摘要
目的评价18F－FDG PET/CT在可疑肝外胆管细胞癌术前诊断及分期中的应用价值。方法回顾性分析2013年1月至2014年10月于解放军总医院肝胆外科就诊并怀疑为肝外胆管细胞癌的116例患者（男72例，女44例，年龄26～89岁）的临床资料。所有患者均于术前行18F－FDG PET/CT检查，将其显像结果同临床最终诊断进行比较，计算其在原发灶、区域淋巴结转移、远处转移诊断中的灵敏度、特异性、阳性预测值、阴性预测值和准确性。采取半定量分析方法，比较良恶性、不同分化、不同部位病变在PET/CT显像结果中的差异。良性组和恶性组间SUVmax的比较采用两样本t检验；高、中、低分化3组间SUVmax的比较采用单因素方差分析；肝门部胆管癌与胆总管癌原发灶诊断灵敏度的比较采用χ2检验。结果所有患者均经剖腹探查及组织病理学确认，其中恶性94例（腺癌93例、鳞状细胞癌1例），良性22例（胆管结石11例、胆管炎9例、胆总管囊肿和结核各1例）。区域淋巴结转移33例，远处转移4例。18F－FDG PET/CT对于原发灶诊断灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为61.7%（58/94）、77.3%（17/22）、92.1%（58/63）、32.1%（17/53）、64.7%（75/116）；对于区域淋巴结转移诊断的灵敏度、特异性为45.5%（15/33）、91.4%（53/58）；对于远处转移诊断的灵敏度、特异性为3/4、94.3%（82/87）。恶性组原发灶SUVmax高于良性组（4.57±3.75、2.72±2.48；t＝2.83，P〈0.05）；高分化（9例）、中分化（32例）、低分化（39例）3组病灶间SUVmax差异无统计学意义（4.89±4.75、4.23±2.49和4.47±2.73；F＝0.269，P〉0.05）；此外，PET/CT对肝门部胆管癌的诊断灵敏度低于胆总管癌，分别为48.6%（17/35）、69.0%（40/58），但差异无统计学意义（χ2＝3.827，P〉0.05）。结论18F－FDG PET/CT在肝外胆管细胞癌术前原发灶诊断中的作用有限，难以鉴别胆管炎性病变，但可发现一些远处转移灶，进而辅助临床治疗方案的选择。
ObjectiveTo evaluate the value of 18F-FDG PET/CT in preoperative diagnosis and staging of suspected extrahepatic cholangiocarcinoma （EHCC）.MethodsThe clinical data of 116 patients （72 males, 44 females; age range 26-89 years） with suspected EHCC from January 2013 to October 2014 were retrospectively analyzed. All patients received preoperative whole body 18F-FDG PET/CT scan. The imaging results were compared with final clinical diagnosis. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT were calculated. Two-sample t test was applied to compare lesion SUVmax of malignant and benign diseases. One-way analysis of variance was applied to compare SUVmax of highly, moderately and poorly differentiated tumors. χ2 test was used to compare the difference of diagnostic sensitivities for hilar cholangiocarcinomas and common bile duct tumors.ResultsAll patients were confirmed by exploratory laparotomy and subsequent histologic examination. A total of 94 cases （93 adenocarcinomas and 1 squamous carcinoma） were confirmed malignant and 22 cases （11 biliary calculi, 9 cholangitis, 1 choledochal cyst, 1 tuberculosis） were confirmed benign. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT for primary tumor were 61.7%（58/94）, 77.3%（17/22）, 92.1%（58/63）, 32.1%（17/53）, 64.7%（75/116）, respectively. The diagnostic sensitivity and specificity for regional lymph node metastasis were 45.5%（15/33）, 91.4%（53/58）, and those for distant metastasis were 3/4, 94.3%（82/87）. The SUVmax of malignant tumors were higher than that of benign lesions （4.57±3.75, 2.72±2.48; t=2.83, P〈0.05）, while the differences of SUVmax among highly, moderately and poorly differentiated tumors were not significant （4.89±4.75, 4.23±2.49, 4.47±2.73; F=0.269, P〉0.05）. 18F-FDG PET/CT showed a lower sensitivity in hilar cholangiocarcinomas than that in common bile duct tumors, while no statistical significance was observed： 48.6% （17/35） vs 69.0% （40/58）, χ2=3.827, P〉0.05.ConclusionsThe value of 18F-FDG PET/CT in preoperative diagnosis and staging of EHCC is limited. It can distinguish some benign diseases from malignant tumors, but with higher false positive for cholangitis. It can help to adjust treatment strategies by detecting distant metastasis.
出处
《中华核医学与分子影像杂志》
CAS
北大核心
2017年第2期65-69,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
