乳腺癌患者血清CA15—3值的临床观察

目的：探讨ＣＡ１５－３在乳腺癌临床应用价值。方法：ＣＡ１５－３试剂盒购自瑞典ＣａｎＡｇ公司,严格按说明书操作,实验批内批间误差符合要求。对乳腺癌和乳腺良病变各３０例进行观察。结果：乳腺癌患者血清ＣＡ１５－３值为８２．２±１４８ｕ／ｍｌ。明显高于乳腺良性病变患者即９．８±４．９ｕ／ｍｌ。两者之间有显著性差异（Ｐ〈０．０５）。乳腺癌手术前后ＣＡ１５－３值及术前有无腋窝淋巴结转移ＣＡ１５－３值进行比较,     

Is 18F-FDG PET/CT useful for imaging and management of patients with suspected occult recurrence of cancer?

Rising serum tumor markers may be associated with negative imaging in the presence of cancer. CT and (18)F-FDG PET may yield incongruent results in the assessment of tumor recurrence. The present study evaluates the incremental role of (18)F-FDG PET/CT for the diagnosis and management of cancer patients with increasing levels of tumor markers as the sole indicator of potential recurrence after initial successful treatment. METHODS: Thirty-six cancer patients with increasing levels of tumor markers during follow-up and negative CT underwent (18)F-FDG PET/CT, which showed 111 sites of increased tracer uptake. PET/CT was compared with PET results on a site-based analysis for characterization of (18)F-FDG foci and on a patient-based analysis for diagnosis of recurrence. The clinical impact of PET/CT on further patient management was evaluated. RESULTS: Thirty patients (83%) had recurrence in 85 malignant sites (77%). For the site-based analysis, PET had a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 96%, 50%, 85%, 85%, and 82%, respectively, as compared with the performance indices of PET/CT of 100%, 89%, 97%, 97%, and 100%, respectively. There was a statistically significant difference between the specificity (P < 0.05) and accuracy (P < 0.001) of PET and PET/CT for precise characterization of suspected lesions. For the patient-based analysis, PET had a sensitivity, specificity, and accuracy of 93%, 50%, and 86%, respectively, as compared with PET/CT with values of 93%, 67%, and 89%, respectively (P = not significant). PET/CT was the single modality that directed further management and treatment planning in 12 patients (33%). CONCLUSION: The results of this study indicate that PET/CT may improve the accuracy of occult cancer detection and further lead to management changes in patients with increasing levels of tumor markers as the sole suspicion of recurrent malignancy.     

Detection of early recurrence with 18F-FDG PET in patients with cervical cancer.

This study investigated the feasibility of PET with (18)F-FDG to evaluate retrospectively early recurrence in patients with cervical cancer. METHODS: From September 1997 to March 2000, 249 patients with no evidence of cervical cancer after treatment were investigated with (18)F-FDG PET. (18)F-FDG PET scanning, beginning 50 min after injection of 370-555 MBq (18)F-FDG, was performed. (18)F-FDG uptake other than physiologic uptake was evaluated with the standardized uptake value and was analyzed by 2 observers who were unaware of CT or MRI data. CT or MRI and needle biopsies were performed to evaluate the positive lesions on (18)F-FDG PET, and all patients were monitored closely for 6 mo for recurrence. RESULTS: Of the 249 patients, 80 patients (32.1%) showed positive lesions with (18)F-FDG PET, and 28 patients (11.2%) were clinically or histologically confirmed as having recurrences. Eighty-two percent of recurrence was detected within 6-18 mo after diagnosis, and 89% of recurrence occurred in Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage IIb and stage III patients. The sensitivity and specificity of (18)F-FDG PET for detection of early recurrence were 90.3% and 76.1%, respectively. The sensitivity of (18)F-FDG PET was high in mediastinal, hilar, and scalene lymph nodes, spine, and liver; however, the sensitivity was relatively low in lung, retrovesical lymph nodes, and paraaortic lymph nodes. Three false-negative cases were detected in lung, retrovesical lymph nodes, and paraaortic lymph nodes. CONCLUSION: (18)F-FDG PET was effective in detecting early recurrences in cervical cancer patients with no evidence of disease. (18)F-FDG PET may be a useful follow-up method for cervical cancer, thereby providing the patients with early opportunities for sophisticated treatments.     

