乳腺癌腋窝淋巴结转移18^F-FDG PET／CT半定量分析预测阈值的临床研究

目的探讨18^F-脱氧葡萄糖（FDG）PET／CT半定量分析方法预测乳腺癌腋窝淋巴结转移的最佳阈值及诊断效能。方法将56例接受腋窝淋巴结清扫术（ALND）的乳腺癌患者分成腋窝淋巴结转移阳性组（简称阳性组）和对照组（阴性组）,回顾其术前18^F-FDG PET／CT结果,测量乳腺癌原发灶（T）、腋窝淋巴结（L）及淋巴结镜像区本底（B）的最大标准摄取值（SUV-T、SUV-L、SUV-B）,计算L/B比值（L／B=SUV-L／SUV-B）。采用受试者工作特征（ROC）曲线确定SUV-T、SUV-L、L/B预测腋窝淋巴结转移的最佳阈值,采用Kappa法分别将最佳阈值下的判断结果与病理诊断结果进行一致性检验。结果56例患者共56个原发病灶,长径为（30±19）mm,SUV-T为5．5±3．5,其中阳性者38例（68％）,阳性组病灶长径[（36±19）mm]及SUV-T（6．3±3．5）明显高于对照组（t值分别为4．060和2．774,P〈0．001和P=0．008）。对628枚淋巴结进行病理活组织检查,检出阳性（转移性）淋巴结182枚（29％）、阴性（非转移性）淋巴结446枚（71％）。PET／CT所示与手术基本匹配的腋窝淋巴结共145枚（Ⅰ区132枚、Ⅱ区11枚、Ⅲ区2枚）,其中转移性淋巴结126枚（Ⅰ区103枚、Ⅱ区11枚、Ⅲ区2枚）。SUV-T、SUV-L、L/B比值ROC曲线下面积分别为0．756,0．821,0．765,最佳阈值分别为3．2,1．0,2．4。采用SUV-T≥3．2为阈值判断56例患者腋窝淋巴结转移的灵敏度、特异性、阳性预测值、阴性预测值、准确性分别为84％（32／38）、67％（12／18）、84％（32／38）、67％（12／18）、79％（44／56）;采用SUV-L≥1．0和L/B≥2．4的判断结果完全一致,分别为92％（35／38）、67％（12／18）、85％（35／41）、80％（12／15）、84％（47／56）;而目测法分析结果分别为95％（36／38）、50％（9／18）、80％（36／45）、82％（9／11）、80％（45／56）。SUV     

18F-FDG PET/CT对非小细胞肺癌区域淋巴结诊断的假阴性与假阳性研究

目的探讨18^F-FDG PET／CT在检测非小细胞肺癌（NSCLC）区域淋巴结中出现假阴性和假阳性的因素。方法随机选择手术治疗的NSCLC患者48例，术前1周内行18^F—FDG PET／CT检查，同期行CT增强扫描，术后根据病理检查结果分析PET／CT诊断NSCLC区域淋巴结转移的假阴性与假阳性因素。结果48例患者共切除区域淋巴结313枚，转移淋巴结51枚，PET／CT结果7枚假阴性。8枚假阳性，阳性预测值和阴性预测值分别为85％，97％，高于CT（57％，94％；P=0．002，0．045）。3枚假阴性淋巴结内的癌灶较小；2枚淋巴结短径约为0．4mm，小于PET／CT的空间分辨率；2枚紧邻原发灶的淋巴结，图像无法区分而视为原发灶。8枚假阳性淋巴结为患者在原发病灶基础上并发不同程度的肺部疾病和淋巴结炎症，使其糖代谢率增高。结论假阳性出于（1）淋巴结的短径小于PET／CT的空间分辨率；（2）淋巴结内的小癌灶糖代谢率较低；（3）紧邻原发灶的淋巴结与原发灶无法区分。原发肿瘤合并肺部疾病是导致PET／CT出现假阳性的重要原因。     

