分化型甲状腺癌术后肺转移的SPECT/CT平面与断层显像诊断研究

doi:10.3877/cma.j.issn.1674-0793.2017.05.011

目的

比较分化型甲状腺癌术后肺转移的单光子/正电子发射断层成像术（SPECT/CT）平面与断层显像诊断价值。

方法

回顾性分析中山大学附属第三医院2012年1月至2016年10月收治的64例疑似分化型甲状腺癌术后肺转移患者的临床资料，所有患者均同时接受SPECT/CT平面与断层显像，对显像诊断结果进行统计分析。

结果

64例患者中确诊为分化型甲状腺癌术后肺转移48例，未发生肺转移16例。SPECT/CT平面显像诊断40例为肺转移，其中12例为假阳性；24例未发生肺转移，其中20例为假阴性。SPECT/CT断层显像诊断52例为肺转移，其中48例为真阳性；12例未发生肺转移，其中4例为假阳性。分化型甲状腺癌术后肺转移的SPECT/CT断层显像的敏感度、特异度、准确性、阳性预测值、阴性预测值均显著高于SPECT/CT平面显像（χ²=12.63、4.00、11.14、3.92、11.25，P=0.032、0.033、0.024、0.042、0.013）。

结论

分化型甲状腺癌术后肺转移的SPECT/CT断层显像诊断价值较SPECT/CT平面显像高，值得在临床推广。

关键词: 分化型甲状腺癌, 肺转移, SPECT/CT平面显像, SPECT/CT断层显像

Objective

To compare the diagnostic values of SPECT/CT planar and tomography imaging in postoperative lung metastases of differentiated thyroid carcinoma.

Methods

Sixty-four cases with suspected postoperative lung metastasis of differentiated thyroid carcinoma from January 2012 to October 2016 were retrospectively analyzed in the Third Affiliated Hospital of Sun Yat-sen University. All patients were given SPECT/CT planar and tomography imaging, and the diagnostic results of SPECT/CT planar and tomography imaging in postoperative lung metastases of differentiated thyroid carcinoma were statistically analyzed.

Results

Among the 64 cases, there were 48 cases of postoperative lung metastases of differentiated thyroid carcinoma, and 16 non pulmonary metastasis. SPECT/CT planar imaging showed lung metastasis in 40 cases, of which 12 were false positive, and non pulmonary metastasis in 24 cases, of which 20 were false negative. SPECT/CT tomographic imaging diagnosed lung metastasis in 52 cases, of which 48 cases were true positive, and non pulmonary metastasis in 12 cases, of which 4 were false positive. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SPECT/CT tomographic imaging of postoperative lung metastases of differentiated thyroid carcinoma were significantly higher than that of SPECT/CT planar imaging (χ²=12.63, 4.00, 11.14, 3.92, 11.25, P=0.032, 0.033, 0.024, 0.042, 0.013) .

Conclusion

The diagnostic value of SPECT/CT tomography imaging in postoperative lung metastases of differentiated thyroid carcinoma is higher than SPECT/CT planar imaging, and is worthy of promotion in the clinic.

Key words: Differentiated thyroid carcinoma, Lung metastasis, SPECT/CT planar imaging, SPECT/CT tomography

图1 SPECT/CT平面显像示患者左肺上野见放射性浓聚灶（A），断层显像示左肺上叶前段见放射性浓聚（C、D、E），但CT图像未见异常密度影（B）。该患者血清刺激性甲状腺球蛋白水平为12.9 μg/L，在后续随访中未发现肺转移瘤征象

图2 SPECT/CT平面显像示双肺未见异常放射性浓聚影（A），但断层显像示双肺多发大小不等类圆形结节灶，边界清楚（B、D），未见放射性浓聚（C、E），考虑双肺多发转移瘤。该患者血清刺激性甲状腺球蛋白水平为1 028.29 μg/L

图3 SPECT/CT平面显像示双肺多发放射性浓聚影（A），断层显像示双肺多发大小不等类圆形结节影，边界清楚，放射性浓聚（B、C、D、E），考虑双肺多发转移瘤。该患者血清刺激性甲状腺球蛋白水平水平为271.05 μg/L

