False-positive helical CT findings of multifocal and multicentric breast cancer: is attenuation of tumor useful for diagnosing enhanced lesions?

OBJECTIVE: To analyze helical CT false-positive multifocal breast cancers and to assess the relevance of the attenuation of tumors for diagnosing enhanced lesions. METHODS: Helical CT studies of 156 invasive breast cancers before breast conserving surgery were examined. A lesion was defined as positive if focal enhancement was detected by CT within 100 seconds after contrast material administration. The attenuation and enhancement percent ratio [(post-contrast value/pre-contrast value)%] were obtained. Attenuation of false-positive and malignant lesions was compared. RESULTS: Helical CT enabled the detection of all 156 invasive tumors with 95 intraductal tumor extensions. The sensitivity and specificity of multifocal/multicentric disease detection by helical CT were 69% and 90%, respectively. False-positive multifocal/multicentric findings were obtained in 11 (7%) of 156 cases. The mean value of the enhancement percent ratio of the index tumors was 237%. Significant differences in the attenuation on post-contrast enhanced scans between the enhanced lesions (index tumors; mean, 82 HU), the true-positive multifocal/multicentric lesions (mean, 73 HU), the false-positive multifocal/multicentric lesions (mean, 87 HU) and normal breast tissue (mean, 32 HU) were found (p<0.0001). The attenuation of the true-positive multifocal/multicentric lesions on post-contrast enhanced scans was significantly less than that of the false-positive multifocal/multicentric lesions (p=0.03). CONCLUSION: Attenuation of tumor is not useful for differential diagnosis of enhanced lesions on helical CT of the breast. The presence of enhancement alone does not always indicate a malignant lesion.     

Three-Dimensional Helical CT of the Breast: Accuracy for Measuring Extent of Breast Cancer Candidates for Breast Conserving Surgery

Objective. To evaluate the accuracy of three-dimensional (3D) helical computed tomography (CT) for assessing the extent of breast cancer of candidates for breast conserving surgery. Methods. Results of helical CT were studied in 144 lesions of 144 patients with breast cancer before breast-conserving surgery. A lesion was defined as positive if focal enhancement was detected by CT within 100s after contrast material administration. After resection, tumors were histopathologically mapped and correlated with the extent of 3D images. Results. Helical CT enabled detection of 143 tumors but not of one ductal carcinoma in situ (DCIS). The median deviation of the tumor extension revealed by 3D helical CT images from pathological assessment was 7.7mm (range 0–60mm). The extent of tumors was significantly correlated with CT measurements (r=0.714, p<0.0001). By multivariate analysis, the presence of invasive tumors with intraductal extensions beyond the edge of the invasive tumor and histologic type (DCIS) were significant risk factors for deviation of the tumor extension revealed by 3D helical CT images from pathological assessment. Conclusion. Three dimensional helical CT of the breast is an accurate preoperative imaging modality for assessing the extent of breast cancer candidates for breast conserving surgery.     

18F-FDG PET/CT对原发性乳腺癌诊断和淋巴结分期的临床价值

目的评价18F-脱氧葡萄糖(18F-FDG)PET/CT对原发性乳腺癌诊断和淋巴结分期的临床价值。方法临床拟诊为乳腺癌的27例女性患者,手术前分别行乳腺钼靶X线和18F-FDG PET/CT检查。全部患者均行手术治疗,共切除32个病灶。23例患者接受了腋淋巴结廓清术,并行病理学诊断。结果32个病灶中,25个为乳腺癌病灶,7个为良性病变。18F-FDG PET/CT诊断的敏感度为80.0%,特异度为71.4%。T1期病灶8个,PET/CT诊断阳性6个;T2期病灶14个,PET/CT诊断阳性12个;T3期病灶2个,PET/CT均诊断阳性。对区域淋巴结转移,PET/CT诊断的敏感度为60.0%,特异度为84.6%,诊断准确度为73.9%。结论对于怀疑多中心乳癌、病期较晚、需要全面评价区域淋巴结状态或疑有远处转移的患者,PET/CT具有优势,对乳腺癌的分期有重要帮助,但尚不适宜于作为乳腺癌的常规检查。     