PET/CT与增强CT检测乳腺癌及其腋淋巴结转移的对照研究

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT显像与螺旋CT增强扫描检测乳腺癌及其腋淋巴结转移的临床价值。方法27例乳腺肿块患者于同日行^18F—FDG PET／CT显像与CT增强扫描。患者俯卧于乳腺专用泡沫垫上接受检查，前者图像由3位核医学科医师采用目测法结合半定量法进行诊断，后者图像由3位影像科医师分析诊断；最后与病理检查结果对照。结果27例患者PET／CT与增强CT均发现31个乳腺肿块，病理检查证实其中21个为乳腺癌，10个为良性病变；发现腋淋巴结91个，共有66个转移（1例有双侧腋淋巴结转移）；PET／CT显像检测乳腺癌原发灶的灵敏度为80．95％，特异性为90％，阳性预测值为94．44％；检测淋巴结转移的灵敏度为89．39％，特异性为88％，阳性预测值为95．16％。增强CT检测乳腺癌原发灶的灵敏度为90．48％，特异性为60％，阳性预测值为82．61％；检测淋巴结转移的灵敏度为86．36％，特异性为52％，阳性预测值为82．61％。^18F—FDG PET／CT和增强CT对腋淋巴结状态的诊断与病理检查结果的列联系数分别为0．64和0．37；两者对乳腺癌及其腋淋巴结转移的诊断特异性差异有显著性（P〈0．05）；对直径〈2cm的病灶，^18F—FDG PET／CT诊断准确性明显高于增强CT（P〈0．05）。结论^18F—FDG PET／CT对诊断乳腺癌及其腋淋巴结转移的特异性均高于增强CT。     

胆囊癌淋巴结转移的多层螺旋CT分析

目的 探讨胆囊癌淋巴结转移的MSCT表现,以期提高对胆囊癌淋巴结转移的认识.方法 65例经手术病理证实的胆囊癌患者行MSCT三期扫描,分析所有胆囊癌淋巴结转移的CT表现,并与手术病理对照.结果 本组收集65例中,43例共发现淋巴结201枚,其中32例中183枚淋巴结符合MSCT转移的诊断标准;11例发现<1 cm淋巴结18枚,其中阳性3枚,准确性为87%;CT的阳性预测值为91%,阴性预测值为83%.胆囊癌淋巴结转移以肝门和胰头十二指肠旁最为多见,其强化方式与原发肿瘤一致.结论 胆囊癌淋巴结转移是最常见的转移方式,MSCT扫描可以明确胆囊癌的淋巴结转移,有助于术前分期和减少误诊.     

正电子发射计算机体层摄影-CT对肺癌的临床应用研究

目的 探讨^18氟-脱氧葡萄糖（^18F-FDG）正电子发射计算机体层摄影（PET）-CT对肺癌诊断、分期、治疗及疗效监测的临床应用价值。方法 80例肺癌患者，其中66例为术前诊断分期，14例为治疗后复查患者。均行^18F-FDG PET-CT检查，23例行胸部检查，57例行全身检查。所有病例均在PET-CT检查前后加做薄层螺旋CT扫描。最后诊断均经手术病理、纤维支气管镜或穿刺活检病理证实。分析不同病理类型肺癌的^18F-FDG摄取能力与病理诊断的符合率。按照美国癌症联合委员会（AJCC）肺癌的TNM分期标准对病变分别行CT、PET-CT分期，并将组织病理结果作为参照标准。结果 （1）所有原发性肺癌均示异常放射性高摄取。不同组织学类型的肺癌对^18F-FDG的摄取能力差异较大，以腺鳞癌和低分化鳞癌的摄取能力最强。（2）66例术前诊断分期的患者中，与病理符合的肺癌N分期，PET-CT61例，CT48例。PET-CT对肺癌的N分期与CT相比差异有统计学意义（X^2=8．89，P〈0．01）。对肺癌N分期的敏感性、特异性、阳性预测值、阴性预测值，PET-CT分别为80．09％、97．14％、96．11％、84．70％；CT分别为56．48％、71．02％、63．21％、64．93％。CT发现了11例患者的17处转移，PET-CT发现了16例患者的39处转移。PET-CT与CT相比，改变了18例患者的治疗计划。（3）对14例治疗后复查的患者PET-CT能显示其在早期评价治疗疗效、区别手术瘢痕与复发提供了指导临床治疗等方面的信息。结论 ^18F-FDG PET-CT对肺癌的诊断、分期有较高的诊断效能，对治疗及预后监测具有积极的意义。     