表1 分化型甲状腺癌术后肺转移的SPECT/CT平面与断层显像诊断结果比较（%）

诊断方法	例数	敏感度	特异度	准确性	阳性预测值	阴性预测值
SPECT/CT平面显像	64	58.3	25.0	50.0	70.0	16.7
SPECT/CT断层显像	64	100.0	75.0	93.8	92.3	100.0
χ²值		12.63	4.00	11.14	3.92	11.25
P值		0.032	0.033	0.024	0.042	0.013

表1 分化型甲状腺癌术后肺转移的SPECT/CT平面与断层显像诊断结果比较（%）

诊断方法	例数	敏感度	特异度	准确性	阳性预测值	阴性预测值
SPECT/CT平面显像	64	58.3	25.0	50.0	70.0	16.7
SPECT/CT断层显像	64	100.0	75.0	93.8	92.3	100.0
χ²值		12.63	4.00	11.14	3.92	11.25
P值		0.032	0.033	0.024	0.042	0.013

[1]	Vidinov K, Nikolova D. Familial papillary thyroid carcinoma (FPTC): a retrospective analysis in a sample of the Bulgarian population for a 10-year period[J]. Endocr Pathol, 2017, 28(1):54-59.
[2]	Che HY, Guo HY, Si XW, et al. Additive effect by combination of Akt inhibitor, MK-2206, and PDGFR inhibitor, tyrphostin AG 1296, in suppressing anaplastic thyroid carcinoma cell viability and motility[J]. Onco Targets Ther, 2014, 7:425-432．
[3]	袁超，刘恒超，胡永全, 等. ¹³¹治疗分化型甲状腺癌术后肺转移的临床研究[J]. 放射免疫学杂志, 2013, 26(2):130-133.
[4]	Fu H, Ma C, Guan W, et al. Expression of Notch 1 receptor associated with tumor aggressiveness in papillary thyroid carcinoma[J]. Onco Targets Ther, 2016, 9:1519-1523．
[5]	Lei J, Zhu J, Li Z, et al．Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis[J]. OncoTargets Ther, 2016, 9:5209-5216.
[6]	青春，朱云枝，汪开明, 等. 小剂量¹³¹治疗24例肺转移性甲状腺癌临床分析[J]. 中华实用诊断与治疗杂志, 2011, 25(12):1169-1173.
[7]	Zayed AA, Ali MK, Jaber OI, et al．Is Hashimoto’s thyroiditis a risk factor for medullary thyroid carcinoma? Our experience and a literature review[J]. Endocrine, 2015, 48(2):629-636.
[8]	李素平，游金辉，温琥玲, 等. ¹³¹ －SPECT/CT断层融合显像在分化型甲状腺癌分期中的价值[J]. 川北医学院学报, 2012, 27(2):109-111.
[9]	田志远，吴庆超. 甲状腺癌淋巴结转移检测方法研究进展[J]. 中华实用诊断与治疗杂志, 2013, 27(11):1051-1053.
[10]	Ho WL, Zacharin MR. Thyroid carcinoma in children, adolescents and adults, both spontaneous and after childhood radiation exposure[J]. Eur J Pediatr, 2016, 175(5):677-683．
[11]	Iliadou PK, Effraimidis G, Konstantinos M, et al. Chronic lymphocytic thyroiditis is associated with invasive characteristics of differentiated thyroid carcinoma in children and adolescents[J]. Eur J Endocrinol, 2015, 173(6):827-833．
[12]	Kalender E, Zeki Celen Y, Elboga U, et al．Lung metastases inpatients with differentiated thyroid carcinoma and evaluation of responseto radioiodine therapy[J]. Rev Esp Med Nucl Imagen Mol, 2012, 31(6):328-331．
[13]	Kand P, Basu S. Clinicoradiological characteristics of patients with differentiated thyroid carcinoma and renal metastasis: case series with follow up[J]. J Laryngol Otol, 2014, 128(2):203-208.
[14]	Murphy C, Schwalb H, Berlangieri S, et al．Intraluminal superior vena cava metastasis in a patient with poorly differentiated thyroid carcinoma[J]. J Clin Oncol, 2015, 33(32):e119-e121.
[15]	Lenzi R, Marchetti M, Muscatello L. Incidental nodal metastasis of differentiated thyroid carcinoma in neck dissection specimens from head and neck cancer patients[J]. J Laryngol Otol, 2017, 131(4):368-371.
[16]	Yang H, Chen Z, Wu M, et al. Remarkable response in 2 cases of advanced poorly differentiated thyroid carcinoma with liposomal doxorubicin plus cisplatin[J]. Cancer Biol Ther, 2016, 17(6):693-697.
[17]	Basu S, Pantvaidya G, Malvadkar S. Excellent response to combined radioiodine and enoxaparin in the setting of tumor venous thrombosis from differentiated thyroid carcinoma involving internal jugular and subclavian veins[J]. Future Oncol, 2013, 9(12):1813-1818.
[18]	Nakayama R, Horiuchi K, Susa M, et al. Clinical outcome after bone metastasis (BM) surgery in patients with differentiated thyroid carcinoma (DTC): a retrospective study of 40 cases[J]. Jpn J Clin Oncol, 2014, 44(10):918-925.