Diagnosis of breast cancer: MDCT versus MRI

In Japan, helical CT has been applied to breast cancers for the accurate determination of cancer extent before surgery. In recent years, multidetector CT (MDCT) has become commercially available. Compared with mammography and ultrasonography, MDCT of the breast is thought to be useful for preoperative assessment of breast-conserving surgery. In contrast, magnetic resonance imaging (MRI) is extremely accurate in the diagnosis of intraductal carcinoma and multicentricity of breast cancer. A real problem related to the use of CT is X-ray exposure. Therefore, it is controversial whether the use of CT for the patients with breast cancer is appropriate or not. Recent studies that compared the use of MDCT and MRI in the same patients concluded that MRI was more accurate for the detection and evaluation of the extent of intraductal carcinoma. We should consider the pitfalls and limitations of CT for assessing the breast cancer extent.     

锥光束乳腺CT增强检查对致密类乳腺内病灶的诊断价值研究

背景与目的：乳腺纤维腺体组织的密度与乳腺癌的发生、发展有密切关系,该研究旨在比较乳腺X线摄影（mammography,MG）、锥光束乳腺CT（cone beam breast computed tomography,CBBCT）平扫及CBBCT增强检查对具有致密类乳腺的临床就诊者的乳腺恶性肿瘤的诊断效能,探讨CBBCT增强检查的临床价值。方法：回顾2012年5月—2014年8月同时接受MG、CBBCT平扫及增强检查的患者,共有来自80例患者的80侧乳腺符合条件入组。将80侧乳腺的MG、CBBCT平扫及增强诊断结果与其病理学检查结果相比较。测量CBBCT增强前后肿物的CT值变化（△CT）,并对其强化程度及类型进行分类。结果：符合条件入组的80侧致密类乳腺,经手术或活检病理学证实,其中40侧为良性,40侧为恶性。将80侧乳腺的MG、CBBCT平扫及增强诊断结果与病理学检查结果比较,绘制受试者工作特征（receiver operating characteristic,ROC）曲线,三者的曲线下面积（area under curve,AUC）分别为0.934（95%CI：0.855~0.977）、0.971（95%CI：0.907~0.996）和0.975（95%CI：0.912~0.997）,P<0.01。以BI-RADS 4b为截断点,三者诊断的灵敏度分别为72.5%、75%和92.5%。CBBCT增强检查可见恶性肿瘤多呈明显不均匀强化,而良性肿瘤强化方式呈多样性。恶性肿瘤强化程度明显高于良性肿瘤,良、恶性肿瘤增强前后的CT值变化（△CT）之间差异有统计学意义（t=-4.180,P<0.01）。结论：CBBCT增强检查有助于提高诊断的准确率及灵敏度,对提高具有致密类乳腺的临床就诊者乳腺肿瘤的诊断效能和良恶 性肿瘤的鉴别具有较高价值。     

The role of FDG PET/CT in patients with locoregional breast cancer recurrence: A comparison to conventional imaging techniques

Purpose

The aim of this study was to evaluate the impact of ¹⁸F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) on clinical management in patients with locoregional breast cancer recurrence amenable for locoregional treatment and to compare the PET/CT results with the conventional imaging data.

Patients and methods

From January 2006 to August 2008, all patients with locoregional breast cancer recurrence underwent whole-body PET/CT. PET/CT findings were compared with results of the conventional imaging techniques and final pathology. The impact of PET/CT results on clinical management was evaluated based on clinical decisions obtained from patient files.

Results

56 patients were included. In 32 patients (57%) PET/CT revealed additional tumour localisations. Distant metastases were detected in 11 patients on conventional imaging and in 23 patients on PET/CT images (p < 0.01). In 25 patients (45%), PET/CT detected additional lesions not visible on conventional imaging. PET/CT had an impact on clinical management in 27 patients (48%) by detecting more extensive locoregional disease or distant metastases. In 20 patients (36%) extensive surgery was prevented and treatment was changed to palliative treatment. The sensitivity, specificity, accuracy, positive and negative predictive values of FDG PET/CT were respectively 97%, 92%, 95%, 94% and 96%.

Conclusions

PET/CT, in addition to conventional imaging techniques, plays an important role in staging patients with locoregional breast cancer recurrence since its result changed the clinical management in almost half of the patients. PET/CT could potentially replace conventional staging imaging in patients with a locoregional breast cancer recurrence.     

