国产乳腺专用PET（PEM）对乳腺癌诊断价值的临床研究

发布时间：2018-03-31 09:05

  本文选题：PEM　切入点：PET　出处：《天津医科大学》2016年博士论文

【摘要】：目的比较具有我国自主知识产权的乳腺专用PET(PEM)与具有相同显像原理的主流显像技术PET在诊断乳腺癌中的价值,并与超声、X线钼靶成像等传统用于乳腺癌诊断的影像技术进行比较,同时分析乳腺癌组织类型、免疫组化、肿瘤标志物等指标,探讨PEM在乳腺癌诊断中的价值及其与乳腺癌临床、病理之间的相关性。方法对临床初诊乳腺肿块患者随机先后行FDG PEM、PET检查,比较PEM、PET及X线、超声诊断乳腺癌的效能,并按照肿瘤大小分组进一步比较。比较乳腺良、恶性病变之间大小及SUVmax的差异。将乳腺癌分为≤1cm和1cm两组,比较两组乳腺癌之间SUVmax的差异。免疫组化分析乳腺癌Ki67、p53、ER及PR表达水平,测定乳腺癌患者血浆CEA及CA153水平,将乳腺癌SUVmax与上述指标进行相关性分析。结果共244例资料完整的患者纳入本研究,共278个病灶。PET、PEM、超声及X线诊断乳腺癌的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为95.5%、58.1%、91.4%、73.5%和88.9%;96.5%、53.5%、90.7%、76.7%和88.9%;85.6%、79.5%、95.2%、53.4%和84.5%;91.8%、85.7%、96.8%、69.2%和90.8%,PEM的诊断效能稍高于其它常规影像学检查,之间差异不具有统计学意义。PEM与PET具有很好诊断乳腺癌一致率,为96.7%。对于1cm的乳腺癌,PET|、PEM、超声及X线检查诊断乳腺癌的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为91.8%、53.3%、92.8%、50.0%和86.7%;93.4%、50%、93.4%、53.6%和87.6%;85%、71.4%、95.0%、42.6%和83.2%;88.2%、82.8%、97.1%、52.2%和87.5%,PEM的诊断效能稍高于其他影像学检查,之间差异不具有统计学意义。对≤1cm的乳腺癌,PET|、PEM、超声及X线诊断乳腺癌的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为60.0%、72.2%、75%、56.5%和65.1%;72.0%、66.7%、75%、65.3%和69.8%;62.5%、78.6%、88.3%、52.4%和68.4%;70.8%、88.9%、90%、69.6%和78.6%,PEM的诊断效能稍高于其他影像学检查,之间差异不具有统计学意义。对≤5mm的乳腺癌,PET|、PEM、超声及X线诊断乳腺癌的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为33.3%、85.7%、66.7%、60%和61.5%;50%、71.4%、60%、62.5%和61.5%;16.7%、85.7%、50%、54.5%和53.8%;33.3%、71.4%、50%、5.6%和53.8%,PEM的诊断效能稍高于其他影像学检查,之间差异不具有统计学意义。在超声诊断错误的患者中,PET诊断准确率为83.3%,PEM诊断准确率为80.6%。钼靶诊断错误的患者中,PET诊断准确率为77.3%,PEM诊断准确率为72.7%。在多灶性乳腺癌的检出中,PEM略高于PET,但不具有统计学差异。乳腺恶性病变的PEM/PET SUVmax要高于乳腺良性病变。乳腺恶性病变的直径要大于乳腺良性病变。1cm的乳腺癌PEM/PET SUVmax要高于≤1cm的乳腺癌。乳腺病灶的PEM SUVmax要高于PET SUVmax,二者之间存在显著正相关性。ER阴性组乳腺癌的PEM/PET SUVmax要高于ER阳性组,乳腺癌FDG PEM/PET SUVmax与ER水平呈负相关。PR阴性组乳腺癌的PEM/PET SUVmax要高于PR阳性组,乳腺癌FDG PEM/PET SUVmax与PR水平呈负相关。P53阴性组乳腺癌的PEM/PET SUVmax要低于P53阳性组,乳腺癌FDG PEM/PET SUVmax与P53水平呈正相关。Ki67增殖指数低表达组乳腺癌的PEM/PET SUVmax要低于Ki67增殖指数高表达组,乳腺癌FDG PEM/PET SUVmax与Ki67水平呈正相关。CEA高组乳腺癌的PEM/PET SUVmax与CEA低组之间差异不具有统计学意义,乳腺癌FDG PEM/PET SUVmax与CEA水平无显著相关性。CA153高组乳腺癌的PEM/PET SUVmax与CA153低组之间差异不具有统计学意义,乳腺癌FDG PEM/PET SUVmax与CA153水平无显著相关性。乳腺癌FDG PEM/PET SUVmax与乳腺癌病灶大小无显著相关性。乳腺癌FDG PEM/PET SUVmax与乳腺癌病理分级无显著相关性。病理高分级乳腺癌的PEM/PET SUVmax要高于低分级。浸润性导管癌的PET/PEM SUVmax要高于非浸润性导管癌。FDG PEM/PET对浸润性乳腺癌的诊断效能要稍高于其他类型乳腺癌,之间差异不具有统计学意义。结论FDG PEM与PET诊断乳腺癌的敏感度均较高,二者诊断一致率好;部分病灶位于PEM扫描野外可导致假阴性诊断,这与PEM本身的设计有关,有待于进一步改善;PEM对于小病灶和多病灶乳腺癌的检出较PET略优势,有待于进一步增加该组病例数证实;FDG PEM/PET SUVmax与乳腺癌预后因素相关;PEM及PET诊断乳腺癌的效能较常规影像学无明显差异,但在常规影像学检查诊断错误的病例中具有较好的诊断准确性,二者结合可明显提高乳腺癌的诊断水平,是常规影像学的有益补充。