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[2]	李龙山, 孙鹏飞. 分化型甲状腺癌治疗的现状和进展[J]. 中华普通外科学文献(电子版), 2017, 11(03): 208-212.
[3]	王培顺, 黎洪浩, 黄天立, 龙淼云, 罗定远, 黄明清, 彭新治. 血清促甲状腺激素水平与分化型甲状腺癌致病风险关系研究[J]. 中华普通外科学文献(电子版), 2011, 05(06): 512-515.
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[7]	李彭媚, 刘刚, 李才弘, 刘长路, 黄婷, 刘娅, 刘代顺. 结肠癌术后经4年无病生存期转移至肺部1例[J]. 中华肺部疾病杂志(电子版), 2019, 12(02): 249-250.
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[9]	程志远, 王俊男, 闫枫尚, 徐子恒, 徐拯, 辛诚, 楼征. 结直肠癌肺转移患者临床特征及预后影响因素分析——基于SEER数据库的回顾性研究[J]. 中华结直肠疾病电子杂志, 2019, 08(03): 251-256.
[10]	中国医师协会外科医师分会多学科综合治疗专业委员会, 中国抗癌协会大肠癌专业委员会. 结直肠癌肺转移多学科综合治疗专家共识（2018版）[J]. 中华结直肠疾病电子杂志, 2018, 07(06): 502-509.
[11]	赵志勋, 王锡山. 直肠癌伴肺转移瘤同期切除手术二例报道[J]. 中华结直肠疾病电子杂志, 2016, 05(04): 355-357.
[12]	武振, 王永坤, 姚玉民. 直径1~4 cm的分化型甲状腺癌的诊治进展[J]. 中华临床医师杂志(电子版), 2021, 15(02): 149-152.
[13]	刘瑞宝. CT引导下125I粒子植入术后治疗肺转移瘤[J]. 中华介入放射学电子杂志, 2018, 06(03): 0-.
[14]	李杰, 谢其根, 孙宗琼, 王卫国, 华燕艳. 碘125粒子植入治疗与立体定向放射治疗肠癌术后反复复发肺转移瘤的临床效果比较[J]. 中华介入放射学电子杂志, 2018, 06(03): 216-221.
[15]	高坤, 郑燕. 结直肠癌术后肺转移的临床治疗决策[J]. 中华胸部外科电子杂志, 2021, 08(01): 56-62.

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Study of SPECT/CT planar and tomography imaging in the diagnosis of postoperative lung metastasesof differentiated thyroid carcinoma

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Study of SPECT/CT planar and tomography imaging in the diagnosis of postoperative lung metastasesof differentiated thyroid carcinoma