Preliminary results of quadrantectomy and radiation therapy for breast cancer

Between November 1987 and December 1992, a total of 200 breast carcinomas in 199 patients were treated by definitive radiation therapy following quadrantectomy and level III axillary dissection. One patient with simultaneous bilateral breast cancers was excluded and 198 patients with breast cancer were enrolled in this study. There were 9 Stage 0, 117 Stage I and 72 Stage II tumors by the UICC tumor classification system (1987). Histological examination revealed that 9 tumors were non-invasive carcinomas and 189 were invasive carcinomas. For radiation therapy, a total of 50 Gy was delivered to the ipsilateral breast using⁶⁰Co γ rays. In three cases with level III lymph node involvement, the ipsilateral supraclavicular and parasternal regions were also irradiated. Boost irradiation was given to 8 of 12 margin-positive patients, and 2 of 24 patients in whom tumor cells were present within 5 mm from the margin. We used a CT simulator for the treatment planning of radiation therapy in 196 tumors. During follow-up for 16-77 months (median: 35 months), 2 patients died of unrelated causes and 6 developed distant metastasis (4 to bone and 2 to lung). Local recurrence was noted in 1 patient. Acute reactions to radiation therapy included moist desquamation involving the tip of the breast and the axilla in 14 and 5 patients, respectively, as well as bright erythema in 7 patients. Late reactions included arm edema in 12 patients, patchy depigmentation at the tip of the breast in 5 patients, moderate telangiectasia in 1 patient, and symptomatic radiation pneumonitis in 1 patient. The actuarial overall survival, cause-specific survival, disease-free survival, and relapse-free survival rates at 5 years were97.2%, 100%, 93.5%, and 93.0%, respectively. This excellent locoregional control, together with a highly acceptable toxicity strongly suggests the usefulness of quadrantectomy and radiation therapy for Japanese women with breast cancer. The possible indications include clinical Stage 0 and, I breast cancer, and clinical Stage II cancer in patients with relatively large breasts and with the primary tumor not located close to the nipple.     

Magnetic resonance imaging of breast lesions--a pathologic correlation

Magnetic resonance imaging of the breast is useful in assessing breast lesions. An understanding of the pathologic characteristics of the tumors may help to understand these magnetic resonance imaging observations. Large lesional size (>10 mm), ill-defined margin, and irregular outlines are associated with malignancy. These correlate with the pathological features of breast tumor, characterized by rapid growth rate, large size, and infiltrative growth pattern, invasion into stroma resulting in desmoplasia, and hence irregular outline and margin. The detection and estimation of tumor extent of invasive lobular carcinoma is problematic, even with magnetic resonance imaging, which is considered the most sensitivity. This inaccuracy likely derives from the characteristic linear, single cells infiltration growth pattern of the tumor, which is also often underestimated by clinical examination. Estimation of tumor extent after neoadjuvant chemotherapy is also essential but problematic by imaging, as the shrunken tumor becomes fibrotic, with stromal hyalinization, diminished microvasculature and tumor break up causing size underestimation. Non-enhancement of breast tumors occurs in about 8% of cases correlates with diffuse growth pattern, particularly of infiltrative lobular carcinoma. The observation of disproportionately high non-enhancing ductal carcinoma in situ remains an enigma. Finally, early rim enhancement correlates with small cancer nests, low ratio of peripheral to central fibrosis and high ratio of peripheral to central microvessel density. These may be related to increased vascular endothelial growth factor mediated increased microvessel density as well as increased permeability, which manifest as increased rapid contrast uptake and dissipation.     

Computed tomography in suspected local breast cancer recurrence

Purpose The purpose of this prospective study was to test computed tomography (CT) in the evaluation of local breast cancer recurrence.Materials and methods Our study population included 103 women referred for mamma CT examination for reasons of suspicious findings in a conservatively treated breast. In these patients, both clinical and conventional imaging studies (mammography, ultrasonography) features of local recurrences were non specific or suspicious. The patients underwent breast CT before and 90 s after intra-venous contrast medium administration. Criterion for cancer recurrence was detection of a lesion with an enhancement of 20 UH or more. The final diagnosis was based on operative histopathological findings or follow-up for over two years.Results Local recurrence was confirmed on histology in 52 patients. CT identified 47 breast recurrent cancers. False-positive contrast enhancement was seen in five patients. CT showed 90% sensitivity, 90% specificity and 90% accuracy.Conclusion Although mamma CT examination proved to have a high diagnostic efficacy in evaluating breast cancer recurrence, routine computed tomography is unnecessary for most patients.     

