18F-FDG PET/CT在行結腸癌檢查時發現同時性重復癌的價值

朱湘　宋秀宇　王健　徐文貴

18F-FDG PET/CT在行結腸癌檢查時發現同時性重復癌的價值

朱湘宋秀宇王健徐文貴

目的探討18氟-氟脫氧葡萄糖（18F-FDG）PET/CT用于檢查結腸癌時發現同時性重復癌的價值。方法回顧性分析232例經病理證實結腸癌病人的18F-FDG PET/CT影像資料和臨床病理結果，采用卡方檢驗比較18F-FDG PET/CT結果與病理結果并行kappa系數一致性檢驗，分析PET/CT顯像的診斷效能。結果232例病理證實的結腸癌病人中，56例病理證實為重復癌。18F-FDG PET/CT診斷真陽性53例，假陽性4例，其中2例經腸鏡病理證實分別為息肉和管狀腺瘤（癌前病變），1例病理證實為甲狀腺腺瘤，1例為肺炎性假瘤。假陰性3例，其中1例為胃竇部印戒細胞癌，1例為腎透明細胞癌，另1例18F-FDG PET/CT顯像為高代謝，診斷為結腸癌肝轉移，結果病理證實為結腸癌+原發性肝癌。18F-FDG PET/CT診斷重復癌的敏感度為94.64%，特異度為97.58%，準確度為96.83%，陽性預測值92.98%，陰性預測值98.17%。與病理診斷結果比較，兩者間差異無統計學意義（P≈1.000），而且兩者間一致性良好（κ=0.917，P=0.000）。結論應用18F-FDG PET/CT進行結腸癌檢查時可以有效發現同時性重復癌。

結腸癌；重復癌；正電子發射體層成像；體層攝影術，X線計算機

DOI：10.19300/j.2016.L3674

【Abstract】ObjectiveTo investigate the value of18F-FDG PET/CT in detecting synchronous primary malignant neoplasms in patients with colon cancer.Methods232 cases with pathology-proven colon cancer who underwent18F-FDG PET/CT imaging were retrospectively evaluated in the study.By comparing with the pathological diagnosis with chi square test and the kappa coefficient test，the diagnostic efficacy of PET/CT imaging for synchronous primary malignant neoplasms was analyzed.ResultsAmong 232 cases with histologically confirmed colon cancer，there were 56 cases were pathologically diagnosed as synchronous primary malignant neoplasms.Fifty-three cases were true positive cases diagnosed by18F-FDG PET/CT.There was 4 false positive cases，of which 1 case was polyps，1 case was adenoma（precancerous lesions），1 case was thyroid adenoma，and one was pulmonary inflammatory pseudotumor.There were 3 false negative cases，including 1 case of gastric antrum ring cell carcinoma，1 case of renal clear cell carcinoma，and 1 case of primary hepatocellular carcinoma which was diagnosed as colon cancer liver metastasis by18F-FDG PET/CT imaging.The sensitivity，specificity，and accuracy of18F-FDG PET/CT imaging were 94.64%，97.58%，and 96.83%respectively.There was no statistically significant difference between pathological and PET/CT diagnosis（P≈1.000），and showed high consistency between the two diagnostic methods （kappa value 0.917，P=0.000）.Conclusion18F-FDG PET/CT can effectively detect unexpected synchronous primary malignant neoplasms in patients with colon cancer.

【Key words】Colon carcinoma；Synchronous malignant neoplasms；PET；Tomography，X-ray computed

Int J Med Radiol，2016，39（2）：116-119

作者單位：天津醫科大學腫瘤醫院分子影像及核醫學診療科，天津300060

通訊作者：徐文貴，E-mail：wenguixu@163.com

基金項目：國家科技重大項目（2013ZX09303001）

結腸腫瘤是最常見的胃腸道腫瘤，隨著經濟水平的提高及國人生活方式的改變，結腸癌的發病率日漸增多，且呈逐年上升趨勢。結腸癌的臨床分期直接影響預后，分期越早的病人，其5年生存率越高。同時，隨著診療技術的提高，重復癌（multiple primary carcinoma，MPC）的報道越來越多。……