PET-CT诊断ⅠA2~ⅡA期宫颈癌原发灶和盆腔淋巴结转移的价值

目的：探讨18F-氟脱氧葡萄糖PET-CT （18F-FDG PET-CT）在诊断国际妇产科联盟（FIGO）ⅠA2~ⅡA期宫颈癌原发灶和盆腔淋巴结转移中的临床价值。方法：回顾性分析91例FIGOⅠA2~ⅡA期宫颈癌患者的临床资料。计算PET-CT诊断宫颈癌原发灶的敏感度，并比较转移性淋巴结与非转移性淋巴结的长径、短径和最大标准摄取值（SUVmax）。通过受试者工作特征（ROC）曲线和曲线下面积（AUC）确定短径和SUVmax诊断淋巴结转移的最佳分界值，并计算其诊断盆腔淋巴结转移的敏感度、特异度和准确度。结果：91例宫颈癌患者中，PET-CT检查阳性89例，PET-CT诊断宫颈癌原发灶的敏感度为96.7%。转移性淋巴结和非转移性淋巴结的短径分别为（6.50±2.31） mm和（4.21±1.49） mm，SUVmax分别为4.56±3.34和1.92±1.41，组间比较差异有统计学意义（t=4.855和31.685，均P<0.05）。淋巴结短径和SUVmax诊断淋巴结转移的AUC分别为0.802和0.861，最佳分界值分别为5.5 mm和2.05。以短径≥ 5.5 mm且SUVmax ≥ 2.05为诊断标准，诊断单个淋巴结转移的敏感度为85.0%，特异度为93.0%，准确度为86.8%。结论：PET-CT诊断ⅠA2~ⅡA宫颈癌原发病灶的敏感度高，对盆腔淋巴结转移也具有较高的诊断价值，以短径≥ 5.5 mm且SUVmax ≥ 2.05作为转移性淋巴结诊断标准时准确性最高。
Abstract: Objective: To assess the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-CT (PET-CT) in detection of primary tumor and pelvic lymph node metastasis in International Federation of Gynecology and Obstetrics (FIGO) stages ⅠA2-ⅡA cervical cancer.Methods: The clinical data of 91 patients with FIGO stagesⅠA2-ⅡA cervical cancer were retrospectively analyzed. The sensitivity of 18F-FDG PET-CT in detection of cervical cancer was calculated. The long diameter, short diameter and SUVmax were compared between metastatic lymph nodes (MLN) and non-metastatic lymph nodes (NMLN). The optimal cut-off values of different indexes were determined by receiver operating characteristic (ROC) curve and area under curve (AUC), and the sensitivity, specificity and accuracy were calculated.Results: 18F-FDG PET-CT examinations were positive in 89 patients (89/91, 96.7%). The short diameters of NMLN and MLN were (6.50±2.31)mm and (4.21±1.49)mm(t=4.855, P<0.05); the SUVmax of NMLN and MLN were 4.56±3.34 and 1.92±1.41(t=31.685, P<0.05). ROC AUCs of the short diameter and SUVmax in diagnosis of metastatic lymph nodes were 0.802 and 0.861. Taken short diameter ≥ 5.05 mm and SUVmax ≥ 2.05 as cut-off values, the corresponding sensitivity, specificity and accuracy in diagnosis of metastatic lymph nodes were 85.0%, 93.0% and 86.8%, respectively.Conclusion: 18F-FDG PET-CT is sensitive to detect primary lesion and pelvic lymph node metastases in FIGO stages ⅠA2-Ⅱ A cervical cancer, and the highest diagnostic accuracy may be obtained by taking short diameter ≥ 5.05 mm and SUVmax ≥ 2.05 as the standard. Key words: Fluorodeoxyglucose F18/diagnostic use Lymphatic metastasis Tomography,emission-computed/methods Neoplasm recurrence,local Pelvic neoplasms/radionuclide imaging Tomography,X-ray computed/methods Uterine cervical neoplasms/radionuclide imaging