Evaluation of axillary status in patients with breast cancer using thin-section CT

BACKGROUND: In recent years, the surgical management of patients with breast cancer has shifted to a locoregional approach, and evaluating the patient's axillary lymph node status is of the greatest importance in determining the appropriate treatment strategy. We evaluated on the efficacy of preoperative axillary staging using contrast-enhanced computed tomography (CE-CT). METHODS: Between 2000 and 2003, 235 patients with operable breast cancer who underwent CE-CT before surgery and 137 patients who received neoadjuvant chemotherapy (NAC) and underwent CE-CT before NAC and surgery were enrolled in this study. The axillary status was evaluated based on three criteria (short-axis diameter, shape, and enhancement type), and the diagnosis was correlated with the histopathological results. RESULTS: In patients who did not receive NAC, the size criterion of a short-axis diameter of more than 5 mm provided a sensitivity of 78%, a specificity of 75%, and an accuracy of 76% in predicting node-positive status. According to the size criterion of a short-axis diameter of more than 5 mm and the shape criterion of the absence of intranodal fat density, the specificity and accuracy were 90% and 81%, respectively, and according to the enhancement type criterion of early enhancement, the corresponding values were 89% and 78%. Evaluation was more difficult in patients who received NAC and the sensitivity of the size-based criterion in the patients who received NAC was lower than in those who did not. CONCLUSION: These findings suggest that CE-CT based on size criteria is useful for evaluating the preoperative axillary status of breast cancer patients, but that evaluation is more difficult and the sensitivity is reduced in patients who have received NAC.     

X线立体定位引导真空负压旋切活检在诊断0期乳腺癌的应用价值

目的探讨X线立体定位引导真空负压旋切活检技术在临床触诊和B超检查均为阴性乳腺微小病灶中诊断0期乳腺癌方面的价值。方法本院于2007年10月～2009年5月用数字化俯卧式穿刺活检定位系统引导真空负压旋切活检系统对113例B超检查为阴性临床不可触及的X线下可疑病灶(BIRADS评级为4级)进行微创切取活检。结果手术成功率100%。113例病例中共发现18例乳腺癌,其中乳腺导管内癌12例,导管内癌并微浸润(浸润突破基底膜小于2mm)4例,浸润性导管癌1例,浸润性小叶癌1例。乳腺癌术后病理分期0期12例,Ⅰ期6例。无严重出血等并发症。结论 X线立体定位引导真空负压旋切活检临床触诊和B超检查均为阴性的X线下乳腺微小病灶,对诊断0期乳腺癌有较高的价值。     

Whole-breast volume perfusion images using 256-row multislice computed tomography: visualization of lesions with ductal spread

Background  The aim of this study was to apply perfusion techniques to breast tumors using a prototype 256-row multislice computed tomography (CT) scanner (which allows a wide range of 128 mm to be scanned and can provide whole-breast perfusion maps without any dead angles) to improve contrast and assess the possibility of precisely depicting the extent of breast cancer. Patients and methods  The study group included seven patients with breast cancer who were scheduled to undergo radical surgery and radiotherapy. Dynamic scanning was performed using a 256-row multislice CT scanner during normal respiration. Volume perfusion images of the entire breast were obtained using the maximum slope method. Perfusion map images and early-phase breast CT images at 54 s were compared by means of pathological examination. Results  All breast cancers could be distinguished from normal mammary glands based on the perfusion value. The extent of cancer depicted in perfusion images showed excellent agreement with the pathology findings for invasive ductal carcinoma and ductal carcinoma in situ. In three patients, all ductal spread, parts of which were not visualized by early-phase CT, were depicted in volume perfusion images. Simulation analysis suggested that perfusion maps could be generated with fewer scanning points. Conclusion  The results of the present study suggest that volume perfusion imaging may be useful for depicting the extent of breast cancer, with excellent sensitivity. Further research is needed to determine the clinical relevance of these findings.     

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node (IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observations suggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.     

