18F-FDG PET/CT显像偶发甲状腺癌的葡萄糖代谢与临床病理学的相关性研究

背景与目的：18F-FDG PET/CT的广泛应用导致偶发甲状腺癌的比例明显增加，偶发甲状腺癌灶的糖代谢与甲状腺癌病理学的相关性尚不清楚。研究因非甲状腺疾病行18F-FDG PET/CT显像、偶发甲状腺癌的患者，分析甲状腺癌灶的糖代谢与肿瘤的分化程度、淋巴结转移的相关性。方法：回顾性分析18F-FDG PET/CT显像偶发甲状腺瘤患者195例，53例患者手术病理诊断为甲状腺癌。分别测量甲状腺癌灶的最大标准摄取值(SUVmax)、病变大小、病变个数，同时测量患者正常甲状腺组织的SUVmax。通过病理分析病理学分型、淋巴结转移，患者分为G1组(分化型甲状腺癌)、G2组(非分化型甲状腺癌)、G3组(甲状腺癌无淋巴结转移)和G4组(甲状腺癌有淋巴结转移)。分析G1组与G2组、G3组与G4组间甲状腺癌灶的糖代谢的差异。结果：53例患者中，PET显像发现甲状腺癌灶53个。病理学发现甲状腺癌灶62个，乳头状甲状腺癌37例，滤泡状甲状腺癌4例，髓样癌9例，低分化癌3例。正常甲状腺组织的SUVmax为1.51±0.30，G1组(41例)SUVmax为4.25±1.70，G2组(12例)SUVmax为6.34±2.45，G1组和G2组的SUVmax均显著高于正常甲状腺组织(t=11.0，t=7.10，P<0.01)，但G1组与G2组的SUVmax差异无统计学意义(t=3.61，P>0.05)。G3组(29例)的SUVmax为4.77±2.15，G4组(24例)的SUVmax为4.67±2.02，差异无统计学意义(t=0.33，P=0.56)。结论：18F-FDG PET/CT显像偶发癌分化型甲状腺癌、非分化型甲状腺癌均具有高糖代谢改变；不同分化程度、淋巴结转移能力的甲状腺癌灶的糖代谢水平差异无统计学意义。

The correlation study between the glucose metabolism of 18F-FDG PET/CT incidental thyroid cancer and clinicopathologic characteristics

Background and purpose:The proportion of incidental thyroid cancer in PET imaging was sig-niifcantly increased with the wide application of18F-FDG PET/CT. The correlation between the glucose metabolism of thyroid incidental thyroid cancer and pathological changes is unclear. The objective of this study is to analyze the relationship between the glucose metabolism by18F-FDG PET/CT and tumor differentiation or lymph node metastasis in patients with incidental thyroid cancer.Methods:A total of 195 patients with focal FDG-avid thyroid incidentaloma during cancer evaluation were enrolled. Fifty-three patients were diagnosed as having thyroid cancer by the pathology. The SUVmax of thyroid cancer foci, lesion size, lesion number, and SUVmax of normal thyroid tissue were quantiifed. The tumor pathological grades and lymph node metastasis were analyzed by the pathology. The patients were broken down into 4 groups (G1, G2, G3 and G4) according to the tumor pathological grades and lymph node metastasis (differentiated thyroid cancer, non-differentiated thyroid cancer, without lymph node metastasis and with lymph node metastasis). The differences of glucose metabolism between G1and G2groups, G3 and G4 groups were analyzed.Results:Fifty-three foci were found by PET imaging. Sixty-two foci were found by the pathology (37 papillary thyroid carcinoma, 4 follicular thyroid carcinoma, 9 medullary thyroid carcinoma, 3 poorly differentiated thyroid cancer). The SUVmax in the normal thyroid tissue, G1and G2were 1.51±0.30, 4.25±1.70 and 6.34±2.45, respectively. The SUVmax in the G1and G2were signiifcantly higher than in the normal thyroid tissue (t=11.0,t=7.10,P<0.01). The SUVmax of G3was 4.77±2.15, and the SUVmax of G4group was 4.67±2.02. The differences between G1and G2groups, G3 and G4groups were not statisti-cally signiifcant (t=3.61,P>0.05;t=0.33,P=0.56).Conclusion:The differentiated incidental thyroid carcinoma and non-differentiated incidental thyroid carcinoma had high glucose metabolism, and there was no signiifcant difference in the levels of glucose metabolism in different differentiation degree and metastasis ability cancer.