Thyroglobulin levels and thyroglobulin doubling time independently predict a positive 18F-FDG PET/CT scan in patients with biochemical recurrence of differentiated thyroid carcinoma

Purpose

To assess the relationship between serum thyroglobulin (Tg) levels, Tg doubling time (Tg-DT) and the diagnostic performance of ¹⁸F-FDG PET/CT in detecting recurrences of ¹³¹I-negative differentiated thyroid carcinoma (DTC).

Methods

Included in the present study were 102 patients with DTC. All patients were treated by thyroid ablation (e.g. thyroidectomy and ¹³¹I), and underwent ¹⁸F-FDG PET/CT due to detectable Tg levels and negative conventional imaging. Consecutive serum Tg measurements performed before the ¹⁸F-FDG PET/CT examination were used for Tg-DT calculation. The ¹⁸F-FDG PET/CT results were assessed as true or false after histological and/or clinical follow-up.

Results

Serum Tg levels were higher in patients with a positive ¹⁸F-FDG PET/CT scan (median 6.7 ng/mL, range 0.7–73.6 ng/mL) than in patients with a negative scan (median 1.8 ng/mL, range 0.5–4.9 ng/mL; P?<?0.001). In 43 (88 %) of 49 patients with a true-positive ¹⁸F-FDG PET/CT scan, the Tg levels were >5.5 ng/mL, and in 31 (74 %) of 42 patients with a true-negative ¹⁸F-FDG PET/CT scan, the Tg levels were ≤5.5 ng/mL. A Tg-DT of <1 year was found in 46 of 49 patients (94 %) with a true-positive ¹⁸F-FDG PET/CT scan, and 40 of 42 patients (95 %) with a true-negative scan had a stable or increased Tg-DT. Moreover, combining Tg levels and Tg-DT as selection criteria correctly distinguished between patients with a positive and a negative scan (P<0.0001).

Conclusion

The accuracy of ¹⁸F-FDG PET/CT significantly improves when the serum Tg level is above 5.5 ng/mL during levothyroxine treatment or when the Tg-DT is less than 1 year, independent of the absolute value.     

MCA and CA 15-3 in the follow-up of patients with breast cancer]

After surgery and radiotherapy circulating serum levels of the tumour markers MCA and Ca 15-3 were evaluated in 226 clinically disease-free breast cancer patients. 15 of them presented with local recurrences and/or distant metastases after a follow-up period of twelve months. Six patients belonged to the group of 180 with both markers negative, two belonged to the 32 patients with only one marker positive, and seven to the group of 14 with both markers positive. After twelve months the probability of disease-free survival (calculated by the method of Kaplan-Meier) is 96% in patients with negative tumour markers and only 51.4% in patients with both markers positive (p less than 0.001). After 16 months these values are 96% versus 25.7% with the same statistical significance. The value of tumour marker examinations in the regular follow-up of patients with breast cancer lies in the early detection of tumour activity and therefore in a better chance of response to subsequent treatment. The diagnostic sensitivity of MCA was 75.5%, and for Ca 15-3 70.24%.     

18F-FDG PET显像在乳腺癌中的应用

^18F-FDG(^18F-氟脱氧葡萄糖)PET(正电子发射型计算断层显像)是反映恶性肿瘤代谢特征的一种无创性的功能显像方法。在绝大多数肿瘤中均得到广泛应用。本文通过对国内外乳腺癌^18F-FDG PET。显像的文章进行全面综合分析，旨在探讨^18F-FDG PET显像在乳腺癌中的应用原理及其临床应用价值。与传统影像学相比，^18F-FDG PET。显像能够更为准确地发现原发性乳腺癌远处转移和局部复发，可以在治疗早期及时评价化疗疗效以指导临床治疗。对于原发性乳腺癌的诊断。PET显像不作为首选检查。但对于临床检查或常规影像检查难以进行或无明确结论的病人。PET显像可以作为其乳腺肿块定性诊断的最佳选择。     