Clinical use of contrast-enhanced computed tomography for decision making in breast conserving surgery

Background  A reduction in local residual breast cancer is important to avoid local recurrence after breast conserving treatment (BCT). Previous studies suggested the usefulness of contrast-enhanced computed tomography (CE-CT) in detecting extensive intraductal component (EIC), which is associated with local recurrence. This study investigates the practical role of CE-CT in BCT. Methods  In 130 women whose breasts were examined by CE-CT preoperatively, intraductal spread detected using ultrasound (US), mammography (MMG) and CE-CT, and EIC detected by histological examination were analyzed to determine possible correlations among the extent and subtypes of intraductal components. Results  The sensitivities of EIC detection by US, MMG and CE-CT were 29%, 53% and 88%, respectively, and the corresponding specificities were 58%, 70% and 72%, respectively. In 6 patients, EIC could only be visualized using CE-CT. CE-CT demonstrated the extent of cancerous lesions more accurately than standard diagnostic modalities. Intraductal components with a higher histological grade tended to show stronger enhancement. Most false negative intraductal components obtained on CE-CT (6/7) were of a low histological grade. Conclusions  CE-CT is useful for visualizing EIC and small invasive foci of breast cancer, and can suggest the optimal extent of resection.     

Magnetic resonance imaging in breast cancer: A literature review and future perspectives

Early detection and diagnosis of breast cancer are essential for successful treatment. Currently mammography and ultrasound are the basic imaging techniques for the detection and localization of breast tumors. The low sensitivity and specificity of these imaging tools resulted in a demand for new imaging modalities and breast magnetic resonance imaging (MRI) has become increasingly important in the detection and delineation of breast cancer in daily practice. However, the clinical benefits of the use of pre-operative MRI in women with newly diagnosed breast cancer is still a matter of debate. The main additional diagnostic value of MRI relies on specific situations such as detecting multifocal, multicentric or contralateral disease unrecognized on conventional assessment (particularly in patients diagnosed with invasive lobular carcinoma), assessing the response to neoadjuvant chemotherapy, detection of cancer in dense breast tissue, recognition of an occult primary breast cancer in patients presenting with cancer metastasis in axillary lymph nodes, among others. Nevertheless, the development of new MRI technologies such as diffusion-weighted imaging, proton spectroscopy and higher field strength 7.0 T imaging offer a new perspective in providing additional information in breast abnormalities. We conducted an expert literature review on the value of breast MRI in diagnosing and staging breast cancer, as well as the future potentials of new MRI technologies.     

CT、MRI检查在外周原始神经外胚层肿瘤诊治中的作用

目的：通过对影像学和病理学的分析，旨在提高对外周神经外胚层肿瘤(pPNET)的认识。方法：回顾性分析有完整影像和病理资料的6例pPNET。结果：软组织pPNET的CT表现为大的、边界不清的软组织肿块，密度不均匀伴坏死囊变，不伴钙化，增强后呈不均匀强化。骨pPNET主要表现为较大的溶骨性骨质破坏伴软组织肿块，无新生骨、瘤骨，增强后不均匀强化。MRI在SE序列T1W表现为等肌肉信号，T2W表现为不均匀高信号，增强后强化不均匀，可见类似包膜和分隔样改变。结论：pPNET的影像学表现没有明显特征性。CT和MRI的作用主要用于描述肿瘤内部结构、侵犯范围以及与周围组织、血管神经的关系，同时可以提供肿瘤远处转移的信息，对临床手术可切除性与评价疗效有着非常重要的意义。     

64排螺旋CT三期增强扫描在判断胃癌浸润深度的临床价值

目的:探讨64排螺旋CT三期增强扫描在术前判断胃癌浸润深度的临床价值。方法:确诊为胃癌的65例患者,术前均通过64排螺旋CT三期增强扫描判断胃癌浸润的深度,与术中探查及术后病理结果进行对比。结果:65例胃癌患者术前行64排螺旋CT三期增强扫描,通过与术中探查及术后病理对比,对胃癌T分期总的准确率为84.62%（55/65）,T1期为83.33%（5/6）,T2-3期为89.47%（34/38）,T4a期为75%（12/16）,T4b期为80%（4/5）。 结论:64排螺旋CT三期增强扫描在术前判断胃癌浸润深度的准确度高,为判断能否手术切除提供可靠的依据。     

Assessment of response by breast helical computed tomography to neoadjuvant chemotherapy in large inflammatory breast cancer