18F-FDG符合线路显像在食管癌术前分期中的价值

目的 探讨^18F-FDG符合线路显像在食管癌术前分期中的价值。方法 35例食管癌患者术前行^18F—FDG符合线路显像及CT检查，其中30例行手术治疗，以术后病理检查结果作为“金标准”，比较^18F—FDG符合线路显像及CT检查对原发肿瘤、淋巴结及远处转移（TNM）分期的价值；另5例发现远处转移，放弃手术治疗。结果 ^18F-FDG符合线路显像T分期与病理T分期比较符合率为63％（19／30）；^18F-FDG与CT探测淋巴结病变的灵敏度为60．00％和54．28％，特异性为94．44％和77．77％，准确性为84．80％和71．20％，阴性预测值为85．86％和81．39％，阳性预测值为80．77％和48．72％，其中特异性、准确性及阳性预测值差异有统计学意义。^18F—FDG符合线路显像发现5例远处转移，改变了其治疗方案。结论 ^18F-FDG符合线路显像对食管癌的术前分期、治疗方案的制定有临床应用价值。     

螺旋CT容积扫描和重建技术对食管癌术前评分法N分期的研究

目的探讨螺旋CT容积扫描和重建技术对食管癌术前淋巴结转移性的判断价值。方法前瞻性研究2001年12月至2007年7月在我院接受CT检查并手术治疗的食管癌病例359例，T分期采用Botet方法。评分结果与手术、病理对照，统计准确性、敏感性、特异性和阳性预测值、阴性预测值及Youden指数。结果本组359例，1．5-2mm重建放大显示且与手术、病理对照淋巴结共3137枚，而8～10mm显示仅2459枚。以2．0分为转移判断标准，准确性96．6％（3031／3137），敏感性91．2％（375／411），特异性97.4％（2656／2726），阳性预测值84.3％（375／445），阴性预测值98．7％（2656／2692），Youden指数为0．89。结论螺旋CT容积扫描和薄层重建放大技术有助于显示纵隔淋巴结的数目和形态，评分法对食管癌术前淋巴结转移性判断准确可靠，能有效帮助临床对食管癌术前准确分期。     

18F-FDG符合线路SPECT/CT显像对乳腺癌腋窝淋巴结转移的诊断价值

目的探讨18F-FDG符合线路SPECT/CT显像半定量分析法预测乳腺癌腋窝淋巴结转移的最佳阈值。资料与方法以58例行腋窝淋巴结清扫术的乳腺癌患者为研究对象,18F-FDG符合线路SPECT/CT测量腋窝淋巴结(L)与对侧相应部位腋窝本底(B)最大放射性计数比值(L/B值)。以病理为"金标准",通过ROC曲线建立预测乳腺癌腋窝淋巴结转移的最佳阈值,将最佳阈值下的判定结果与病理结果行一致性检验。结果 58例患者共检测到119枚与手术区匹配的淋巴结(直径≥8mm)。L/B值的ROC曲线下面积为0.938,最佳阈值为2.22。采用L/B值≥2.22预测腋窝淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值分别为88.9%、97.9%、98.5%、85.2%,与病理诊断的一致性较好(Kappa=0.862,P<0.05)。结论采用L/B值≥2.22作为预测直径≥8mm的腋窝淋巴结转移的标准具有较高的准确性,可用于腋窝淋巴结转移的评估。     