血糖水平对18F-FDG PET/CT图像质量的影响

目的 研究血糖水平对18F-脱氧葡萄糖(FDG) PET/CT图像质量的影响.方法 80例行体格检查或评价肿瘤性质的受检者,按空腹血糖水平分为9组(组间距为1mmol/L),第1组为血糖正常组,即血糖＜6.0mmol/L(10例);第2～9组血糖水平高于正常,分别为6.0～6.9mmol/L(11例),7.0～7.9mmol/L(13例),8.0～8.9mmol/L(11例),9.0～9.9mmol/L(11例),10.0～10.9mmol/L(8例),11.0～11.9mmol/L(6例),12.0～12.9mmol/L(5例),≥13.0mmol/L(5例).受检者做完PET/CT检查后,图像质量由2位有经验的医师独立判断.同时根据肝不同层面的标准摄取值(SUV)最大值(SUVmax)及SUV平均值(SUVavg)分别计算肝图像噪声.采用SPSS 12.0软件进行统计学处理.结果 (1)9组之间图像质量评分、肝噪声差异有统计学意义(P均＜0.05).将第2～9组图像质量评分、肝噪声分别与第1组进行比较,第2～7组与第1组差异无统计学意义(P均＞0.05);第8,9组与第1组比较差异有统计学意义(P均＜0.05),且评分低于第1组.(2)血糖水平与图像质量评分呈负相关(r=-0.52,P＜0.05);血糖水平与肝噪声呈正相关(SUVmax、SUVavgr值分别为0.33和0.60,P均＜0.05);SUVavg所算噪声与血糖水平的相关性优于SUVmax.结论 图像质量随血糖水平的升高而下降,血糖＜12.0mmol/L时与血糖正常者PET/CT图像质量差异无统计学意义,但当血糖水平≥12.0mmol/L时图像质量将显著下降.     

^18F-FDG PET/CT对可疑复发性宫颈癌的临床价值

目的 探讨^18F-FDG PET/CT在可疑复发性宫颈癌临床诊疗中的价值.方法 回顾性分析51例宫颈癌根治后随访期间临床可疑复发的患者,记录患者的治疗资料、可疑复发表现、18F-FDG PET/CT显像结果、同期常规影像检查结果、病理及临床随访结果、PET/CT结果对临床诊疗的影响.结果 PET/CT诊断宫颈癌复发43例,最终经病理检查及临床随访证实复发性宫颈癌40例,盆腔脓肿2例,放射性肠炎1例;PET/CT未见恶性征象8例,病理检查及临床随访均未见异常.PET/CT诊断复发性宫颈癌灵敏度为100.00%（40/40）,特异性为72.73%（8/11）,准确性为94.12%（48/51）.PET/CT指导制订临床诊疗及随访计划34例,改变治疗计划7例.与其他影像检查相比,PET/CT可发现更多的病灶.结论^18F-FDG PET/CT能有效诊断复发性宫颈癌,指导临床诊疗.     

18F-FET PET compared with 18F-FDG PET and CT in patients with head and neck cancer.

Recent studies suggest a somewhat selective uptake of O-(2-[18F]fluoroethyl)-L-tyrosine (FET) in cerebral gliomas and in squamous cell carcinoma (SCC) and a good distinction between tumor and inflammation. The aim of this study was to investigate the diagnostic potential of 18F-FET PET in patients with SCC of the head and neck region by comparing that tracer with 18F-FDG PET and CT. METHODS: Twenty-one patients with suspected head and neck tumors underwent 18F-FET PET, 18F-FDG PET, and CT within 1 wk before operation. After coregistration, the images were evaluated by 3 independent observers and an ROC analysis was performed, with the histopathologic result used as a reference. Furthermore, the maximum standardized uptake values (SUVs) in the lesions were determined. RESULTS: In 18 of 21 patients, histologic examination revealed SCC, and in 2 of these patients, a second SCC tumor was found at a different anatomic site. In 3 of 21 patients, inflammatory tissue and no tumor were identified. Eighteen of 20 SCC tumors were positive for both 18F-FDG uptake and 18F-FET uptake, one 0.3-cm SCC tumor was detected neither with 18F-FDG PET nor with 18F-FET PET, and one 0.7-cm SCC tumor in a 4.3-cm ulcer was overestimated as a 4-cm tumor on 18F-FDG PET and missed on 18F-FET PET. Inflammatory tissue was positive for 18F-FDG uptake (SUV, 3.7-4.7) but negative for 18F-FET uptake (SUV, 1.3-1.6). The SUVs of 18F-FDG in SCC were significantly higher (13.0 +/- 9.3) than those of 18F-FET (4.4 +/- 2.2). The ROC analysis showed significantly superior detection of SCC with (18)F-FET PET or 18F-FDG PET than with CT. No significant difference (P = 0.71) was found between 18F-FDG PET and 18F-FET PET. The sensitivity of 18F-FDG PET was 93%, specificity was 79%, and accuracy was 83%. 18F-FET PET yielded a lower sensitivity of 75% but a substantially higher specificity of 95% (accuracy, 90%). CONCLUSION: 18F-FET may not replace 18F-FDG in the PET diagnostics of head and neck cancer but may be a helpful additional tool in selected patients, because 18F-FET PET might better differentiate tumor tissue from inflammatory tissue. The sensitivity of 18F-FET PET in SCC, however, was inferior to that of 18F-FDG PET because of lower SUVs.     