Breast helical computed tomography (CT) was evaluated for use in assessing response to neoadjuvant chemotherapy and residual tumor volume. Forty-three patients with large, inflammatory breast cancers (stage IIA, 12; IIB, 13; IIIA, 9; IIIB, 9), all histologically confirmed by core biopsy, were evaluated prior to and following neoadjuvant chemotherapy. The breast helical CT procedure involved patients in the prone position using single acquisition during quiet respiration following intravenous injection of nonionic contrast material. Helical CT results (3.2-mm slices and maximum intensity projections) were compared to clinical and mammographic evaluations, as well as to pathologic findings. All tumors were clearly visible by breast helical CT, showing important tumor enhancement. Helical CT evaluation of response to chemotherapy (using World Health Organization criteria) corresponded better with mammography (78%, Cohen's kappa statistic (kappa) = 0.65) than with clinical examination (53%, kappa = 0.30). Helical CT measurement of residual tumor volume after neoadjuvant chemotherapy and correlation with pathologic findings were globally satisfactory. The intraclass correlation coefficient was 0.69 (excellent for rounded opacities [0.97], but not as good for diffuse, scattered or multinodular opacities [0.60]). By contrast, clinical and mammographic correlations were globally unsatisfactory (0.49 and 0.28, respectively). Breast helical CT can be very useful in the quantitative assessment of response to neoadjuvant chemotherapy and preoperative determination of residual tumor volume. For this reason, it can be considered an alternative to breast magnetic resonance imaging because of its simplicity, rapidity, and accessibility.     

CT and 3 Tesla MRI in the TN Staging of Colon Cancer: A Prospective,Blind Study

(1) Background: Computer tomography (CT) scanning is currently the standard method for staging of colon cancer; however, the CT based preoperative local staging is far from optimal. The purpose of this study was to investigate the sensitivity and specificity of magnetic resonance imaging (MRI) compared to CT in the T- and N-staging of colon cancer. (2) Methods: Patients underwent a standard contrast-enhanced CT examination. For the abdominal MRI scan, a 3 Tesla unit was used, including diffusion weighted imaging (DWI). Experienced radiologists reported the CT and MRI scans blinded to each other and the endpoint of the pathological report. (3) Results: From 2018 to 2021, 134 patients received CT and MRI scans. CT identified 118 of the 134 tumors, whereas MRI identified all tumors. For discriminating between stage T3ab and T3cd, the sensitivity of CT was 51.1% and of MRI 80.0% (p = 0.02). CT and MRI showed a sensitivity of 21.4% and 46.4% in detecting pT4 tumors and a specificity of 79.0% and 85.0%, respectively. (4) Conclusion: Compared to CT, the sensitivity of MRI was statistically significantly higher in staging advanced T3cd and T4 tumors. MRI has the potential to be used in the treatment planning of colon cancer.     

血清肿瘤抗原检测联合CT与PET-CT扫描对肺癌确诊率的比较

背景与目的:正电子发射计算机断层显像(positronemissiontomography-computedtomography,PET-CT)是一种新的、用于影像学诊断的、将人体生物学信息与解剖信息结合的分子影像设备,具有更好的空间分辨力和早期的肿瘤探测能力。本研究中我们比较肿瘤标志物检测联合螺旋CT扫描与PET-CT全身代谢显像对肺癌诊断及临床分期的准确率。方法:手术或穿刺活检确诊为肺癌的43例患者,术前行螺旋CT扫描并有血清学CA125、CA19-9、CEA检测结果,为明确诊断及临床分期同时行PET-CT扫描,比较两种方法对肺癌的检出率以及临床分期结果。结果:血清肿瘤抗原检测联合CT扫描与PET-CT显像对肺癌诊断符合率分别为67.44%和90.70%,肺癌局部病灶显示阳性率分别为86.05%和95.35%,对纵隔淋巴结检出的阳性率分别为65.12%和83.72%,同时PET-CT显像检出肿瘤标志物联合CT扫描未发现的6例远处转移。与CT扫描相比,PET-CT显像使43例患者中的5例(11.63%)临床分期提前,7例(16.28%)推后,使4例(9.3%)患者改变了治疗方式。结论:PET-CT比血清肿瘤抗原检测联合CT扫描对肺癌的诊断阳性率高,且对肺癌的临床分期更加准确,PET-CT全身代谢显像是诊断肺癌及进一步明确肺癌分期的一种良好方法。