PET/CT在卵巢癌术后监测复发/转移上的优势:与血清CA125及增强CT比较

目的:探讨18F-脱氧葡萄糖(18F-FDG)PET/CT在早期发现卵巢癌术后复发/转移方面的价值，并与血清CA125检测及增强CT进行比较。方法:回顾性分析过去5年内在我院行卵巢癌二次手术，并在术前均行血清CA125、增强CT、PET/CT检查的患者36例（99个病灶）。分别计算出以患者个体为研究单位时血清CA125及PET/CT检查的阳性预测值、阴性预测值、灵敏度、特异度、准确度等参数，并比较二者在监测卵巢癌术后个体复发/转移方面的效能。采用卡方检验或Fisher确切概率法来比较增强CT、PET/CT两种方法诊断卵巢癌术后转移/复发病灶的差异性，并分别计算出以病灶为研究单位时的阳性预测值、阴性预测值、灵敏度、特异度、准确度等参数，比较二者在诊断卵巢癌术后复发/转移病灶方面的效能。结果:PET/CT诊断出34/36例复发/转移的患者，而血清CA125以0~35 U/ml为基准时仅诊断出11/36例复发/转移的患者。前者诊断卵巢癌术后复发/转移患者的阳性预测值、灵敏度、准确度明显高于后者（97%、100%、97% vs 91%、32%、33%）。PET/CT与增强CT在诊断卵巢癌术后复发/转移病灶效能方面差异具有统计学意义（P=0.037）。PET/CT能够诊断出78/99个卵巢癌术后复发/转移的真阳性病灶，而增强CT仅能够诊断出70/99个。PET/CT以病灶为研究单位的阳性预测值、阴性预测值、灵敏度、特异度、准确度均比增强CT高（94% vs 89%、62.5% vs 30%、93% vs 83%、67% vs 40%、89% vs 77%）。结论:对于符合二次手术条件的患者，PET/CT诊断卵巢癌术后复发/转移方面的价值要优于血清CA125及增强CT。

The capabilities of PET/CT in monitoring recurrence/metastasis in postoperative ovarian cancer:Comparison with serum CA125 and enhanced CT

Objective:To study the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography （PET/CT） in early detection of postoperative recurrence/metastasis of ovarian cancer in comparison with serum CA125 and contrast-enhanced computed tomography (CECT).Methods: We retrospectively analyzed thirty-six patients (99 lesions) who had undergone secondary cytoreductive surgery for ovarian cancer in our hospital in the past five years and who had performed serum CA125，CECT and PET/CT before secondary cytoreductive surgery.Serum CA125 and PET/CT were used to calculate based on the risk individual research unit of recurrence/metastasis，positive predictive value (PPV)，negative predictive value (NPV)，sensitivity，specificity，the accuracy of diagnosis.And then we compared these parameters with each other.Chi-square test or Fisher's exact test was used to compare the differences between CECT and PET/CT methods in the detection of metastasis/recurrence lesions of ovarian cancer after surgery.The PPV，NPV，sensitivity，specificity and accuracy of diagnosis were calculated and then we compared these parameters of CECT and PET/CT.Results:PET/CT could find out 34/36 patients with recurrence/metastasis of ovarian cancer after surgery，while serum CA125 only found out 11/36 patients.The PPV，sensitivity and the accuracy of PET/CT in diagnosis of ovarian cancer recurrence/metastasis were significantly higher than those with serum CA125 (97%，100%，97% vs 91%，32%，33%).The efficacy of PET/CT and CECT in diagnosing postoperative recurrence/metastasis of ovarian cancer lesions was statistically significant (P=0.037).PET/CT could find out 78/99 true positive lesions with recurrence/metastasis of ovarian cancer after surgery，while CECT just found out 70/99 ones.The PPV，NPV sensitivity，specificity，and the accuracy of PET/CT with lesions as the research unit were all higher than that of CECT (94% vs 89%，62.5% vs 30%，93% vs 83%，67% vs 40%，89% vs 77%).Conclusion:For patients who meet secondary cytoreductive surgery criteria，PET/CT diagnosis of ovarian cancer recurrence/metastasis is superior than serum CA125 and CECT.