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1.

Objective

The aim of this study was to evaluate the role of PET/CT in post-operative assessment and therapeutic follow up of renal cell carcinoma (RCC).

Patients and methods

30 patients having pathologically proven RCC underwent PET/CT examination following a preset protocol as baseline study within 1?month post radical nephrectomy. They all had a second PET/CT examination following the same protocol after 6 to 12?months as systematic follow up or to assess the therapeutic response.

Results

13 out of 30 patients (43.3%) were performing their regular follow up post radical nephrectomy, 14 cases (46.7%) were under chemotherapy while 3 cases (10%) were receiving combined chemo and radiotherapy.In first setting follow up examination 18F-FDG PET/CT showed 17 true positive (TP), 12 true negative (TN) and 1 false negative (FN) cases while CT showed 11 TP, 11 TN, 7 FN and 1 false positive (FP) cases. 18F-FDG PET/CT vs. CT revealed sensitivity, specificity and accuracy of 94.4% vs. 61.1%, 100% vs. 91.7% and 96.7% vs.73.3% respectively.

Conclusion

18F-FDG PET/CT is more accurate than CT in post-operative and therapeutic follow up of renal cell carcinoma.  相似文献   

2.

Background

Metastatic adrenal disease can occur in a wide diversity of malignancies. Distinguishing benign from metastatic adrenal masses in oncologic patients is vital.

Objective

To appraise the 18F-FDG PET/CT performance for distinguishing benign from metastatic adrenal masses.

Material and methods

In the current prospective study, 21 patients with proven extra-adrenal primary malignancy, having adrenal masses?≥10?mm on the axial CT images of their PET/CT examinations, were enrolled. Positive PET findings for malignancy were considered if the mass showed FDG uptake equivalent to or more prominent than the FDG liver uptake. Alternatively, negative PET findings for malignancy were considered if the mass showed FDG uptake not as much of the FDG liver uptake. Afterward, the obtained results were correlated with serial imaging follow-up or histopathological diagnosis by surgery or percutaneous biopsy as the diagnostic standard of reference.

Results

An overall number of 24 adrenal masses was diagnosed. Positive PET/CT results were found in 14 adrenal masses. All were finally considered to be metastases by serial imaging follow-up (n?=?8) and histopathological analysis by surgery (n?=?1) and percutaneous biopsy (n?=?5). Accordingly, no false positive result was obtained. Negative PET/CT results were observed in 10 adrenal masses, 9 of them were finally confirmed to be benign by serial imaging follow-up. The remaining mass was finally confirmed to be metastasis by percutaneous biopsy and hence, it represented the false negative result. 93% sensitivity, 100% specificity and 96% accuracy for identifying adrenal metastases were obtained.

Conclusion

18F-FDG PET/CT is a precise, non invasive modality for distinguishing benign from metastatic adrenal masses in oncologic patients.  相似文献   

3.

Objective

The aim of our study was to determine the role of PET-CT in detection of recurrence and metastasis of renal cell carcinoma.

Patients and methods

Our study included twenty patients with renal cell carcinoma. All patients were from those attending to radio-diagnosis department in Sharq El Madina Hospital in Alexandria referred for PET/CT study. The following were done for all patients: Careful history taking, clinical examination, ultrasound, enhanced CT and PET/CT.

Results

One patient (5%) had positive PET/CT findings at different bone sites with high metabolic activity however these lesions were negative at CECT without any anatomical changes neither lytic nor sclerotic changes could be detected at these bone sites, with sensitivity, specificity and accuracy of PET/CT were 100%, 83% and 95% respectively.

Conclusion

PET/CT had advantage to PET and CT alone, making it an appropriate imaging technique in recurrence detection, therapeutic assessment and follow up of patients with renal cell carcinoma.  相似文献   

4.

Aim and objectives

The aim of this study was to assess the role of 18-F FDG-PET/CT in evaluating the peripheral malignant neuronal affection as well as perineural tumoral spread that occurs in patients with cancers.

Methodology

50 patients with clinical symptoms of neurological deficits (34 male and 16 female) were included, their ages ranged from 17 to 74 with a mean of 45?years. PET/CT was done for all patients followed by clinical correlation after anti-inflammatory drugs and chemotherapy.

