2017-01目录

目的 研究99Tcm-联肼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸环肽二聚体（99Tcm-3PRGD2）整合素受体显像在乳腺癌定性诊断中的价值及与钼靶检查的对比。方法 选取初诊乳腺占位患者84例，均为女性。所有患者行2 h、4 h 99Tcm-3PRGD2 整合素受体显像及钼靶检查，以术后病理结果作为“金标准”，比较不同显像方法（全身显像及胸部SPECT/CT显像）对乳腺癌定性诊断的价值，并与钼靶结果进行对比分析。采用SPSS22.0软件，对数据进行t检验和χ2检验。结果 SPECT/CT显像的诊断效能高于全身显像；乳腺癌99Tcm-3PRGD2摄取率[病灶容积最大计数（T_max）、病灶容积平均计数（T_mean）、T_max/本底平均计数（B）值及T_mean/B值]均明显高于良性占位（t=2.09~3.19，均P＜0.05），且T_max/B值差异更为明显（t=3.19，P＜0.01）；2 h、4 h显像对乳腺癌诊断效能差异无统计学意义（t=0.63~1.25，均P>0.05）。SPECT/CT显像诊断乳腺癌的灵敏度大于95.0%，联用钼靶后灵敏度可以提高到98.4%；对致密型乳腺患者，SPECT/CT显像与钼靶诊断乳腺癌的灵敏度、特异度、准确率分别为95.2%、83.3%、91.7%和78.6%、76.2%、77.8%，前者的准确率高于后者，且差异有统计学意义（χ2=4.341，P＜0.05）。结论 99Tcm-3PRGD2 SPECT/CT显像定性诊断乳腺癌具有高灵敏度，是对钼靶的有益补充，尤其对致密型乳腺占位患者具有独特优势。

Evaluation of 99Tcm-3PRGD2 integrin receptor imaging in qualitative diagnosis of breast cancer and its comparison with mammography

Objective To evaluate the value of 99Tcm-3PRGD2 integrin receptor imaging in qualitative diagnosis of breast cancer and then compare this technique with mammography. Methods A total of 84 female patients with established breast lesions were recruited. All patients were examined using 99Tcm-3PRGD2 integrin receptor imaging and mammography. Diagnosis of breast (especially dense breast) lesion by using these two techniques was analyzed and compared with postoperative pathology as the gold standard. T test and χ2 test were used for data statistical analysis by using SPSS22.0 software. Results The diagnostic efficiency of SPECT/CT imaging was higher than that of whole-body imaging. The intake rates of Tmax, Tmean, Tmean/B, and Tmax/B were significantly higher in breast cancer than in benign nodules(t=2.09~3.19, all P<0.05), and their difference in intake of Tmax/B was obvious(t=3.19, P<0 . 01). The difference between 2 and 4 h imaging was not significant(t=0.63~1.25, all P>0.05). The sensitivity of SPECT/CT in diagnosis of breast cancer was more than 95.0%, which could be increased to 98.4%when this technique was combined with mammography. For dense mammary gland, the sensitivity, specificity, and accuracy of 99Tcm-3PRGD2 SPECT/CT and mammography were 95.2%, 83.3%, and 91.7% and 78.6%, 76.2%, and 77.8%, respectively, 99Tcm-3PRGD2 SPECT/CT had a higher accuracy(X2=4.341, P<0.05). Conclusions 99Tcm-3PRGD2 SPECT/CT had high sensitivity and was a useful complement to mammography. This technique demonstrated a higher diagnostic value than mammography for qualitative diagnosis of dense mammary gland.