The Clinical Significance In Primary Liver Malignant Tumors And Lymph Node Metastasis Diagnosis Combined 18F-FDG PET-CT With Tumor Marker

Objection:1.To explore the value of 18F-FDG PET/CT in the diagnosis of intrahepatic lesions and lymph node metastases of primary hepatic malignant tumors.2.To explore the value of 18F-FDG PET/CT combined with tumor markers in the diagnosis of primary hepatic malignant tumors,especially combined with alpha-fetoprotein(AFP)in the diagnosis of hepatocellular carcinoma.3.To explore the diagnostic possibility of SUVmax value,a semi-quantitative analysis index of PET-CT,for HCC differentiation.4.To explore the relationship between maximum diameter(dmax)and SUVmax in primary hepatic malignant tumors.Methods:The clinical data of patients with suspected hepatic malignancies who were admitted to Shengjing Hospital affiliated to China Medical University between January 2013 and June 2018 were collected.All patients underwent 18F-FDG PET/CT and tumor marker examination.The clinical data of patients with primary hepatic malignancy or benign liver lesions were retrospectively analyzed.Cases were included in the standard for:(1)All patients did not receive radiation radiotherapy,chemotherapy,and molecular targeted therapy before examination.(2)All patients were finally diagnosed as primary hepatic malignancies or benign liver lesions by puncture pathology or postoperative pathology.(3)All patients underwent laboratory tests such as PET/CT,enhanced CT(or MRI)and hepatobiliary and pancreatic cancer series tumor markers.There were 92 patients who met the inclusion criteria,including69 males and 23 females,aged 22-81 years,with an average age of 56.4±11.8 years.Among them,82 cases of liver malignant tumors(50 cases of hepatocellular carcinoma,32 cases of other malignant tumors of the liver)and 10 cases of benign liver lesions.The PET-CT images analysis method is as follows:(1)Visual analysis method: According to the PET image,the concentration of 18F-FDG in the lesion is higher than that of the surrounding normal tissue,which is considered to be a liver malignant tumor lesion.In the PET image,the 18F-FDG in the lesion was negative or lower than the surrounding normal liver tissue,and the benign lesion was considered.By comparing the results of pathological examination with those of pathological examination,the qualitative diagnosis of PET-CT by visual analysis was analyzed.(2)Semi-quantitative analysis: The Maximal Standardized Uptake Value(SUVmax)was analyzed.SUVmax?2.5 was considered as malignant for lesion positive,and benign lesions were considered negative for SUVmax<2.5.By comparing the pathological results of the lesions,the diagnostic results of SUVmax semi-quantitative analysis for liver malignant tumors were analyzed.The SUVmax values of highly differentiated,moderately differentiated,and poorly differentiated patients were compared in the hepatocellular carcinoma group,and the differences between the two were compared.The best cut-off value of SUVmax was found by calculating the area under ROC curve,and its sensitivity,specificity and accuracy in the diagnosis of primary hepatic malignant tumors were analyzed.Statistical analysis was performed using SPSS 17.0software,and P < 0.05 was considered as statistically significant.Result:1.The sensitivity,specificity and accuracy of 18F-FDG PET-CT imaging using visual analysis to identify liver malignant tumors and benign lesions were 95.1%,60%,and 91.3%.The sensitivity,specificity and accuracy of semi-quantitative analysis(with SUVmax=4.7 being the best value)were 69.0%,72.7%,and 69.5%.The sensitivity,specificity and accuracy of PET-CT in the diagnosis of hilar lymphatic metastasis were 70%,100%,and 75%.2.The sensitivity,specificity and accuracy of PET-CT and PET-CT combined with tumor markers for the diagnosis of primary hepatic malignancies were not statistically significant.The sensitivity,specificity and accuracy of PET-CT and PET-CT combined with AFP in the diagnosis of hepatocellular carcinoma were not statistically significant after chi-square test.3.The average SUVmax of the highly differentiated patients in the hepatocellular carcinoma group was 4.37±2.35,and the moderately differentiated SUVmax=6.25±3.54.The comparison between the two SUVmax,t =-2.10,P=0.04<0.05,the difference was statistically significant.4.The Pearson correlation coefficient of dmax and SUVmax in primary hepatic malignant tumors was r =0.2,and R was between 0.20 and 0.39,indicating a low positive correlation between SUVmax and lesion dmax.Conclusion:1.18F-FDG PET-CT has significant diagnostic value for primary liver malignant tumors and lymph node metastasis.2.There was no significant difference in the diagnostic value of 18F-FDG PET-CT combined with tumor markers and PET-CT alone for primary hepatic malignancies.3.The SUVmax of 18F-FDG PET-CT can partially reflect the degree of tumor differentiation.The higher the SUVmax,the lower the degree of differentiation and the higher the degree of malignancy.4.There is a positive correlation between the SUVmax of the primary liver malignancy and the dmax of the lesion.