Results

Interpretation of the PET/CT studies and clinical correlation revealed 10 true positive cases with malignant neuronal involvement, 4 false positive cases diagnosed clinically as radiotherapy-induced neuropathy, 34 true negative cases and 2 false negative cases with negative PET/CT study and clinical evidence of nerve affection with sensitivity 83.33%, specificity 89.47%, PPV 71.43%, NPV 94.44% and diagnostic accuracy 88%. P-value?>?0.05 was considered statistically significant.

Conclusion

PET/CT has a significant role in detection of neuronal involvement by malignancy in cancer patients. Correlation between PET/CT and clinical outcome after chemotherapy improves the accuracy of diagnosis.  相似文献   

5.

Purpose

This study aimed at assessment of the role of (PET/CT) in lymphoma after completion of therapy to differentiate post-treatment fibrosis from residual viable tumor and being familiar with the limitations and interpretative pitfalls of PET/CT.

Method and materials

The present study was performed on 50 patients(27 males and 23 females).18F-FDG was injected IV one hour before performing the study. Contrast enhanced CT was performed followed by PET.

Results

After the end of therapy; PET/CT revealed (38%) of cases showed a partial regression, (28%) of cases showed a progressive disease, (22%) of cases with complete metabolic disease remission, (8%) of cases showed a stationary disease and the remaining (4%) of cases showed mixed response to therapy. CT only agreed with PET/CT in 76% of the cases. Some physiologic uptake often occurs after treatment in (4%) of patients. PET/CT has 100% sensitivity,68.75 % specificity, 87.17% PPV, 100% NPV and 90% accuracy in treatment response of lymphoma; compared to 94.1% sensitivity and 50% specificity, 80% PPV, 80% NPV and 80% accuracy for CECT.

Conclusion

PET/CT is a multimodality technique that can accurately monitor the treatment response of lymphoma. It can differentiate residual mass containing viable tumor from post treatment fibrosis.  相似文献   

6.

Objective

The aim of this study was to compare the diagnostic performance of positron emission tomography/computed tomography (PET/CT) scan and CT scan in follow up of proven gynecological malignancies omental deposits in first setting follow up after treatment.

Patients and methods

60 female patients having proven omental deposits from gynecological malignancies underwent PET/CT examination following a preset protocol as baseline study. 34 cases of them had a second PET/CT examination following same protocol after 5–11 months considered as first setting follow up study aiming to assess therapeutic response.

Results

Out of 34 cases 2 cases (6%) showed only newly developed lesions, 8 cases (23.5%) showed progression, 8 cases (23.5%) showed mixed response and 16 cases (47%) showed regression or complete resolution. In first setting follow up examination 18F-FDG PET/CT showed 31 TP, 2 TN and 1 FN cases while CT showed 29 TP, 2 TN, 2 FN and 1 FP cases. 18F-FDG PET/CT vs. CT revealed sensitivity, specificity and accuracy of 96.88% vs. 93.55%, 100% vs. 66.67% and 97.06% vs. 91.18% respectively.

Conclusion

18F-FDG PET/CT is more accurate than CT in assessment of therapeutic response of proven gynecological malignancies omental deposits in first setting follow up.  相似文献   

7.

Aim

Assessment of the clinical benefit of [18F]-FDG PET/CT examinations in restaging of patients with non Hodgkin lymphoma (NHL) in Egypt.

Patients, methods

This study was performed on 45 patients with NHL. PET-CT and CECT were analyzed after end of chemotherapy regimen, using 12?months follow-up as standard of reference.

Results

Follow-up of patients with NHL after 12?months of treatment revealed significant differences between staging by CT versus PET/CT (P?=?0.0001). Disease was upstaged by PET/CT in 36% (mostly in stages I and II) and downstaged in only 2% of patients. Agreement between PET-CT & CECT were usually in stage III and IV. Evaluation showed a sensitivity of 77% for CT alone, 95% for FDG-PET-CT.

Conclusion

FDG PET-CT significantly improved sensitivity and specificity in restaging of NHL and therefore should be used routinely in follow up of patients with lymphoma.  相似文献   

8.

Aims

The point of this research is to investigate the potential role of (18-F-FDG/PET) in the identification of hepatocellular carcinoma (HCC) and its metastases.

