Value of 18F-FDG PET/CT imaging combined with CA125 and HE4 in postoperative recurrence / metastasis of epithelial ovarian cancer
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摘要:
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。。 Abstract:ObjectiveTo 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. MethodsFrom 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. ResultsThe 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/mL and 45.5 pmol/L respectively. The sensitivity, specificity, positive predictive value, negative predictive value and consistent rate of 18F-FDG PET/CT+CA125critical value + HE4critical value for evaluating postoperative recurrence / metastasis of epithelial ovarian cancer patients were 98.1%, 75.0%, 94.6%, 90.0%, 93.9%, respectively. Conclusion18F-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+CA125critical value + HE4critical 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/mL 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. -
Key words:
- ovarian cancer /
- PET / CT imaging /
- CA125 /
- HE4 /
- recurrence /
- metastasis
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图 1 复发，转移组SUVmax，CA125及HE4诊断效能ROC曲线
Figure 1. ROC curves of SUVmax, CA125 and HE4 diagnostic efficacy of recurrence and metastasis
图 2 18F-FDG PET/CT显像及病理结果图
患者52岁，术前已绝经（46岁绝经），病理类型为子宫内膜样癌（低分化），初诊分期为IIB期. 血清CA125为8.50 U/mL，血清HE4为38.9 pmol/L. 18F-FDG PET/CT显像结果提示：阴道残端两侧结节伴FDG代谢活跃，考虑转移瘤，大小分别为2.4 cm×2.2 cm（A、B），SUVmax约5.76（右侧）；2.4 cm×2.1 cm，SUVmax约2.17（左侧）；左侧下腹壁结节伴FDG代谢活跃，考虑转移瘤，大小约1.5×1.0 cm（C、D），SUVmax约14.2. E：下腹部及盆腔腹膜I级增厚；F：腹壁肿物穿刺病理结果为腺癌.
Figure 2. 18F-FDG PET/CT imaging and pathological findings
表 1 18F-FDG PET/CT显像检测结果与随访结果的比较（n）
Table 1. Comparison between 18F-FDG PET/CT imaging and follow-up result
诊断方法 随访结果 合计 阳性 阴性 PET/CT 阳性 51 4 55 阴性 2 8 10 合计 53 12 65 
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表 2 联合检测诊断结果（%）
Table 2. Diagnostic result of combined detection
诊断方式 灵敏度 特异度 阳性预测值 阴性预测值 一致率 PET/CT+CA125 94.3 66.7 92.6 72.7 89.2 PET/CT+HE4 92.5 66.7 92.5 66.7 87.7 PET/CT+CA125+HE4 98.1 66.7 92.9 88.9 78.2
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表 3 PET/CT+CA125临界值+HE4临界值检测结果（%）
Table 3. Result of PET/CT+CA125critical value + HE4critical value
诊断方式 灵敏度 特异度 阳性预测值 阴性预测值 一致率 PET/CT+CA125临界值+
HE4临界值98.1 75.0 94.6 90.0 93.9
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