
[6]Dassen AE,Lips DJ,Hoekstra CJ,et al.FDG-PET has no definite role in preoperative imaging in gastric cancer[J].Eur J Surg Oncol,2009,35(5):449-455.
[7]Mukai K,Ishida Y,Okajima K,et al.Usefulness of preoperative FDG-PET for detection of gastric cancer[J].Gastric Cancer,2006,9(3):192-196.
[8]Ott K,Fink U,Becker K,et al.Prediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging:results of a prospective trial[J].J Clin Oncol,2003,21(24):4604-4610.
[9]Stahl A,Ott K,Weber WA,et al.FDG PET imaging of locally advanced gastric carcinomas:correlation with endoscopic and histopathological findings[J].Eur J Nucl Med Mol Imaging,2003,30(2):288-295.
[10]Youn SH,Seo KW,Lee SH,et al.18F-2-Deoxy-2-Fluoro-DGlucose positron emission tomography:computed tomography for preoperative staging in gastric cancer patients[J].J Gastric Cancer,2012,12(3):179-186.
[11]Kawamura T,Kusakabe T,Sugino T,et al.Expression of glucose transporter-1 in human gastric carcinoma:association with tumor aggressiveness,metastasis,and patient survival[J].Cancer,2001,92(3):634-641.
[12]Yamada A,Oguchi K,Fukushima M,et al.Evaluation of 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography in gastric carcinoma:relation to histological subtypes,depth of tumor invasion,and glucose transporter-1 expression[J].Ann Nucl Med,2006,20(9):597-604.
[13]Zhu Z,Li F,Mao Y,et al.Improving evaluation of primary gastric malignancies by distending the stomach with milk immediately before18F-FDG PET scanning[J].J Nucl Med Technol,2008,36(1):25-29.
[14]Kamimura K,Nagamachi S,Wakamatsu H,et al.Role of gastric distention with additional water in differentiating locally advanced gastric carcinomas from physiological uptake in the stomach on18F-fluoro-2-deoxy-D-glucose PET[J].Nucl Med Commun,2009,30(6):431-439.
[15]丁勇,张书文,田嘉禾,等.18FDG-PET诊断胃癌及影响因素[J].中国医学影像学杂志,2003,11(5):335-337.
[16]Namikawa T,Okabayshi T,Nogami M,et al.Assessment of18Ffluorodeoxyglucose positron emission tomography combined with computed tomography in the preoperative management of patients with gastric cancer[J].Int J Clin Oncol,2014,19(4):649-655.
[17]Takebayashi R,Izuishi K,Yamamoto Y,et al.18F-fluorodeoxyglucose accumulation as a biological marker of hypoxic status but not glucose transport ability in gastric cancer[J].J Exp Clin Cancer Res,2013,32:34.
[18]Choi BH,Song HS,an YS,et al.relation between fluorodeoxyglucose uptake and glucose transporter-1 expression in gastric signet ring cell carcinoma[J].Nucl Med Mol Imaging,2011,45(1):30-35.
[19]Kim SK,Kang KW,lee JS,et al.Assessment of lymph node metastases using18F-FDG PET in patients with advanced gastric cancer[J].Eur J Nucl Med Mol Imaging,2006,33(2):148-155.
[20]Mochiki E,Kuwano H,Katoh H,et al.Evaluation of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography for gastric cancer[J].World J Surg,2004,28(3):247-253.