18F-FDG PET/CT显像联合CA125及HE4在上皮性卵巢癌患者术后复发/转移诊断中的价值

目的探讨18F-脱氧葡萄糖PET/CT显像联合血清糖类抗原125及人附睾蛋白4检测在上皮性卵巢癌患者术后复发/转移中的诊断价值。方法回顾性分析2018年7月~2019年9月在我院核医学科行18F-FDG PET/CT显像并显像前已行血清CA125及HE4值检测的65例上皮性卵巢癌患者作为研究对象。分18F-FDG PET/CT显像诊断组和18F-FDG PET/CT+CA125+HE4诊断组进行诊断并依据随访标准进行随访，各组诊断结果与随访结果进行比较。结果18F-FDG PET/CT显像在评估上皮性卵巢癌患者术后复发/转移的灵敏度、特异度、阳性预测值、阴性预测值、一致率分别为96.22%、66.7%、92.73%、80.0%、90.77%。18F-FDG PET/CT+CA125+HE4评估上皮性卵巢癌患者术后复发/转移的灵敏度、特异度、阳性预测值、阴性预测值、一致率分别为98.1%、66.7%、92.9%、88.9%、92.3%。复发/转移组CA125及HE4受试者工作特征曲线得知临界值分别为20.65 U/mL、45.5 pmol/L。18F-FDG PET/CT+CA125_临界值+HE4_临界值评估上皮性卵巢癌患者术后复发/转移的灵敏度、特异度、阳性预测值、阴性预测值、一致率分别为98.1%、75.0%、94.6%、90.0%、93.9%。结论18F-FDG PET/CT显像在评估上皮性卵巢癌患者术后复发/转移上有优势。18F-FDG PET/CT+CA125+HE4检测在评估上皮性卵巢癌患者术后复发/转移上有较高的诊断价值，三者联合检测优于单独检测及两者联合检测。18F-FDG PET/CT+CA125_临界值+HE4_临界值检测在评估上皮性卵巢癌患者术后复发/转移上有更高的诊断价值。在临床随访过程中发现血清CA125≥20.65 U/mL，血清HE4≥45.5 pmol/L，并持续增加时应保持警惕，并选择18F-FDG PET/CT显像来提高上皮性卵巢癌复发/转移检出率，早期发现复发/转移病灶。。 

Value of 18F-FDG PET/CT imaging combined with CA125 and HE4 in postoperative recurrence/metastasis of epithelial ovarian cancer

Objective To investigate the diagnostic value of 18F-fluorodeoxyglucose PET/CT imaging combined with serum carbohydrate antigen 125(CA125) and human epididymal protein 4(HE4) in the diagnosis of postoperative recurrence/metastasis in patients with epithelial ovarian cancer. Methods From July 2018 to September 2019, 65 patients with epithelial ovarian cancer who had detected serum CA125 and HE4 before 18F-FDG PET/CT imaging were retrospectively analyzed. The patients were divided into 18F-FDG PET/CT imaging diagnosis group and 18F-FDG PET/CT+CA125+HE4 diagnosis group and followed up according to the follow-up criteria. The diagnostic results of each group were compared with the follow-up results. Results The sensitivity, specificity, positive predictive value, negative predictive value and consistent rate of 18F-FDG PET/CT imaging in evaluating postoperative recurrence/metastasis of patients with epithelial ovarian cancer were 96.22%,66.7%, 92.73%, 80.0%, 90.77%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and consistent rate of 18F-FDG PET/CT+CA125+HE4 in evaluating postoperative recurrence/metastasis of patients with epithelial ovarian cancer were 98.1%, 66.7%, 92.9%, 88.9% and 92.3%, respectively. Receiver operating characteristic of CA125 and HE4 subjects in recurrence/metastasis group showed that the critical value were 20.65 U/m L and 45.5 pmol/L respectively. The sensitivity, specificity, positive predictive value, negative predictive value and consistent rate of 18F-FDG PET/CT+CA125 critical value +HE4 critical value for evaluating postoperative recurrence/metastasis of epithelial ovarian cancer patients were 98.1%, 75.0%, 94.6%,90.0%, 93.9%, respectively. Conclusion 18F-FDG PET/CT imaging has an advantage in evaluating postoperative recurrence/metastasis in patients with epithelial ovarian cancer. 18F-FDG PET/CT+CA125+HE4 detection has a high diagnostic value in evaluating postoperative recurrence/metastasis in patients with epithelial ovarian cancer. The combined detection of the three is better than that of single detection and combined detection of both. The detection of 18F-FDG PET/CT+CA125 critical value +HE4 critical value has a higher diagnostic value in evaluating postoperative recurrence/metastasis of patients with epithelial ovarian cancer. During the clinical follow-up, it was found that serum CA125≥20.65 U/m L and serum HE4≥45.5 pmol/L. We should be vigilant when it continues to increase, and 18F-FDG PET/CT imaging should be selected to improve the detection rate of recurrence/metastasis of epithelial ovarian cancer and to detect recurrence/metastasis lesions in the early stage.