The Correlative Study To PET/CT Imaging And The Serum Level Of PCNA And VEGF In Patients Of Digestive System Malignant Tumor

Part-1The Application of PET/CT Imaging for the Diagnosis ofDigestive System Malignant TumorObjective:To analyze the characteristics of PET/CT imaging in digestive system tumor patients;and to investigate the diagnosis value of¹⁸F-FDG PET/CT in primary tumors and distant metastasis of patients with digestive system malignant tumor.Methods:¹⁸F-FDG PET/CT imaging was performed on twenty-six patients diagnosed with digestive system malignancy,and all images were analyzed by image fusion software.At the same time,primary tumor focus size and SUV_maxax value,lymph node focus size and SUV_maxax value in the patients with digestive system tumor were measured by software.The relationships between SUV_maxax and the clinical pathological factors were analyzed by SPSS19.0.The properties of lesions were confirmed by histopathological examination,the results of multi-modalities imaging or clinical follow-up.Results:1.25 cases were accurately detected by ¹⁸F-FDG PET/CT among the26 patients with digestive system malignancy,and the positive detection rate of PET/CT imaging was 96.2%（25/26）for digestive system tumor.The primary tumor SUV_maxax value and tumor size was 13.24±7.50 and 3.41±1.70cm respectively;with the maximum diameterof primary tumor increasing,SUV_maxax value was significantly increased（r=0.448,p<0.05）;as the age increasing,SUV_maxax value was decreased gradually（r=-0.429,p<0.05）.The SUV_maxax values of primary lesions with distant organ metastasis group were significantly higher than that of lymph node metastasis group and the non-metastasis group（p<0.05）.However,there was no significant difference in the primary lesion SUV_maxax between the different group of sex,pathological type,and age（p>0.05）.2.Among the 25 patients with digestive system tumors accurately diagnosed by ¹⁸F-FDG PET/CT,there were 16 patients with positive imaging and 9 patients with negative imaging of lymph node metastasis.Among them,11/16 patientswere true positive and 6/9 patientswere true negative.The diagnostic accuracy was 68%（17/25）,the sensitivity was 78.6%（11/14）and the specificity was 54.5%（6/11）.The SUV_maxax of metastatic lymph nodes was9.90±5.94,the maximum diameter was 1.55±0.47 cm.With the increase of primary lesion SUV_max,the SUV_maxax value and size of lymph node increased respectively（r=0.639,p<0.05;r=0.590,p<0.01）.The SUV_maxax values of lymph nodes were associated with the maximum diameter of lymph nodes（r=0.654,p<0.05）.3.14 patients of digestive system tumor with distant metastasis were diagnosed by ¹⁸F-FDG PET/CT imaging among 25 patients,true positive in12/14 cases,true negative in 10/11 cases.The diagnosis accuracy rate was88%（22/25）,specificity was 83.3%（10/12）and sensitivity was 92.3%（12/13）.Most of the distant metastasis organs were lung,bone,liver,and rectum.And,¹⁸F-FDG PET/CT imaging have changed the staging of some patients.Summary:1.¹⁸F-FDG PET/CT imaging has a high detection rate for the diagnosis of primary lesions in patients with digestive system malignant tumors.The SUV_maxax value of primary tumor was related to tumor size,age of patients and distant organ metastasis.But,it might not relate to gender,pathological type,lymph node metastasis and other factors.2.¹⁸F-FDG PET/CT imaging has significant diagnostic value for detection of lymph node metastases in patients with digestive system malignant tumors.The SUV_maxax and maximum diameter of lymph nodes were associated with the SUV_maxax of primary lesion;and there is also a correlation between the SUV_maxax and size of lymph node metastases.3.¹⁸F-FDG PET/CT imaging has a high accuracy in the detection of distant metastatic lesions in patients with digestive system malignant tumor.¹⁸F-FDG PET/CT imaging can change some patients’s clinical stages,and has significance guiding value to make preoperative clinical stage and treatment options for the patients with digestive system cancer.Part-2The Application of PET/CT Imaging for the Evaluation ofRecurrence and Metastasis of Digestive System TumorObjective:To analyze the imaging features of ¹⁸F-FDG PET/CT in patients with digestive system tumorpost-interventional treatment;to evaluate the clinical value of ¹⁸F-FDG PET/CT imaging in diagnosis of recurrence,metastasis,and re-staging in patients with digestive system tumor post-interventional treatment.Methods:To analysis retrospectively for 61 digestive system malignant patients post-interventional treatment with ¹⁸F-FDG PET/CT scans and the SUV_maxax