Patients and method

The present study was performed on 22 patients (15 newly diagnosed, 7 previously treated).18F-FDG was injected IV 1?h before the scan. Non-contrast-enhanced CT was performed trailed by PET in the same session. PET/CT scans were performed on (Philips Gemini-NM system). The whole study took around 20–30?min.

Results

PET/CT revealed increased local liver tumor 18-F-FDG uptake in 13/17 of those patients (6 solitary uptakes and 7 multi-nodular uptakes). Primary tumor SUV max. extended from 3 to 11 (mean 6.1) and liver tumor background ratio (TBR) varied from 0.4 to 3 (mean 2.05). 18-F-FDG PET/CT showed extrahepatic metastasis in 6 newly diagnosed patients. It also showed local tumor recurrence in 4 treated patients; 3 of them with no metastasis and 1 previously treated patient had local recurrence and distant metastasis. PET/CT has 76.5% sensitivity, 60% specificity, 86.7% PPV, 42.9% NPV and 59% accuracy in defining HCC and its extrahepatic metastases.

Conclusion

This study affirms the achievability of 18-F-FDG PET/CT for identification of primary HCC and its extrahepatic metastases.  相似文献   

9.

Purpose

To compare the sensitivity and specificity of 18F-fluordesoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), 18F-FDG PET/magnetic resonance (18F-FDG PET/MR) and 18F-FDG PET/MR including diffusion weighted imaging (DWI) in the detection of sentinel lymph node metastases in patients suffering from malignant melanoma.

Material & Methods

Fifty-two patients with malignant melanoma (female: n =?30, male: n =?22, mean age 50.5?±?16.0 years, mean tumor thickness 2.28?±?1.97 mm) who underwent 18F-FDG PET/CT and subsequent PET/MR & DWI for distant metastasis staging were included in this retrospective study. After hybrid imaging, lymphoscintigraphy including single photon emission computed tomography/CT (SPECT/CT) was performed to identify the sentinel lymph node prior to sentinel lymph node biopsy (SLNB). In a total of 87 sentinel lymph nodes in 64 lymph node basins visible on SPECT/CT, 17 lymph node metastases were detected by histopathology. In separate sessions PET/CT, PET/MR, and PET/MR & DWI were assessed for sentinel lymph node metastases by two independent readers. Discrepant results were resolved in a consensus reading. Sensitivities, specificities, positive predictive values and negative predictive values were calculated with histopathology following SPECT/CT guided SLNB as a reference standard.

Results

Compared with histopathology, lymph nodes were true positive in three cases, true negative in 65 cases, false positive in three cases and false negative in 14 cases in PET/CT. PET/MR was true positive in four cases, true negative in 63 cases, false positive in two cases and false negative in 13 cases. Hence, we observed a sensitivity, specificity, positive predictive value and negative predictive value of 17.7, 95.6, 50.0 and 82.3% for PET/CT and 23.5, 96.9, 66.7 and 82.3% for PET/MR. In DWI, 56 sentinel lymph node basins could be analyzed. Here, the additional analysis of DWI led to two additional false positive findings, while the number of true positive findings could not be increased.

Conclusion

In conclusion, integrated 18F-FDG PET/MR does not reliably differentiate N-positive from N-negative melanoma patients. Additional DWI does not increase the sensitivity of 18F-FDG PET/MR. Hence, sentinel lymph node biopsy cannot be replaced by 18F-FDG-PE/MR or 18F-FDG-PET/CT.
  相似文献   

10.

Aim of the work

To evaluate the diagnostic reliability of qualitative and quantitative data of 18F-FDG PET/CT scanning in the identification and differentiation of adrenal incidentalomas discovered in cancer patients.

Materials and methods

Forty-five consecutive cancer patients (24 males and 21 females), with 54 discovered adrenal incidentalomas, were subjected to whole-body 18F-FDG PET/CT scanning protocol. For each adrenal nodule, the adrenal SUVmax, SUVavg, T/L SUVratio and activity scores were estimated.

