超声、PET/CT及两者联合检测对恶性黑色素瘤淋巴结转移的临床价值分析

Clinical value of ultrasound, PET/CT and their combined detection in lymph node metastasis of malignant melanoma

摘要:

目的 探讨超声、正电子发射断层成像/计算机断层成像（positron emission tomography/computed tomography，PET/CT）及两者联合检测对恶性黑色素瘤（malignant melanoma，MM）淋巴结转移评估的准确性，指导临床MM患者淋巴结活检及清扫的术前评估。方法 收集41例MM住院患者临床资料，分析术前淋巴结相关影像资料、术后淋巴结病理结果及病理结果跟影像结果的相关性。结果 超声、PET/CT以及两者联合检测的敏感度分别是47.36%、73.68%、78.95%，特异度分别是59.09%，86.36%、50.00%，准确度分别是53.66%、80.49%、63.41%，阳性预测值分别是50.00%、82.35%、57.69%，阴性预测值分别是56.52%，79.17%、73.33%，正确指数分别是6.45%、60.04%、28.95%。结论 PET/CT在评估MM术前淋巴结是否转移方面具有重要价值，其准确度、特异度、阳性预测值、阴性预测值均高于超声及两者联合检测，当PET/CT检查淋巴结转移为阴性时，应结合超声两者联合综合判断，避免淋巴结转移漏诊，提高淋巴结转移检出率，使MM患者早诊断、早治疗，从而获得最佳治疗效果。影像学虽然不能作为诊断标准和最终依据，但可指导临床行淋巴结活检手术前的评估，减少漏诊。

Abstract:

Objective To investigate the accuracy of ultrasound，positron emission tomography/computed tomography（PET/CT） and their combined detection in the evaluation of lymph node metastasis of malignant melanoma（MM），and to guide the preoperative evaluation of lymph node biopsy and dissection in patients with MM.Methods The clinical data of 41 hospitalized patients with MM were collected. Preoperative lymph node imaging data，postoperative lymph node pathological results and the correlation between pathological results and imaging results were analyzed.Results The sensitivity of ultrasound，PET/CT and their combined detection were 47.36%，73.68%，and 78.95%，the specificity were 59.09%， 86.36%，and 50.00%，the accuracy were 53.66%，80.49%，and 63.41%，the positive predictive value were 50.00%，82.35%，and 57.69%，the negative predictive value were 56.52%，79.17%，and 73.33%，and the correct index were 6.45%，60.04%，and 28.95%.Conclusion PET/CT is of great value in assessing preoperative lymph node metastasis of MM，and its degree of accuracy，specificity， positive predictive value，and negative predictive value are higher than those of ultrasound and the joint detection. When the PET/CT examination lymph node metastasis is negative，we should combine with ultrasound to make the joint comprehensive judgment，thereby avoiding missed diagnosis of lymph node metastasis，and improving the detection rate of lymph node metastasis. Early diagnosis and early treatment of MM patients can obtain the best therapeutic effect. Although imaging cannot be used as the diagnostic criteria and final basis，it can guide clinical evaluation before lymph node biopsy surgery to reduce missed diagnosis.