[Abstract]:Objective to compare with our own intellectual property rights of special breast PET (PEM) value and mainstream technology of PET imaging with the same imaging principle in the diagnosis of breast cancer, and ultrasound, mammography imaging is used to compare the traditional imaging techniques in the diagnosis of breast cancer, and analysis of breast cancer tissue types, immunohistochemistry tumor markers, and other indicators, to evaluate the value of PEM in diagnosis of breast cancer and its clinical pathological correlation between breast cancer. Methods the clinical diagnosis of breast masses were underwent FDG PEM PET examination, compared with PEM, PET and X, the efficiency of ultrasound in the diagnosis of breast cancer, and further grouped according to tumor size compare breast size differences, and SUVmax between malignant lesions. Breast cancer is divided into 1cm and 1cm two groups, the difference of SUVmax between the two groups were compared breast cancer. Immunohistochemical analysis of breast cancer Ki67, p53, ER and PR The level of breast cancer patients, determination of plasma CEA and CA153 levels, breast cancer SUVmax and these indicators were analyzed. Results a total of 244 patients with complete data were included in this study, a total of 278 lesions were.PET, PEM, ultrasound and X-ray diagnosis of breast cancer, the sensitivity, specificity, positive predictive value, negative predictive the value and accuracy rate were 95.5%, 58.1%, 91.4%, 73.5% and 88.9%; 96.5%, 53.5%, 90.7%, 76.7% and 88.9%; 85.6%, 79.5%, 95.2%, 53.4% and 84.5%; 91.8%, 85.7%, 96.8%, 69.2% and 90.8%, the diagnostic value of PEM is slightly higher than the other conventional imaging examination, the difference was not statistically between the significance of.PEM and PET have good consistency for the diagnosis of breast cancer, 96.7%. 1cm for breast cancer, PET|, PEM, ultrasound and X-ray examination in the diagnosis of breast cancer sensitivity, specificity, positive predictive value, negative predictive value and accuracy are 91.8%, 53.3%, 92.8%, 93.4%, 50% and 86.7%; 50%, 93. 4%,53.6%鍜，

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