Results

Most of the detected adrenal incidentalomas were benign (61.82%), and unilateral (77.8%). The mean T/L SUVratio was significantly higher in malignant compared to benign incidentalomas (P?<?0.001). Most of benign incidentalomas had activity score 1 (60%), while, most of malignant incidentalomas had activity score 3 (62.5%). The ROC curves analyses of 18F-FDG PET/CT in the studied adrenal incidentalomas revealed that, for identification of malignant lesions, the T/L SUVratio at cut-off value >1.60 showed the highest accuracy (99.09%) sensitivity (97.1%) and specificity (100%).

Conclusion

The quantitative (T/L SUVratio at cut-off value?>?1.60 and SUVmax at cut-off value?>?2.97) and qualitative (activity score of?≥?2) analytic data obtained by 18F-FDG PET/CT can be considered as powerful parameters for identification and differentiation of adrenal incidentalomas in cancer patients.  相似文献   

11.

Objectives

Our aim in this study was to evaluate the efficiency of combined positron emission tomography and computed tomography (PET/CT), in the detection of the primary tumor origin in patients with cancer of unknown primary (CUP).

Methods

PET/CT were performed for 52 patients with CUP. These patients presented with metastatic lesions that were proven pathologically, and no primary site was detected by previous investigations.

Results

The number of patients with true positive primary tumor sites was 29 (55.8%), 4 patients with false positive results (7.7%), 9 patients with true negative results (17.3%) and 10 patients with false negative results (19.2%). The sensitivity was 74.4%, specificity was 69.2% and accuracy was 73.1%. Our positive predictive value in this study was 87.9% and our negative predictive value for this study was 47.4%.

Conclusions

This study showed an advantage of PET/CT in the detection of the site of the primary tumor in patients diagnosed with CUP.  相似文献   

12.

Aim

To clarify the role of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG) PET/CT in evaluating of bronchioalveolar carcinoma (BAC) recurrence and its ability to differentiate recurrent pure BAC type from recurrent adenocarcinoma containing BAC.

Methods

A prospective study included 24 PET/CT scans (22 patients with known BAC; 14 male; 8 female; age range 49:75 Y.). 15 PET/CT scans performed for suspicious of recurrence and 9 scans for post treatment restating.

Results

Among 15 cases with suspicious of recurrence; upstaging detected in 9 cases and downstaging in 1 case. In 9 cases underwent PET/CT scans for restaging after treatment; upstaging in one patient. Sensitivity?=?100%, Specificity?=?83.3%, PPV?=?94.1%, NPV?=?100% and accuracy?=?95.4%. Statistically significant difference was found between FDG uptake in recurrent BAC and primary BAC (P?<?0.0001) and between FDG uptake of recurrent pure BAC type and adenocarcinoma containing BAC (P?<?0.0001).

Conclusion

In patients with known BAC, PET/CT proved high accuracy in detection of recurrence lesion sites and higher staging accuracy. [18F]FDG PET/CT scan was able to differentiate between recurrent adenocarcinoma containing BAC and recurrent pure BAC type.  相似文献   

13.

Purpose

To estimate the accuracy of 18FDG PET/CT in detection of recurrent cancer ovary and to describe the localization of metastases for restaging.

Materials and methods

44 female patients with suspicion of ovarian cancer recurrence underwent a PET/CT scan from September 2013 to August 2015.

Results

CA-125 levels were elevated in 36 patients, 25 patients presented with alterations on imaging and 18 patients had clinical suspicion of recurrence. Imaging examinations were normal in 10/36 patients with elevated CA-125. 18FDG PET/CT scan was positive in 39/44 patients, and it was negative in 5/44 patients, 4/5 patients continued to be disease free all over the follow-up (true negative), while PET-CT missed recurrence in 1/5 patient (false negative). 1/39 patient was false positive. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of integrated PET/CT were calculated to be 91%, 76%, 96%, 50% and 87%.

Conclusion

18FDG PET/CT is an accurate modality for detection of recurrence of ovarian cancer. The accuracy of PET–CT in precise localization of suspicious FDG uptake can lead to proper assessment of disease recurrence, thus allow for restaging of the disease and subsequently optimizing treatment plan for these patients.  相似文献   

14.

Objective

The goal of this study was to highlight the usefulness of fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (18-F-FDG PET/CT) in soft tissue sarcoma (STS) follow-up to distinguish fibrosis from residual/recurring viable tumours and to detect distant metastases.

