CAJ | 학술논문

目的探讨18F-FDG PET/CT在鼻咽癌患者颈部淋巴结转移分期中的作用.方法按前瞻性设计研究方案,纳入2009年3月至2010年11月病理确诊为鼻咽癌的初治患者62例,其中男48例,女14例,中位年龄43岁.患者放疗前1周内行CT或MRI检查并进行AJCC分期,然后行18FFDG PET/CT检查后再次分期.以治疗后随访6个月以上结果为标准,评价2种检查方法进行N分期的准确性.分析PET/CT N分期对治疗方案的影响,并计算Kappa值,进行一致性检验,率的比较采用x2检验.结果 62例患者中,N0 9例,N1 16例,N2 24例,N3 13例.18F-FDG PET/CT N分期准确性为96.8％(60/62),与实际N分期一致性检验Kappa值为0.955；CT或MRI N分期准确性为72.7％(45/62),Kappa值为0.607.30.6％(19/62)患者PET/CT与CT或MRI N分期不一致,随访证实PET/CT正确改变了27.4％(17/62)患者的N分期；其中l例从N0提高至N2,由根治性放疗改为放化疗综合治疗,另16例改变了转移淋巴结GTV的勾画和照射剂量.PET/CT咽后淋巴结检出率为54.8％(34/62),其灵敏度、特异性和准确性分别为80.0％ (20/25)、94.4％(17/18)和86.0％(37/43).比较43例同时有MRI和PET/CT检查结果的患者资料,两者对咽后淋巴结的检出率分别为60.5％(26/43)和55.8％ (24/43),差异无统计学意义(x2=2.000,P＞0.05).结论 18F-FDGPET/CT较常规CT或MRI对鼻咽癌N分期的准确性高,且能较好地显示咽后淋巴结,在定性较小淋巴结方面有一定优势.
목적 탐토18F-FDG PET/CT재비인암환자경부림파결전이분기중적작용.방법 안전첨성설계연구방안,납입2009년3월지2010년11월병리학진위비인암적초치환자62례,기중남48례,녀14례,중위년령43세.환자방료전1주내행CT혹MRI검사병진행AJCC분기,연후행18FFDG PET/CT검사후재차분기.이치료후수방6개월이상결과위표준,평개2충검사방법진행N분기적준학성.분석PET/CT N분기대치료방안적영향,병계산Kappa치,진행일치성검험,솔적비교채용x2검험.결과 62례환자중,N0 9례,N1 16례,N2 24례,N3 13례.18F-FDG PET/CT N분기준학성위96.8％(60/62),여실제N분기일치성검험Kappa치위0.955；CT혹MRI N분기준학성위72.7％(45/62),Kappa치위0.607.30.6％(19/62)환자PET/CT여CT혹MRI N분기불일치,수방증실PET/CT정학개변료27.4％(17/62)환자적N분기；기중l례종N0제고지N2,유근치성방료개위방화료종합치료,령16례개변료전이림파결GTV적구화화조사제량.PET/CT인후림파결검출솔위54.8％(34/62),기령민도、특이성화준학성분별위80.0％ (20/25)、94.4％(17/18)화86.0％(37/43).비교43례동시유MRI화PET/CT검사결과적환자자료,량자대인후림파결적검출솔분별위60.5％(26/43)화55.8％ (24/43),차이무통계학의의(x2=2.000,P＞0.05).결론 18F-FDGPET/CT교상규CT혹MRI대비인암N분기적준학성고,차능교호지현시인후림파결,재정성교소림파결방면유일정우세.
Objective To investigate the value of 18F-FDG PET/CT in N staging nasopharyngeal carcinoma (NPC) patients compared with CT or MRI.Methods Sixty-two patients (48 males,14 females,median age 43 y) with NPC confirmed by biopsy were enrolled into this prospective study.All patients underwent CT or MRI as well as 18F-FDG PET/CT imaging 1 week before the radiotherapy and staging was based on AJCC 6th edition.The accuracies of the two imaging methods for N staging were evaluated by follow-up clinical results (≥6 months).Kappa and x2 tests were used to analyze the usefulness of 18F-FDG PET/CT imaging for N staging.Results All of the 62 patients (N0 =9,N1 =16,N2 =24,N3 =13) underwent imaging.In this patient-based analysis,the accuracy of 18F-FDG PET/CT imaging for N staging was 96.8％ (60/62) and Kappa was 0.955,which were 72.7％ (45/62) and 0.607 for CT or MRI.30.6％ (19/62) patients had discrepant results of N staging in PET/CT and CT or MRI.27.4％ (17/62)patients underwent changes in their N staging by PET/CT correctly.Of note,one patient's stage changed from N0 to N2 (radiotherapy to chemoradiotherapy) and another 16 patients had changes in the exposure doses for drawing GTV.The positive rate of PET/CT for retropharyngeal 1ymph node detection was 54.8％ (34/62),and the sensitivity,specificity and accuracy were 80.0％ (20/25),94.4％ (17/18) and 86.0％ (37/43).By comparing 43 patients that underwent MRI and PET/CT imaging,results were comparative in nodal detection:60,5％ (26/43) in MRI vs 55.8％ (24/43) in PET/CT (x2 =2.000,P ＞0.05).Conclusions 18F-FDG PET/CT imaging has higher accuracy for N staging in NPC than CT or MRI.It could also be more sensitive to retropharyngeal lymphadenopathy especially for small lymph nodes.