PET/CT using 18F-FDG in suspected lung cancer recurrence: diagnostic value and impact on patient management.

The goal of this study was to assess the value of hybrid imaging using a combined PET/CT device with 18F-FDG in the diagnosis and clinical management of suspected recurrent lung cancer. METHODS: Forty-two patients with non-small cell lung cancer (NSCLC) with suspected recurrence due to new clinical, biochemical, and radiologic findings were prospectively evaluated. PET/CT results were compared with PET interpreted with side-by-side CT data. A final diagnosis of recurrence was confirmed by histologic tissue sampling during surgery or biopsy or by further clinical and radiologic work-up. The impact of PET/CT on patient management was assessed. RESULTS: Twenty-four of 27 positive PET/CT studies (89%) were proven to have recurrent disease. Fourteen of 15 negative PET/CT studies (93%) had no evidence of disease. The sensitivity, specificity, and positive and negative predictive values of PET/CT for diagnosis of recurrence were 96%, 82%, 89%, and 93% compared with 96%, 53%, 75%, and 90%, respectively, for PET. PET/CT changed the PET lesion classification in 22 patients (52%), by determining the precise localization of sites of increased 18F-FDG uptake. PET/CT changed the management of 12 patients (29%) by eliminating previously planned diagnostic procedures (5 patients), by initiating a previously unplanned treatment option (4 patients), or by inducing a change in the planned therapeutic approach (3 patients). CONCLUSION: In patients with a suspected recurrence of NSCLC, PET/CT provides a better anatomic localization of suspicious lesions compared with PET interpreted with side-by-side CT data. This improved diagnostic performance of PET/CT has a further impact on the clinical management and treatment planning of the patients.     

18F-FDG PET/CT对可疑复发性宫颈癌的临床价值

目的 探讨18F-FDG PET/CT在可疑复发性宫颈癌临床诊疗中的价值.方法 回顾性分析51例宫颈癌根治后随访期间临床可疑复发的患者,记录患者的治疗资料、可疑复发表现、18F-FDG PET/CT显像结果、同期常规影像检查结果、病理及临床随访结果、PET/CT结果对临床诊疗的影响.结果 PET/CT诊断宫颈癌复发43例,最终经病理检查及临床随访证实复发性宫颈癌40例,盆腔脓肿2例,放射性肠炎1例;PET/CT未见恶性征象8例,病理检查及临床随访均未见异常.PET/CT诊断复发性宫颈癌灵敏度为100.00%(40/40),特异性为72.73%(8/11),准确性为94.12%(48/51).PET/CT指导制订临床诊疗及随访计划34例,改变治疗计划7例.与其他影像检查相比,PET/CT可发现更多的病灶.结论 18F-FDG PET/CT能有效诊断复发性宫颈癌,指导临床诊疗.     

18F-FDG PET/CT predicts survival in patients with inflammatory breast cancer undergoing neoadjuvant chemotherapy

Purpose

The objective of this study was to evaluate the role of ¹⁸F-FDG PET/CT in predicting overall survival in inflammatory breast cancer patients undergoing neoadjuvant chemotherapy.

Methods

Included in this retrospective study were 53 patients with inflammatory breast cancer who had at least two PET/CT studies including a baseline study before the start of neoadjuvant chemotherapy. Univariate and multivariate analyses were performed to assess the effects on survival of the following factors: tumor maximum standardized uptake value (SUVmax) at baseline, preoperatively and at follow-up, decrease in tumor SUVmax, histological tumor type, grade, estrogen, progesterone, HER2/neu receptor status, and extent of disease at presentation including axillary nodal and distant metastases.

Results

By univariate analysis, survival was significantly associated with decrease in tumor SUVmax and tumor receptor status. Patients with decrease in tumor SUVmax had better survival (P?=?0.02). Patients with a triple-negative tumor (P?=?0.0006), a Her2/neu-negative tumor (P?=?0.038) or an ER-negative tumor (P?=?0.039) had worse survival. Multivariate analysis confirmed decrease in tumor SUVmax and triple-negative receptor status as significant predictors of survival. Every 10 % decrease in tumor SUVmax from baseline translated to a 15 % lower probability of death, and complete resolution of tumor FDG uptake translated to 80 % lower probability of death (P?=?0.014). Patients with a triple-negative tumor had 4.11 times higher probability of death (P?=?0.004).