Methods

Twenty-three patients with confirmed STS underwent PET/CT scans. Bone and visceral sarcomas were excluded. Detailed case-based and statistical analyses were performed. Final diagnosis was confirmed by clinical or radiological examination and/or biopsy.

Results

The most common pathological diagnoses were synovial sarcomas (26.1%). PET/CT detected local disease recurrence in 8 cases. True positives for local disease were detected in 6 cases, and false negatives occurred in 2 cases (well-differentiated liposarcoma and low-grade synovial sarcoma). Distant disease was negative in 14/23 cases, and 2 cases were false negatives. Overall, PET/CT had 80% sensitivity, 87.5% specificity, 92.3% PPV, 70% NPV and 82.6% accuracy in STS treatment response follow-up.

Conclusion

18-F-FDG PET/CT is a useful imaging modality for STS follow-up and is effective in guiding biopsies. Locoregional and distant metastatic spread can be detected using PET/CT, with some limitations.  相似文献   

15.

Aim and objectives

To assess the added value of hybrid FDG PET/CT in evaluation of extranodal lymphoma.

Methodology

In this study, PET/CT was done for 50 patients with lymphoma; (36 NHL and 14 HD), to evaluate its value over CT alone in detecting extranodal extension.

Results

The commonest extranodal sites affected by lymphomatous infiltration are in the following order: lung, bone, bone marrow, spleen, liver, GIT, head and neck, pleura, cutaneous tissue, peritoneum, brain, muscle and pancreas. Regarding the final outcome of the reviewed 77 extranodal lesions: depending on the criteria accepted as standard reference including histopathological results, clinical or radiological follow up, CT defined 66 (85.7%) studies as positive and 11 (14.3%) as negative. While PET/CT defined 71 (92.2%) studies as positive and 6 (7.8%) as negative. Most of the disagreement between both modalities (PET/CT and CT) could be detected among splenic, bone and bone marrow lesions. PET/CT was more sensitive and specific than CT alone in detecting extranodal lesions with sensitivity 97.22% and specificity 80%.

Conclusion

PET/CT is superior over CT alone in detecting extranodal extension especially among splenic, bone and bone marrow lesions.  相似文献   

16.

Objective

To assess the influence of clinical features and laboratory test results on the determination of fever of unknown origin (FUO) by means of 18F-FDG PET/CT.

Methods

Retrospective and longitudinal analysis, including all the PET/CT studies requested for FUO. Reference standard was established by serology, cultures or biopsy with other laboratory tests or clinical follow-up when necessary. Clinical variables, inflammation markers, protein analysis, serology and culture results close to the PET scan were obtained. The final diagnosis was classified into three groups attending to the etiology; group 1: infection or neoplasm, group 2: vasculitis, autoimmune disease or non-infectious inflammatory disease and group 3: auto-limited fever or persistent fever without diagnosis. PET/CT scans were classified as positive or negative and helpful or not in the diagnosis of the fever origin. The effect of clinical features and laboratory variables on the PET/CT results was analyzed.

Results

Sixty-seven patients were evaluated. The final diagnosis was: Group 1 (25), Group 2 (20) and Group 3 (22). 89.6% of patients had a positive inflammation marker, 28.4% proteinogram alterations and 20.9% positive cultures. PET/CT was positive in 52/67 patients. PET/CT helped in the establishment of the fever origin in 35 cases and was especially helpful in groups 1 and 2. Sensitivity, specificity and accuracy of PET/CT were: 84, 31 and 61%. PET results shown significant relations with the final diagnosis (p?=?0.035) and culture results (p?=?0.037). No significant relations were observed with the rest of clinical or laboratory variables.

Conclusions

18F-FDG PET/CT had a high sensitivity but a low specificity in the diagnosis of the fever origin, probably due to the high rate of diffuse and auto-limited aetiologies. Patients who are most likely to benefit from the PET/CT study would be those with several positive inflammation markers, reflecting a higher pre-test probability of active disease.
  相似文献   

17.

Objective

Our aim was evaluate the role the PET/CT in the assessment of response to therapy in patients with Non-Hodgkin extra-nodal lymphoma: in particular, a five-point scale (Deauville criteria), which can be employed for early- and late-therapeutic response assessment.

