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目的探讨18F-脱氧葡萄糖(18F-FDG)在诊断乳腺癌及腋窝淋巴结转移的价值。方法对34例乳腺癌患者的乳腺病灶(以健侧为对照)及腋窝淋巴结18F-FDG PET/CT显像结果进行定性分析和半定量分析,结合病理结果,计算两种方法诊断的灵敏度、特异度、准确性。两种方法诊断与病理诊断行一致性检验。对乳腺病灶恶性组及对照组组间最大标准化摄取值(SUVmax)均数的比较采用两独立样本t检验。结果两组间SUVmax均数比较显示:恶性组18F-FDG摄取高于对照组,差异有统计学意义(P=0.00)。1例为大汗腺导管内癌,系原位癌,对18F-FDG摄取不明显,PET/CT图像上未见明显结节影,目测显示0级,SUVmax为1.5。该例病灶微小,小于PET/CT5~8mm的分辨率,造成定性和半定量分析均漏诊。18F-FDG PET/CT定性分析诊断乳腺癌的灵敏度、特异度、准确性分别为97.7%、100.0%、97.9%;半定量分析以SUVmax2.0时,诊断乳腺癌的灵敏度、特异度、准确性为佳,分别为93.2%、100.0%、93.6%。定性分析与病理诊断的一致性极好,Kappa值为0.85,半定量分析与病理诊断有较好一致性,Kappa值为0.64。在腋窝淋巴结转移的诊断上,定性分析的诊断灵敏度、特异度、准确性分别为55.9%、96.1%、90.1%,半定量分析(以文献SUVmax1.8为标准)的诊断灵敏度、特异度、准确性分别为45.8%、97.0%、89.3%。两种分析诊断与病理诊均较好一致性,Kappa值分别为0.57(定性分析)和0.51(半定量分析)。结论18F-FDG PET/CT诊断乳腺恶性病灶时,以SUVmax2.0为临界值进行半定量分析诊断具有较好的诊断价值;在诊断腋窝淋巴结转移方面,定性分析和半定量分析与病理诊均有较好的一致性。
Objective To investigate the value of 18F-FDG in the diagnosis of breast cancer and axillary lymph node metastasis. Methods The results of qualitative and semiquantitative analysis of breast lesions (contralateral to control) and axillary lymph nodes 18F-FDG PET / CT in 34 cases of breast cancer patients were analyzed qualitatively and semi-quantitatively. The sensitivity, specificity Degree, accuracy. Two methods of diagnosis and pathological diagnosis line consistency test. Two independent samples t-test were used to compare the mean normalized maximum uptake values (SUVmax) between the malignant group and the control group. Results The comparison of SUVmax between the two groups showed that 18F-FDG uptake in malignant group was higher than that in control group (P = 0.00). One case of apocarcinoma in ductal carcinoma, Department of carcinoma in situ, 18F-FDG uptake was not obvious, PET / CT images showed no obvious nodules, visual inspection showed 0, SUVmax of 1.5. The lesion is small, less than the resolution of PET / CT5 ~ 8mm, resulting in qualitative and semi-quantitative analysis of missed diagnosis. The sensitivity, specificity and accuracy of 18F-FDG PET / CT for the diagnosis of breast cancer were 97.7%, 100.0% and 97.9%, respectively. The sensitivity, specificity and accuracy of breast cancer diagnosis by 18F-FDG PET / Better, respectively 93.2%, 100.0%, 93.6%. The agreement between qualitative analysis and pathological diagnosis was excellent. The Kappa value was 0.85. The semi-quantitative analysis was in good agreement with the pathological diagnosis. The Kappa value was 0.64. The diagnostic sensitivity, specificity and accuracy of qualitative analysis were 55.9%, 96.1% and 90.1% respectively in the diagnosis of axillary lymph node metastasis. The sensitivity, specificity and accuracy of semi-quantitative analysis (based on the literature SUVmax1.8) Sexuality was 45.8%, 97.0%, 89.3% respectively. The diagnostic and pathological findings of both analyzes were consistent, with Kappa values of 0.57 (qualitative analysis) and 0.51 (semi-quantitative analysis), respectively. Conclusion 18F-FDG PET / CT in the diagnosis of malignant breast lesions, with SUVmax2.0 as the critical value for semi-quantitative analysis of diagnosis has a good diagnostic value; in the diagnosis of axillary lymph node metastasis, qualitative analysis and semi-quantitative analysis and pathological diagnosis of Better consistency.