18F-FDG PET/CT在乳腺癌腋窝淋巴结转移上的诊断价值

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摘要目的：探讨18F-FDG PET/CT对乳腺癌区域淋巴结转移的诊断效能。资料与方法：回顾性分析经手术病理证实的48例乳腺癌患者的术前18F-FDG PET/CT表现，在PET/CT图像上分别测量原发灶及腋窝淋巴结（Axillary lymph node，ALN）的短径和最大标准化摄取值（Maximum standardized uptake value，SUVmax）。以病理诊断为金标准计算诊断灵敏度、特异度、阳性预测值、阴性预测值和准确率。利用ROC曲线分析各项指标诊断ALN转移的最佳截断点，并评估其对ALN转移的诊断效能。另外，应用χ2检验比较PET/CT在不同病理类型乳腺癌ALN转移上的诊断效能。结果：48例乳腺癌患者，病理证实ALN转移29例。以患者为单位和以病灶为单位，PET/CT诊断ALN转移的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为86.21%、84.21%、89.23%、80.00%、85.52%和61.68%、98.26%、94.96%、82.81%、85.55%；PET/CT对浸润性导管癌和浸润性小叶癌患者ALN转移的诊断准确率无统计学差异；ROC曲线分析显示，淋巴结短径和SUVmax诊断ALN转移的最佳截断点分别为6.5 mm（敏感度为66.82%，特异度为89.30%，准确率为81.49%）和1.1（敏感度为91.12%，特异度为95.27%，准确率为93.83%），其中SUVmax曲线下面积更大；以同时满足淋巴结短径≥6.5 cm和SUVmax≥1.1为诊断标准，灵敏度、特异度和准确率分别为50.46%、99.00%和82.14%。结论：18F-FDG PET/CT对于乳腺癌ALN转移有较高的特异度和准确率，以患者为单位，灵敏度较高，而以病灶为单位，灵敏度略低；PET/CT对浸润性导管癌和浸润性小叶癌患者ALN转移的诊断准确率无统计学差异；以SUVmax≥1.1作为判断乳腺癌ALN转移的标准，诊断效能最佳。

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	李雪艳1
	段钰2
	于丽娟1

关键词 ：乳腺肿瘤, 肿瘤转移, 淋巴结, 氟脱氧葡萄糖F18, 正电子发射断层显像术, 体层摄影术, X线计算机

Abstract：Objective: The purpose of this study was to evaluate the diagnostic performance of 18F-FDG PET/CT in axillary lymph node(ALN) metastasis of patients with breast cancer. Methods: We retrospectively analysed the clinical and PET/CT data of 48 breast cancer patients who were pathologically proven． The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated respectively according to the pathological results. Receiver-operating-characteristic(ROC) curve was used to find out the cut-off value of imaging parameters for diagnosing ALN metastasis. Besides, χ2 test was used to assess the diagnostic values of PET/CT in invasive ductal carcinoma(IDC) and invasive lobular carcinoma(ILC). Results: Of the 48 breast cancer patients, 29 patients had pathologically confirmed ALN metastasis. In person and lesion unit, the sensitivity, specificity, positive predicted value, negative predicted value and accuracy of PET/CT were 86.21%, 84.21%, 89.23%, 80.00%, 85.52% and 61.68%, 98.26%, 94.96%, 82.81%, 85.55% respectively. No statistical difference was found between the diagnostic values of PET/CT in ALN metastasis in IDC and ILC patients. ROC curve showed that the cut-off values of the short axis and SUVmax of ALN for predicting metastasis were 6.5 mm (sensitivity was 66.82%, specificity was 89.30%, accuracy was 81.49%) and 1.1(sensitivity was 91.12%, specificity was 95.27%, accuracy was 93.83%) respectively, in which SUVmax had the better relationship with metastasis of ALN. Assess all the ALN again according to the standards of short axis≥6.5 cm and SUVmax≥1.1 simutaneously, the sensitivity, specificity and accuracy were 50.46%, 99.00% and 82.14%. Conclusion: The specificity and accuracy of 18F-FDG PET/CT in predicting ALN metastasis in breast cancer patients are relatively high, as well as the sensitivity in patient unit, while in lesion unit, the sensitivity is relatively low. The diagnostic values of PET/CT in ALN metastasis of IDC and ILC patients have no statistical difference. We consider that the standard of SUVmax=1.1 had the best prognostic value, which might be used as an optimal criteria.

Key words： Breast neoplasms Neoplasm metastasis Lymph nodes Fluorodeoxyglucose F18; Positron-emission tomography; Tomography, X-ray computed

收稿日期: 2015-08-27

PACS:	Ｒ737.9
	Ｒ817.4
	Ｒ814.42

通讯作者: 于丽娟，哈尔滨医科大学附属肿瘤医院 PET/CT-MRI中心，150081。E-mail：yulijuan2003@126.com

作者简介: 李雪艳（1989-），女，河北沧州人，在读硕士研究生。E-mail：650810692@qq.com

引用本文:

李雪艳1，段钰2，于丽娟1. 18F-FDG PET/CT在乳腺癌腋窝淋巴结转移上的诊断价值[J]. 中国临床医学影像杂志, 2016, 27(4): 243-247.
LI Xue-yan1, DUAN Yu2, YU Li-juan1. Diagnostic value of 18F-FDG PET/CT in axillary lymph node metastasis in breast cancer. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(4): 243-247.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2016/V27/I4/243

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