本文選題：PEM　切入點(diǎn)：PET　出處：《天津醫(yī)科大學(xué)》2016年博士論文

【摘要】：目的比較具有我國自主知識(shí)產(chǎn)權(quán)的乳腺專用PET(PEM)與具有相同顯像原理的主流顯像技術(shù)PET在診斷乳腺癌中的價(jià)值,并與超聲、X線鉬靶成像等傳統(tǒng)用于乳腺癌診斷的影像技術(shù)進(jìn)行比較,同時(shí)分析乳腺癌組織類型、免疫組化、腫瘤標(biāo)志物等指標(biāo),探討PEM在乳腺癌診斷中的價(jià)值及其與乳腺癌臨床、病理之間的相關(guān)性。方法對(duì)臨床初診乳腺腫塊患者隨機(jī)先后行FDG PEM、PET檢查,比較PEM、PET及X線、超聲診斷乳腺癌的效能,并按照腫瘤大小分組進(jìn)一步比較。比較乳腺良、惡性病變之間大小及SUVmax的差異。將乳腺癌分為≤1cm和1cm兩組,比較兩組乳腺癌之間SUVmax的差異。免疫組化分析乳腺癌Ki67、p53、ER及PR表達(dá)水平,測(cè)定乳腺癌患者血漿CEA及CA153水平,將乳腺癌SUVmax與上述指標(biāo)進(jìn)行相關(guān)性分析。結(jié)果共244例資料完整的患者納入本研究,共278個(gè)病灶。PET、PEM、超聲及X線診斷乳腺癌的敏感度、特異度、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確率分別為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的診斷效能稍高于其它常規(guī)影像學(xué)檢查,之間差異不具有統(tǒng)計(jì)學(xué)意義。PEM與PET具有很好診斷乳腺癌一致率,為96.7%。對(duì)于1cm的乳腺癌,PET|、PEM、超聲及X線檢查診斷乳腺癌的敏感度、特異度、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確率分別為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的診斷效能稍高于其他影像學(xué)檢查,之間差異不具有統(tǒng)計(jì)學(xué)意義。對(duì)≤1cm的乳腺癌,PET|、PEM、超聲及X線診斷乳腺癌的敏感度、特異度、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確率分別為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的診斷效能稍高于其他影像學(xué)檢查,之間差異不具有統(tǒng)計(jì)學(xué)意義。對(duì)≤5mm的乳腺癌,PET|、PEM、超聲及X線診斷乳腺癌的敏感度、特異度、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確率分別為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的診斷效能稍高于其他影像學(xué)檢查,之間差異不具有統(tǒng)計(jì)學(xué)意義。在超聲診斷錯(cuò)誤的患者中,PET診斷準(zhǔn)確率為83.3%,PEM診斷準(zhǔn)確率為80.6%。鉬靶診斷錯(cuò)誤的患者中,PET診斷準(zhǔn)確率為77.3%,PEM診斷準(zhǔn)確率為72.7%。在多灶性乳腺癌的檢出中,PEM略高于PET,但不具有統(tǒng)計(jì)學(xué)差異。乳腺惡性病變的PEM/PET SUVmax要高于乳腺良性病變。乳腺惡性病變的直徑要大于乳腺良性病變。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,二者之間存在顯著正相關(guān)性。ER陰性組乳腺癌的PEM/PET SUVmax要高于ER陽性組,乳腺癌FDG PEM/PET SUVmax與ER水平呈負(fù)相關(guān)。PR陰性組乳腺癌的PEM/PET SUVmax要高于PR陽性組,乳腺癌FDG PEM/PET SUVmax與PR水平呈負(fù)相關(guān)。P53陰性組乳腺癌的PEM/PET SUVmax要低于P53陽性組,乳腺癌FDG PEM/PET SUVmax與P53水平呈正相關(guān)。Ki67增殖指數(shù)低表達(dá)組乳腺癌的PEM/PET SUVmax要低于Ki67增殖指數(shù)高表達(dá)組,乳腺癌FDG PEM/PET SUVmax與Ki67水平呈正相關(guān)。CEA高組乳腺癌的PEM/PET SUVmax與CEA低組之間差異不具有統(tǒng)計(jì)學(xué)意義,乳腺癌FDG PEM/PET SUVmax與CEA水平無顯著相關(guān)性。CA153高組乳腺癌的PEM/PET SUVmax與CA153低組之間差異不具有統(tǒng)計(jì)學(xué)意義,乳腺癌FDG PEM/PET SUVmax與CA153水平無顯著相關(guān)性。乳腺癌FDG PEM/PET SUVmax與乳腺癌病灶大小無顯著相關(guān)性。乳腺癌FDG PEM/PET SUVmax與乳腺癌病理分級(jí)無顯著相關(guān)性。病理高分級(jí)乳腺癌的PEM/PET SUVmax要高于低分級(jí)。浸潤(rùn)性導(dǎo)管癌的PET/PEM SUVmax要高于非浸潤(rùn)性導(dǎo)管癌。FDG PEM/PET對(duì)浸潤(rùn)性乳腺癌的診斷效能要稍高于其他類型乳腺癌,之間差異不具有統(tǒng)計(jì)學(xué)意義。結(jié)論FDG PEM與PET診斷乳腺癌的敏感度均較高,二者診斷一致率好;部分病灶位于PEM掃描野外可導(dǎo)致假陰性診斷,這與PEM本身的設(shè)計(jì)有關(guān),有待于進(jìn)一步改善;PEM對(duì)于小病灶和多病灶乳腺癌的檢出較PET略優(yōu)勢(shì),有待于進(jìn)一步增加該組病例數(shù)證實(shí);FDG PEM/PET SUVmax與乳腺癌預(yù)后因素相關(guān);PEM及PET診斷乳腺癌的效能較常規(guī)影像學(xué)無明顯差異,但在常規(guī)影像學(xué)檢查診斷錯(cuò)誤的病例中具有較好的診斷準(zhǔn)確性,二者結(jié)合可明顯提高乳腺癌的診斷水平,是常規(guī)影像學(xué)的有益補(bǔ)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，

本文編號(hào)：1690054