18F-FLT和18F-FDG PET/CT对胸段食管癌淋巴结分期诊断的对比研究

目的 评价18F-脱氧胸苷（FLT）PET/CT对未经治疗的胸段食管癌淋巴结分期诊断的价值,并与18F-脱氧葡萄糖（FDG）PET/CT进行比较.方法 选择22例拟行手术治疗的胸段食管癌患者,术前行双显像剂PET/CT检查及淋巴结分期诊断,术后以病理学诊断为＂金标准＂,比较18F-FLT和18F-FDG PET/CT对胸段食管癌淋巴结分期的灵敏度、特异性、准确性、阳性预测值和阴性预测值.应用SPSS 13.0软件进行x2检验.结果 患者均行食管癌切除和淋巴结清扫术,病理检查结果显示16例患者存在淋巴结转移,N0期7例,N1期15例,M1a期6例（其中1例为N0M1a,另外5例为N1M1a）,全组均无M1b期.共检出424枚淋巴结,其中47枚为转移淋巴结.18F-FDG PET/CT诊断呈假阳性的淋巴结14枚,而18F-FLT诊断呈假阳性的淋巴结为3枚;18F-FDG假阴性的淋巴结8枚,18F-FLT假阴性的淋巴结12枚.18F-FLT PET/CT的诊断灵敏度、特异性、准确性、阴性预测值和阳性预测值分别为74.47%（35/47）、99.20%（374/377）、96.46%（409/424）、96.89%（374/386）和92.11%（35/38）,18F-FDG分别为82.98%（39/47）、96.29%（363/377）、94.81%（402/424）、97.84%（363/371）和73.58%（39/53）;两者比较的x2值分别为0.572,6.018,1.017,0.348,3.852,P值分别＞0.05,＜0.05、＞0.05、＞0.05和＞0.05.结论 18F-FLT对食管癌区域淋巴结的诊断灵敏度与18F-FDG显像接近,特异性高于18F-FDG,但仍存在一定的局限性.     

正电子发射计算机体层摄影-CT诊断骨转移瘤的临床价值

目的 应用^18氟-脱氧葡萄糖（^18F-FDG）正电子发射计算机体层摄影（PET）-CT全身显像，探讨PET、同机CT和PET—CT融合图像在骨转移瘤诊断中的价值。方法 共332例^18F-FDG PET—CT受检者中有35例发现骨异常病变。分别阅读和记录^18FDG PET图像、同机CT图像和PET-CT融合图像判断的良、恶性病变，比较3种方法在诊断骨转移瘤上的差异。结果 35例中共检出89个病灶，其中68个病灶最后确诊为恶性肿瘤骨转移，21个为良性病变。PET诊断骨转移病灶62个，诊断良性病变17个，诊断骨转移瘤的敏感性为91．2％（62／68个），特异性为81．0％（17／21个），准确性为88．8％（79／89个）；同机CT诊断骨转移病灶55个，良性病变16个。诊断骨转移瘤的敏感性、特异性和准确性分别为80．9％（55／68个），76．2％（16／21个）和79．8％（71／89个）；PET．CT融合图像诊断骨转移病灶64个，良性病变19个，诊断骨转移瘤的敏感性、特异性和准确性分别为94．1％（64／68个），90．5％（19／21个）和93．2％（83／89个）。结论 PET-CT融合图像在诊断骨转移瘤方面，可减少单用PET或单用CT诊断时的假阴性和假阳性，提高了鉴别骨良、恶性病变的能力。     

CT-pathologic correlation of axillary lymph nodes in breast carcinoma

A prospective study was performed to determine whether thoracic CT yielded useful information regarding the status of axillary lymph nodes (LNs) in patients with breast cancer. Thirty-five consecutive patients with clinically suspected stage II or III breast carcinomas were scanned preoperatively from the supraclavicular regions to the lung bases. Axillary LNs measuring greater than or equal to 1 cm were considered abnormal. The lymph nodes were classified according to their relationship to the pectoralis muscle. Extracapsular lymph node extension was diagnosed when there was irregularity and spiculation of the lymph node margin with surrounding fatty infiltration. Correlation with axillary dissection was obtained in 20 patients, giving a positive predictive value for axillary metastases of 89% with 50% sensitivity, 75% specificity, and 20% negative predictive value. CT was also able to detect the level of axillary involvement accurately when the lymph nodes were enlarged and to evaluate extracapsular LN extension. Although superior to physical examination, CT was not an accurate predictor of axillary LN involvement, primarily because of its low negative predictive value.     

