朱湘　宋秀宇　王健　徐文贵

18F-FDG PET/CT在行结肠癌检查时发现同时性重复癌的价值

朱湘宋秀宇王健徐文贵

目的探讨18氟-氟脱氧葡萄糖（18F-FDG）PET/CT用于检查结肠癌时发现同时性重复癌的价值。方法回顾性分析232例经病理证实结肠癌病人的18F-FDG PET/CT影像资料和临床病理结果，采用卡方检验比较18F-FDG PET/CT结果与病理结果并行kappa系数一致性检验，分析PET/CT显像的诊断效能。结果232例病理证实的结肠癌病人中，56例病理证实为重复癌。18F-FDG PET/CT诊断真阳性53例，假阳性4例，其中2例经肠镜病理证实分别为息肉和管状腺瘤（癌前病变），1例病理证实为甲状腺腺瘤，1例为肺炎性假瘤。假阴性3例，其中1例为胃窦部印戒细胞癌，1例为肾透明细胞癌，另1例18F-FDG PET/CT显像为高代谢，诊断为结肠癌肝转移，结果病理证实为结肠癌+原发性肝癌。18F-FDG PET/CT诊断重复癌的敏感度为94.64%，特异度为97.58%，准确度为96.83%，阳性预测值92.98%，阴性预测值98.17%。与病理诊断结果比较，两者间差异无统计学意义（P≈1.000），而且两者间一致性良好（κ=0.917，P=0.000）。结论应用18F-FDG PET/CT进行结肠癌检查时可以有效发现同时性重复癌。

结肠癌；重复癌；正电子发射体层成像；体层摄影术，X线计算机

DOI：10.19300/j.2016.L3674

【Abstract】ObjectiveTo investigate the value of18F-FDG PET/CT in detecting synchronous primary malignant neoplasms in patients with colon cancer.Methods232 cases with pathology-proven colon cancer who underwent18F-FDG PET/CT imaging were retrospectively evaluated in the study.By comparing with the pathological diagnosis with chi square test and the kappa coefficient test，the diagnostic efficacy of PET/CT imaging for synchronous primary malignant neoplasms was analyzed.ResultsAmong 232 cases with histologically confirmed colon cancer，there were 56 cases were pathologically diagnosed as synchronous primary malignant neoplasms.Fifty-three cases were true positive cases diagnosed by18F-FDG PET/CT.There was 4 false positive cases，of which 1 case was polyps，1 case was adenoma（precancerous lesions），1 case was thyroid adenoma，and one was pulmonary inflammatory pseudotumor.There were 3 false negative cases，including 1 case of gastric antrum ring cell carcinoma，1 case of renal clear cell carcinoma，and 1 case of primary hepatocellular carcinoma which was diagnosed as colon cancer liver metastasis by18F-FDG PET/CT imaging.The sensitivity，specificity，and accuracy of18F-FDG PET/CT imaging were 94.64%，97.58%，and 96.83%respectively.There was no statistically significant difference between pathological and PET/CT diagnosis（P≈1.000），and showed high consistency between the two diagnostic methods （kappa value 0.917，P=0.000）.Conclusion18F-FDG PET/CT can effectively detect unexpected synchronous primary malignant neoplasms in patients with colon cancer.

【Key words】Colon carcinoma；Synchronous malignant neoplasms；PET；Tomography，X-ray computed

Int J Med Radiol，2016，39（2）：116-119

作者单位：天津医科大学肿瘤医院分子影像及核医学诊疗科，天津300060

通讯作者：徐文贵，E-mail：wenguixu@163.com

基金项目：国家科技重大项目（2013ZX09303001）

结肠肿瘤是最常见的胃肠道肿瘤，随着经济水平的提高及国人生活方式的改变，结肠癌的发病率日渐增多，且呈逐年上升趋势。结肠癌的临床分期直接影响预后，分期越早的病人，其5年生存率越高。同时，随着诊疗技术的提高，重复癌（multiple primary carcinoma，MPC）的报道越来越多。……