18F-FDG PET/CT联合血清CA19-9、CEA、NSE鉴别胰腺导管腺癌与胰腺神经内分泌肿瘤

doi:10.3969/j.issn.1006-5725.2023.18.019

Abstract

Abstract:

Objective To discuss the value of ¹⁸F?FDG PET/CT combined with serum CA19?9， CEA and NSE in the differential diagnosis pancreatic ductal adenocarcinoma（pDAC） and pancreatic neuroendocrine tumors（pNETs）. Methods Retrospective analys is of patients who were diagnosed as pDAC or pNETs by pathology， including the clinical data， ¹⁸F?FDG PET/CT images and the level of tumor markers CA19?9， CEA and NSE， and compared age， sex， size and location of the lesions， the involvement of pancreatic ductal， the morphology of the lesionson PET image， SUVmax， surrounding lymphatic metastasis and hepatic metastasis and the level of serum CA19?9， CEA， NSE between the two groups， and figure out the effective indicators in differential diagnosis. The diagnostic efficacy of ¹⁸F?FDG PET/CT imaging SUVmax combined with serum CA19?9， CEA and NSE was compared. Results There were 74 patients were included. The age were between 46 and 82（66.48 ± 8.84）， and 32 were male， 32 were female. 46 patients were pDAC， 28 were pNETs. The mean value of SUVmax were （5.55 ± 2.01） in pDAC group，（4.62 ± 2.01） in pNETs group. It was not statistically significant between the two groups in sex， morphology of the lesions in PET image， SUVmax， surrounding lymphatic metastasis（P > 0.05）， and was statistically significant in age， size of the lesions， location of the lesions， the involvement of pancreatic ductal hepatic metastasis and serum CA19?9， CEA， NSE（P < 0.05）. The diagnostic efficacy of SUVmax combined with serum CA19?9， CEA and NSE was improved compared with SUVmax， which SUVmax combined with CA19?9 had the best diagnostic efficacy with the AUC of ROC curve was 0.891 （95%CI： 0.816～0.967， P < 0.001）. Conclusion The using of ¹⁸F?FDG PET/CT combined with serum CA19?9， CEA， NSE has a high differential diagnosis value in pancreatic ductal adenocarcinoma and pancreatic neuroendocrine tumors， that make up the shortage of using ¹⁸F?FDG PET/CT alone， which the diagnostic efficiency of SUVmax combined with CA19?9 was the best.

Key words: pancreatic ductal adenocarcinoma, pancreatic neuroendocrine tumors, positron emission tomography, X ray computed tomography, ¹⁸F?deoxyglucose, tumor marker

CLC Number:

R735.9

Lichun ZHENG,Huan ZHANG,Cheng GU,Xinyu SHEN,Xiaoming ZHANG,Xiangliu. OUYANG. The differential diagnosis of pancreatic duct a ladenocarcinoma and pancreatic neuroendocrine tumors using ¹⁸F⁃FDG PET/CT combined with serum CA19⁃9， CEA and NSE[J]. The Journal of Practical Medicine, 2023, 39(18): 2395-2400.

Figures/Tables 7

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References 22

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项目	pDAC （n = 46）	pNETs （n = 28）	χ²值	P值
部位			6.336	0.012
胰头	27（58.70）	8（28.57）
胰体尾	19（41.30）	20（71.43）
密度均匀	36（78.26）	21（75.00）	0.105	0.746
胰管扩张	26（56.52）	6（21.43）	8.734	0.003
代谢均匀	21（45.65）	18（64.29）	2.424	0.119
肝转移	16（34.78）	18（64.29）	6.100	0.014
淋巴结转移	22（47.83）	8（28.57）	2.677	0.102

项目	pDAC（n = 46）	pNETs（n = 28）	Z值	P值
CA19-9（U/mL）	177.10（76.22，837.21）	13.40（8.56，21.41）	6.650	< 0.001
NSE（ng/mL）	12.16（9.30，13.76）	17.88（12.72，32.52）	-2.748	0.011
CEA（ng/mL）	3.80（2.41，6.25）	1.74（0.84～3.12）	3.511	0.001

方法	灵敏度（%）	特异度（%）	准确度（%）	阳性预测值（%）	阴性预测值（%）
SUVmax	86.96	50.00	72.97	74.07	70.00
SUVmax+CA19-9	78.26	100.00	86.49	100.00	73.68
SUVmax+CEA	95.65	60.71	82.43	80.00	89.47
SUVmax+NSE	93.48	53.57	78.38	76.79	83.33
χ²值^*	1.211	18.667	4.181	11.053	0.089
P值^*	0.271	0.000	0.041	0.001	0.765
χ²值^△	2.190	0.650	1.911	0.541	2.266
P值^△	0.139	0.420	0.167	0.462	0.132
χ²值^▲	1.108	0.072	0.587	0.109	0.932
P值^▲	0.292	0.789	0.443	0.741	0.334

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The differential diagnosis of pancreatic duct a ladenocarcinoma and pancreatic neuroendocrine tumors using ¹⁸F⁃FDG PET/CT combined with serum CA19⁃9， CEA and NSE

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病理	例数	SUVmax		SUVmax+CA19-9		SUVmax+CEA		SUVmax+NSE
病理	例数	pDAC	pNETs	pDAC	pNETs	pDAC	pNETs	pDAC	pNETs
pDAC	46	40	6	36	10	44	2	43	3
pNETs	28	14	14	0	28	11	17	13	15

The differential diagnosis of pancreatic duct a ladenocarcinoma and pancreatic neuroendocrine tumors using 18F⁃FDG PET/CT combined with serum CA19⁃9， CEA and NSE

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The differential diagnosis of pancreatic duct a ladenocarcinoma and pancreatic neuroendocrine tumors using ¹⁸F⁃FDG PET/CT combined with serum CA19⁃9， CEA and NSE