彩色多普勒超声对良恶性乳腺肿瘤的研究

目的：探讨彩色多普勒超声（ColourDopplerUltrasonography．CDU）在判断乳腺肿物良恶性和腋淋巴结转移的价值。材料和方法：作者分析了58例乳腺实性肿物的彩色多普勒超声和临床怀疑乳腺癌且CDU为阳性的30例病人的腋淋巴结CDU扫查结果。结果：发现34例乳腺癌中26例CDU有阳性表现，而24例良性肿物则均无阳性结果。得出CDU对乳腺癌的敏感性为77％，特异性100％，阳性符合率100％，肿癌直径小于1cm和浸润性小叶癌的CDU阳性率最低。对照术后病理，10例腋淋巴结CDU阳性者均已有淋巴结浸润，另有4例已受累的淋巴结CDU为阴性。CDU对腋淋巴结受累敏感性为71％，特异性100％，阳性符合率100％。结论：CDU对乳腺肿物良恶性以及腋淋巴结转移的判断上有重要的应用价值。     

Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes

Axillary lymph node status is the most important prognostic factor in breast cancer patients and is currently determined by surgical dissection. This study was performed to assess whether dynamic gadopentetate dimeglumine (Gd) enhanced MRI is an accurate method for non-invasive staging of the axilla. 47 women with a new primary breast cancer underwent pre-operative dynamic Gd enhanced MRI of the ipsilateral axilla. Lymph node enhancement was quantitatively analysed using a region of interest method. Enhancement indices and nodal area were compared with histopathology of excised nodes using a receiver operating characteristic (ROC) curve approach. 10 patients had axillary metastases pathologically and all had > or =1 lymph node with an enhancement index of >21% and a nodal area of >0.4 cm(2). 37 patients had negative axillary nodes pathologically. 20 of these had enhancement indices <21% and nodal areas <0.4 cm(2). Using this method, a sensitivity of 100%, a specificity of 56%, a positive predictive value of 38% and a negative predictive value of 100% could be achieved. Using this method of quantitative assessment, dynamic Gd enhanced MRI may be a reliable method of predicting absence of axillary nodal metastases in women with breast cancer, thereby avoiding axillary surgery in women with a negative MRI study.     

Evaluation of axillary status in breast cancer. CT-based determination of sentinel lymph node size

Purpose:
To determine whether the location and size of sentinel lymph nodes (SLN) on CT are predictive of the axillary lymph node status in patients with breast cancer. Material and Methods:
Forty patients with confirmed breast cancer underwent 5-mm CT of both breasts and axillae and the most inferior lymph node in the affected axilla was designated the SLN. Based on CT assessment of the axillary lymph node status, 22 (55%) patients then underwent dye- and gamma probe (DGP)-guided SLN biopsy followed by axillary dissection; 18 (45%) underwent dissection without prior SLN biopsy. The localization and status of the SLN determined on CT and by DGP-guided biopsy were compared. Biopsied and excised nodes were subjected to histopathologic examinations. Results:
All SLN identified on CT were close to the lateral thoracic artery and their localization corresponded well with SLN identified by the DGP-guided method. The positive predictive value of CT diagnosis was 100%. Histopathologic examination of excised nodes confirmed that none of the SLN biopsies was false-negative. Conclusion:
Our CT criteria were highly accurate for identification and diagnostic assessment of SLN and useful for evaluating the axillary status in patients with breast cancer.     

FDG PET positive lymph nodes are highly predictive of metastasis in breast cancer

AIM: To determine whether or not fluorodeoxyglucose positron emission tomography (FDG PET) imaging when positive could obviate the necessity for sentinel lymph node biopsy and for complete axillary node dissection in patients with breast cancer. METHODS: A total of 80 female patients with a histological diagnosis of breast cancer and clinically negative axillary nodes underwent an FDG PET and sentinel lymph node biopsy (SLNB) or total axillary dissection for staging of axilla. Both SLNB and axillary dissection were performed in 72 patients, while eight patients had total axillary dissection without SLN biopsy. RESULTS: Of the 80 patients, 36 had lymph node metastasis on histopathology. SLNB was positive for metastasis in 35 (97%) of 36 patients (29 macrometastasis and seven micrometastasis). In the patient with false negative SLNB, the lymph node was completely replaced by the tumour. The FDG PET was true positive in 16 of 36 patients (sensitivity, 44%). There were two false positive studies with FDG PET, resulting in a specificity of 95%. The positive predictive value and accuracy of FDG PET for the detection of axillary lymph node metastasis were 89% and 72%, respectively. Univariate analysis revealed that higher grade of tumour, increased size and number of axillary lymph nodes were significantly associated with positive FDG PET results for axillary staging. CONCLUSION: FDG PET cannot replace histological staging using SLNB in patients with breast cancer. However, FDG PET has a high specificity and positive predictive value for staging of the axilla in these patients. The patients with higher grade of tumour, larger size and higher number of axillary lymph nodes may be considered for FDG PET scan for axillary staging.     