Conclusion

Decrease in tumor SUVmax is an independent predictor of survival in patients with inflammatory breast cancer undergoing neoadjuvant chemotherapy. Further investigation with prospective studies is warranted to clarify its role in assessing response and altering therapy.     

18F-FDOPA PET/CT for detection of recurrence in patients with glioma: prospective comparison with 18F-FDG PET/CT

Purpose

Differentiation between recurrence and radiation necrosis in patients with glioma is crucial, since the two entities have completely different management and prognosis. The purpose of the present study was to compare the efficacies of ¹⁸F-FDG PET/CT and 3,4-dihydroxy-6-[¹⁸F]fluoro-phenylalanine (¹⁸F-FDOPA) PET/CT in detection of recurrent gliomas.

Methods

A total of 28 patients (age 38.82?±?1.25 years; 85.7 % men) with histopathologically proven glioma with clinical/imaging suspicion of recurrence were evaluated using ¹⁸F-FDG PET/CT and ¹⁸F-FDOPA PET/CT. ¹⁸F-FDG PET/CT and ¹⁸F-FDOPA PET/CT images were evaluated qualitatively and semiquantitatively. The combination of clinical follow-up, repeat imaging and/or biopsy (when available) was taken as the reference standard.

Results

Based on the reference standard, 21 patients were positive and 7 were negative for tumour recurrence. The sensitivity, specificity and accuracy of ¹⁸F-FDG PET/CT were 47.6 %, 100 % and 60.7 %, respectively, and those of ¹⁸F-FDOPA PET/CT were 100 %, 85.7 % and 96.4 %, respectively. The results of ¹⁸F-FDG PET/CT and ¹⁸F-FDOPA PET/CT were concordant in 57.1 % of patients (16 of 28) and discordant in 42.9 % (12 of 28). The difference in the findings between ¹⁸F-FDG PET/CT and ¹⁸F-FDOPA PET/CT was significant (P?=?0.0005, McNemar’s test). The difference was significant for low-grade tumours (P?=?0.0039) but not for high-grade tumours (P?=?0.250).

Conclusion

¹⁸F-FDOPA PET/CT is highly sensitive and specific for detection of recurrence in glioma patients. It is superior to ¹⁸F-FDG PET/CT for this purpose and is especially advantageous in patients with low-grade gliomas.     

血清CA15-3、CEA及全身骨显像联合检查对乳腺癌骨转移的诊断价值

目的 探讨血清糖类抗原15-3(carbonhydrate antigen 15-3,CA15-3)、癌胚抗原(carcinoembryonic antigen,CEA)测定联合全身骨显像(WBS)对提高乳腺癌骨转移诊断的临床价值。方法 对92例乳腺癌患者分别进行血清CA15-3、CEA检测和WBS,并进行对比分析。结果 乳腺癌骨转移组,血清CA15-3和CEA水平显着增高,与无骨转移的乳腺癌组比较有统计学差异(CA15.3:t=91.8342;CEA:t=77.6323,P<0.01)。CA15-3、CEA及全身骨显像联合检测对诊断乳腺癌骨转移其灵敏度、特异度分别为95.74%、88.89%,较单独检测某项指标诊断效率均有提高。结论 血清CA15-3、CEA及全身骨显像联合检测可提高乳腺癌骨转移的诊断效率,特别是全身骨显像结果模棱两可时意义更大。     

血清CA15-3、CEA及全身骨显像联合检查对乳腺癌骨转移的诊断价值

目的 探讨血清糖类抗原15-3(carbonhydrate antigen 15-3,CA15-3)、癌胚抗原(carcinoembryonic antigen,CEA)测定联合全身骨显像(WBS)对提高乳腺癌骨转移诊断的临床价值.方法 对92例乳腺癌患者分别进行血清CA15-3、CEA检测和WBS,并进行对比分析.结果 乳腺癌骨转移组,血清CA15-3和CEA水平显著增高,与无骨转移的乳腺癌组比较有统计学差异(CA15.3:t=91.8342;CEA:t=77.6323,P<0.01).CA15-3、CEA及全身骨显像联合检测对诊断乳腺癌骨转移其灵敏度、特异度分别为95.74%、88.89%,较单独检测某项指标诊断效率均有提高.结论 血清CA15-3、CEA及全身骨显像联合检测可提高乳腺癌骨转移的诊断效率,特别是全身骨显像结果模棱两可时意义更大.