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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (6): 1071-1077. doi: 10.19723/j.issn.1671-167X.2019.06.017

• 论著 • 上一篇    下一篇

18F-FDG PET/CT联合多种肿瘤标志物在结直肠中分化腺癌术后复发及转移中的应用价值

张旭初,张建华,王荣福(),范岩,付占立,闫平,赵光宇,白艳霞   

  1. 北京大学第一医院核医学科,北京 100034
  • 收稿日期:2017-10-24 出版日期:2019-12-18 发布日期:2019-12-19
  • 通讯作者: 王荣福 E-mail:rongfu_wang@163.com

Diagnostic value of 18F-FDG PET/CT and tumor markers (CEA, CA19-9, CA24-2) in recurrence and metastasis of postoperative colorectal moderately differentiated adenocarcinoma

Xu-chu ZHANG,Jian-hua ZHANG,Rong-fu WANG(),Yan FAN,Zhan-li FU,Ping YAN,Guang-yu ZHAO,Yan-xia BAI   

  1. Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
  • Received:2017-10-24 Online:2019-12-18 Published:2019-12-19
  • Contact: Rong-fu WANG E-mail:rongfu_wang@163.com

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摘要：

目的 探讨18F-FDG PET/CT与肿瘤标志物(CEA、CA19-9、CA24-2)在结直肠中分化腺癌患者术后探测及提示复发和转移灶中的应用。方法 对55例结直肠中分化腺癌患者进行 18F-FDG PET/CT显像及肿瘤标志物筛查,并与病理及临床随访结果进行比较。结果 对18F-FDG PET/CT对于结直肠中分化腺癌术后复发及转移灶的诊断效能为:灵敏度95.74%(45/47),特异性75.00%(6/8),阳性预测值95.74%(45/47),阴性预测值75.00%(6/8),准确率92.73%(51/55),其中假阳性2例,假阴性2例。CEA组、CA19-9组、CA24-2组及肿瘤标记物联合组灵敏度分别为68.09%(32/47)、28.57%(12/42)、40.00%(16/40)及74.47%(35/47),特异性为50.00%(4/8)、66.67%(4/6)、71.73%(5/7)及50.00%(4/8),阳性预测值为88.89%(32/36)、85.71%(12/14)、88.89%(16/18)及89.74%(35/39),阴性预测值为26.67%(4/19)、11.42%(4/34)、17.24%(5/29)及25.00%(4/16),准确率为65.45%(36/55)、32.65%(16/49)、44.68%(21/47)及70.91%(39/55)结论 18F-FDG PET/CT对于结直肠癌术后中分化腺癌患者复发及转移灶的探测具有较高的灵敏度及特异性,各项肿瘤标志物对病灶转移及复发均有一定的提示作用,多项肿瘤标志物联合应用更准确。

关键词: 结直肠肿瘤, 正电子发射断层显像计算机体层摄影术, 生物标记, 肿瘤, 肿瘤复发, 局部, 肿瘤转移

Abstract:

Objective: To evaluate the diagnostic value of 18F-FDG PET/CT and tumor markers (CEA,CA19-9,CA24-2) in detection for recurrence and metastasis of postoperative colorectal moderately differentiated adenocarcinoma.Methods: Fifty-five patients were enrolled in this study. All of the patients were tested with serum CEA within 2 weeks when they underwent 18F-FDG PET/CT scan, and some patients were tested with serum CA19-9 and CA24-2 simultaneously. According to the pathology and clinical results of their follow-up, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT and tumor markers were calculated based on different divided groups, respectively.Results: According to the pathology and the results of their clinical follow-up, the sensitivity of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 95.74%, 68.09%, 28.57%, 40.00% and 74.47%, respectively. The specificity of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 75.00%, 50.00%, 66.67%, 71.43% and 50.00%, respectively. The positive predictive value of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 95.74%, 88.89%, 85.71%, 88.89% and 89.74%, respectively. The negative predictive value of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 75.00%, 26.67%, 11.42%, 17.24%, 25.00%, respectively. The accuracy of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 92.73%, 65.47%, 32.65%, 44.68% and 70.91%, respectively. There were 2 cases of false positive and 2 cases of false negative in 18F-FDG PET/CT.Conclusion: 18F-FDG PET/CT has high value in detecting recurrence and metastasis of postoperative colorectal carcinoma. Tumor markers have the positive value to imply the recurrence and metastasis of postoperative colorectal carcinoma and are useful to indicate when to perform the 18F-FDG PET/CT. The combination of tumor markers could improve the diagnostic efficiency to some extent.

Key words: Colorectal neoplasms, Positron emission tomography computed tomography, Biomarkers, tumor, Neoplasm recurrence, local, Neoplasm metastasis

中图分类号: 

  • R735.5

表1

PET/CT、病理及各肿瘤标记物组结果"

PET/CT Pathology CEA (n=55) CA19-9 (n=49) CA24-2 (n=47) Combination of tumor markers (n=55)
Elevated Normal Elevated Normal Elevated Normal Elevated Normal
Positive Positive 30 15 12 28 16 22 33 12
Positive Negative 1 1 1 1 1 1 1 1
Negative Negative 3 3 1 4 1 4 3 3
Negative Positive 2 0 0 2 0 2 2 0

表2

PET/CT及各项肿瘤标志物发现结直肠中分化腺癌术后复发及转移灶的诊断效能"

Testing items Sensitivity Specificity PPV NPV Accuracy
PET/CT (n=55) 95.74 75.00 95.74 75.00 92.73
CEA (n=55) 68.09 50.00 88.89 26.67 65.45
CA19-9 (n=49) 28.57 66.67 85.71 11.42 32.65
CA24-2 (n=47) 40.00 71.43 88.89 17.24 44.68
Combination of tumor markers (n=55) 74.47 50.00 89.74 25.00 70.91

表3

PET/CT在各肿瘤标志物升高和正常组发现结直肠中分化腺癌术后复发及转移灶的诊断效能"

Group Sensitivity Specificity PPV NPV Accuracy
Elevated CEA (n=36) 93.75 75.00 96.77 60.00 91.67
Normal CEA (n=19) 100.00 75.00 93.75 100.00 94.74
Elevated CA19-9 (n=14) 100.00 50.00 92.31 100.00 92.86
Normal CA19-9 (n=35) 93.33 80.00 96.55 66.67 91.43
Elevated CA24-2 (n=18) 100.00 50.00 94.12 100.00 94.44
Normal CA24-2 (n=29) 91.67 80.00 95.56 66.67 89.66
Elevated tumor markers (n=39) 94.29 75.00 97.06 60.00 92.31
Normal tumor markers (n=16) 100.00 75.00 92.31 100.00 93.75

图1

直肠癌术后,可见右侧髂内动脉旁肿大淋巴结,各项肿瘤标志物均正常(CEA 1.86 μg/L、CA19-9 24.93 U/mL、CA24-2 18.13 U/mL)"

图2

右半结肠癌术后,PET/CT显像提示右侧附件区囊实性病灶,葡萄糖代谢增高,CEA 5.83 μg/L、CA19-9<0.60 U/mL、CA24-2 5.3 U/mL"

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ISSN 1671-167X
CN 11-4691/R
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