CT灌注成像评价乳腺癌腋窝淋巴结状态的临床应用价值

目的 探讨CT灌注成像(CTP)评价乳腺癌腋窝肿大淋巴结状态的临床应用价值.方法 对45例局限浸润性乳腺癌伴有临床可触及同侧腋窝淋巴结肿大患者的46个"靶"淋巴结进行多层螺旋CT(MSCT)动态增强扫描,在静脉内以4.0 ml/s流率注射40 ml对比剂后,对病灶5 min层厚连续4个层面行同层动态扫描,分别半自动计算"靶"淋巴结及其扫描层面肌肉组织灌注参数值:血流量(BF)、血容量(BV)、平均通过时间(MTY)和表面渗透性(PS),并使用非参数Mann-WhitneyU检验进行统计学分析.结果 46个腋窝"靶"淋巴结经术后病理学标本证实为转移性淋巴结32个、阴性14个(均为反应性增生淋巴结炎).32个转移性"靶"淋巴结中有22个为前哨淋巴结(68%).阴性和转移性"靶"淋巴结的灌注参数平均值分别为:BF(76.18±31.53)和(161.60±40.94)ml·100mg-1mg·min-1;BV(5.81±2.50)和(9.15±3.02)ml/100 mg;MTT(6.80±1.55)和(5.50 4±1.84)s;PS(25.82±4.62)和(25.96±7.47)ml·100 mg-1·min-1.转移性和阴性"靶"淋巴结BF之间的r=0.14,P<0.05,BV、MTY和Ps之间的r值分别为-0.03、0.05、0.07,P值均>0.05.结论 CTP在形态学基础上增加功能信息可为临床评价淋巴结状态提供有用信息.     

螺旋CT表面覆盖法成像对乳腺癌的诊断价值

目的　明确乳腺癌的CT征象 ,评价螺旋CT表面覆盖法成像 (SSD)对乳腺癌的诊断价值。方法　乳腺癌 3 3例 ,螺旋扫描表面覆盖法成像 ,采用立体三维表现方式将预先设置的某一CT域值范围内的相邻象素 ,经过运算生成一个立体模型的外表面 ,将同一密度值的象素点或一个区域按照正常的横断面图像的空间、位置和方向生成三维表面覆盖影像 ,并按照给出的观察方向设置相应的色彩。结果　乳腺癌CT表现为 :圆形、椭圆形或不规则形肿块 ,不均匀强化或明显强化 ,边缘毛刺 ,导管牵拉征 ,库伯韧带受累 ,沙粒样钙化 ,局部皮肤胸壁浸润及周围脂肪间隙变形 ,腋窝淋巴结转移。结论　螺旋CTSSD法对乳腺癌的诊断及鉴别诊断有一定的价值     

Detection of nodal metastatic disease in patients with non-small cell lung cancer: comparison of positron emission tomography (PET), contrast-enhanced computed tomography (CT), and combined PET-CT

Of 31 patients with lung cancer, 19 underwent PET-CT and 12 had CT followed by PET. Thoracic lymph nodes were sampled by mediastinoscopy or thoracotomy. Sensitivities, specificities, positive (PPV), and negative predictive values (NPV) were calculated based on histopathology. Ninety nodes (41 malignant) were identified. Sensitivity, specificity, PPV, and NPV were 94%, 73%, 66%, and 96% for PET-CT, respectively. In 12 patients who underwent PET and CT separately, these values were 90%, 31%, 64%, and 71% for PET and 81%, 50%, 69%, and 66% for CT, respectively.