Methods

Sixty patients with pathologically confirmed Non-Hodgkin lymphoma (NHL) were enrolled in this prospective study. All patients underwent the following PET/CT examinations: initial PET/CT for staging, interim PET/CT and end of treatment PET/CT. Response assessment was done using new Cheson’s guidelines and five-point scale (Deauville criteria).

Results

All patients were evaluated for response to therapy in the early interim, followed by late interim, as well as end treatment assessment for the overall response. We found good concordance of response assessment according to the Deauville criteria classification with International Harmonization Project (IHP) classification. After early interim 48/60 patients had concordant designations (91.7%, 83.3%, 70%, and 33.3%) and 12 patients had discordant designations. After late interim, 56/60 patients had concordant designations (100%, 100%, 80%, and 50%) and four patients had discordant designations. After end of treatment, 54/60 patients had concordant designations (100%, 100% and 71.4%) and six patients has discordant designations.

Conclusion

Response assessment according to the Deauville criteria classification showed good concordance with IHP classification. According to our findings, we recommend the use of Deauville criteria in reporting of PET/CT for staging and assessment of response to treatment.  相似文献   

18.

Purpose

The aim of this study is to clarify the role of 18-F-FDG PET/CT over CT alone in the detection of primary, recurrent and metastatic disease in renal cancers patients.

Patients and methods

In this study; 18-F-PET/CT scans were performed for 25 patients (19 males and 6 females) with renal cancer. A patient-based analysis was performed in a dedicated manner to pick up lesions on CT, PET and PET/CT fused images. Statistical analysis was calculated. A final diagnosis of disease extent was affirmed by clinical, radiologic workup and histopathological correlation.

Results

PET/CT has 100% sensitivity, 93% specificity, 100% PPV, 91% NPV and 96% accuracy; compared to 100% sensitivity and 70% specificity, 83% PPV, 100% NPV and 88% accuracy for CT in diagnosis of primary, recurrent and metastatic disease in renal cancer.

Conclusion

Incorporated 18-F FDG PET/CT is a very versatile and accurate imaging technique for renal cancers. It significantly improves the accuracy and predictive values over CT alone for detection of primary, recurrent and metastatic disease in renal cancer thus change the treatment decision.  相似文献   

19.

Objective

We investigated the prevalence and clinical significance of incidental focal 18F-FDG uptake in the frontal process of the maxilla, mimicking malignancy on PET/CT.

Methods

From a total of 32,834 patients who underwent 18F-FDG PET/CT, patients with focal uptake in the frontal process of the maxilla were selected by a database search. For those patients, medical records including relevant imaging studies were reviewed.

Results

Thirty-nine patients (0.12 %) demonstrated focal uptake on PET/CT. On CT of PET/CT, all lesions showed ground-glass attenuation with or without bony expansion, consistent with fibrous dysplasia. When comparing previous PET/CT, follow-up PET/CT, and CT, a significant difference in degree of 18F-FDG uptake was noted, with no associated change in the size of maxillary lesions. There were no patients who had symptoms or signs related to maxillary lesions during follow-up.

Conclusion

Focal 18F-FDG uptake in the frontal process of the maxilla is a rare, incidental, and persistent finding with variable uptake and can represent a benign condition.
  相似文献   

20.

Purpose

to assess the efficacy of FDG PET/CT in detecting unexpected additional primary malignant neoplasms in patients being evaluated by PET/CT for known malignancies compared to conventional staging work-up (CSW).

Patients and methods

Of 1889 patients referred for whole-body FDG PET/CT in the period from February 2015 to May 2016, only 273 were included in this prospective study. Patients included are those with histopathologicaly proven primary malignancy and sent for initial tumor staging before treatment within 1 month of CSW that was performed for the patients according to the site and cell type of the primary tumor. Histopathologic examination was performed for lesions indicating additional primary cancer detected by either PET/CT or CSW.

Results

In 13 out of 273 patients included in the study (4.76%) only were proved to have additional primary cancer, the PPV of PET/CT for detecting an additional primary cancer was 56.5%. Also, it showed high sensitivity of 89.2%, which was significantly higher than 23% from the CSW (P < 0.005).

Conclusion

PET/CT is more accurate than CSW for detecting additional primary cancer with a higher sensitivity and positive predictive value, which consequently affect further management.  相似文献   

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