正电子发射体层显像-CT检查联合CA125连续检测诊断早期无症状的复发性卵巢上皮性癌的价值

目的评估正电子发射体层显像（PET）-CT检查联合CA125连续检测在早期无症状的复发性卵巢上皮性癌（卵巢癌）诊断中的价值。方法对26例在山东省肿瘤医院初治、手术病理分期为Ⅱ-Ⅵ期的卵巢癌患者,在接受肿瘤细胞减灭术并经多疗程化疗达到完全缓解后又出现可疑复发者进行PET-CT检查。此类患者CA125水平已降至正常值（即35kU／L）以下并稳定一段时间后,连续3次测定均呈持续升高趋势,但CT检查未能发现可疑病灶,或虽发现可疑病灶但病变范围不能确定。其中,16例给予再次化疗和（或）放疗,10例接受再次肿瘤细胞减灭术。结果（1）26例患者中,17例CA125水平≥35kU／L,其中14例CT检查显示盆腹腔存在复发灶的患者中,PET-CT检查发现10例病变范围与CT检查一致,4例除盆腹腔病灶外尚伴有远处转移;3例CT检查未发现明确病灶者中,PET-CT检查均提示存在盆腹腔复发,1例发现骨转移。另9例CA125水平〈35kU／L,其中3例CT检查和PET-CT检查均发现盆腹腔复发灶,6例CT检查未发现明确病变者中PET-CT检查均发现1处以上可疑复发或转移灶。（2）10例再次手术者中,CA125水平≥35kU／L者6例,〈35kU／L者4例;4例CT检查发现可疑病灶及6例CT检查阴性者中,PET-CT检查均提示存在至少1处代谢异常部位（病灶数为1～5个）。（3）10例再次手术者中,CT检查发现的可疑病灶,术后病理检查均证实为转移灶;PET-CT检查提示的异常代谢部位手术后病理检查也证实均为转移灶。（4）再次手术后1个月,4例术前CA125水平〈35kU／L者,术后CA125水平均明显下降,其中位数水平降低了3．2倍;6例术前CA125水平≥35kU／L者,4例术后CA125水平〈35kU／L,1例化疗2个疗程后降至〈35kU／L,1例持续升高。结论PET-CT检查能发现临床前期的复发灶或常规辅助检查未能发现或明确的复发灶,PET-CT检查联合CA125连续检测诊断复发性卵巢癌的准确性高,是诊断卵巢癌早期复发的可靠手段。PET-CT检查引导下可以提高再次肿瘤细胞减灭术的准确性和彻底性。

Value of positron emission tomography-CT imaging combined with continual detection of CA125 in serum for diagnosis of early asymptomatic recurrence of epithelial ovarian carcinoma

OBJECTIVE: To evaluate the value of positron emission tomography (PET)-CT imaging combined with continual detection of CA125 in serum for diagnosis of early recurrent ovarian epithelial carcinoma. METHODS: Twenty six patients received PET-CT imaging, who were all diagnosed as primary epithelial ovarian cancer of stage II - IV and had complete remission after cytoreductive surgery and multiple courses of chemotherapy in Shandong Provincial Cancer Hospital. After a steady period, all patients experienced progressive rising of CA125 values 3 times in 2 months. But no positive lesion was found by CT, or although suspicious positive focus was found, the recurrent and (or) metastatic extent was not definite. Out of 26 patients, 16 were delivered rechemotherapy and (or) radiotherapy, and 10 received re-cytoreductive surgery. RESULTS: (1) Of 26 patients, the value of CA125 was more than 35 kU/L in 17, and in 14 of 17, pelvic or abdominal cavity recurrence was diagnosed by CT and PET-CT, and 4 showed simultaneously distant metastasis on PET-CT. In the remaining 3 patients of which CT findings were negative, 2 had pelvic and abdominal cavity recurrence, and one had bone metastasis on PET-CT. Of 9 patients with progressive rising CA125 levels but the value was less than cut-off (< 35 kU/L), only 3 were found recurrence in pelvic and abdominal cavity by CT; however, all showed at least one suspicious recurrent or metastasis lesion on PET-CT. (2) Of 10 patients who received re-cytoreductive surgery, the value of CA125 was higher than cut-off in 6, and less in 4. Four were diagnosed as recurrence by CT and PET-CT, and 6 were only confirmed by PET-CT with 1 - 5 abnormal metabolic lesions found. (3) In 10 patients who received re-cytoreductive surgery, all suspicious positive lesions identified by CT were proved recurrence or metastasis by pathology, and abnormal metabolic lesions showed by PET-CT were all confirmed to be metastasis by postoperative pathology. (4) After 1 month of re-cytoreductive surgery, the value declined by 3.2 fold in 4 whose CA125 value was less than cut-off; in another 6, the value declined to less than cut-off in 4, and in one after 2 cycles of re-chemotherapy, but the remaining one patient had persistent CA125 values more than cut-off. CONCLUSIONS: PET-CT could reveal recurrence and (or) metastasis which may be missed or could not be confirmed by routine diagnostic methods before clinical presentations. Combined with the continual detection of CA125, a high accuracy of diagnosis can be achieved. So it is an effective means for diagnosis of early recurrent ovarian cancer. The re-cytoreductive surgery can be more accurate and radical with the help of PET-CT.