valueof recurrent and metastatic lesions,the diagnostic value of¹⁸F-FDG PET/CT imaging and simultaneous CT scans for recurrent and metastatic lesions were compared on digestive system malignancy.The diagnostic effects of ¹⁸F-FDG PET/CT were investigated on clinical re-staging and treatment strategies in digestive system malignant tumors post-interventional treatment.Results:1.Among the 61 patients with digestive system malignancy post-interventional treatment,¹⁸F-FDG PET/CT imaging was positive in 46cases and negative in 15 cases.56 patients were correctly diagnosed about recurrence and metastasis（43 cases were true positive and 13 cases were true negative）,2 cases were false negative and 3 was false positive.The SUV_maxax value of recurrent and metastasis focus was 10.95±4.52.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ¹⁸F-FDG PET/CT imaging in the diagnosis of recurrent metastases were95.6%（43/45）,81.3%（13/16）,91.8%（56/61）,93.5%（43/46）and 86.7%（13/15）,respectively.2.Among 61 digestive system malignant patients post-interventional treatment,43 cases were correctly diagnosed with simultaneous diagnosis of CT,including 31 were true positive,4 were false positive,12 were true negative,and 14 were false negative.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 68.9%（31/45）、75.0%（12/16）、70.5%（43/61）、88.6%（31/35）and 46.2%（12/26）,respectively.3.In the 56 digestive system malignant patients post-interventional treatment diagnosed accurately by ¹⁸F-FDG PET/CT,the clinical stages of 20patients（35.7%,20/56）have changed,18 of them were up-regulated and 2cases were down-graded in clinical stages.The treatment plans were changed in 16 patients with clinical stages changed（28.6%,16/56）,and the treatment strategies were unchanged in 4 patients with clinical stages changed.Summary:1.¹⁸F-FDG PET/CT imaging has a higher detection rate of recurrent and metastases than that of CT examination in digestive system malignant tumors post-interventional treatment,and has obvious diagnostic value for the detection of metastatic lymph nodes and metastases of distant organ.2.¹⁸F-FDG PET/CT imaging has changed the clinical stages of partial patients with digestive system tumor post-interventional treatment,and has a significance reference value for the clinical re-staging and formulation of treatment protocols in patients with digestive system malignancy.Part-3The Serum Levels of PCNA and VEGF in Patients withDigestive System Malignant TumorObjective:To detect the serum levels of PCNA and VEGF in patients with digestive system malignancy before and after interventional therapy.And to analyze the correlation between the serum level of PCNA,VEGF and clinicopathological factors in patients with digestive system malignancy.The roles of PCNA and VEGF in the development,recurrence and metastasis of tumor were evaluated.Methods:31 serum samples from the digestive system malignant tumor patients with ¹⁸F-FDG PET/CT imaging were enrolled in our hospital.Among them,15 cases were before intervention,and 16 recurrence cases were after intervention.All cases were confirmed by pathology or imaging examination and clinical follow-up.15 normal serum samples from health examination（control group）were selected into this study.The serum levels of PCNA and VEGF were measured by ELISA.The changes of the serum level of PCNA and VEGF were compared with before and after interventional therapy,and the relationship between the level of PCNA,VEGF and other clinical pathological characteristics were analyzed by SPSS 19.0 statistical software.Results:1.The serum levels of PCNA and VEGF in 15 control group cases were199.19±37.12ng/ml and 106.07±27.30pg/ml respectively.The serum levels of PCNA and VEGF in 15 patients with digestive system tumor before intervention were 132.87±87.37ng/ml and 158.21±57.07pg/ml respectively.The serum levels of PCNA and VEGF in 16 patients with digestive system tumor after intervention were 245.54±102.16ng/ml and 120.02±52.66pg/ml,respectively.The serum level of PCNA in patients with recurrence and metastasis was significantly higher than that in patients before intervention（p<0.05）.However,there was no significant difference in the serum level of PCNA in control group cases and digestive system tumor patients before or after intervention treatment（p>0.05）.The serum level of VEGF in patients with digestive system tumor before intervention were significantly higher than that in control group cases and that in patients with recurrence and metastasis after interventional treatment（p<0.05）.But,there was no significant difference in the serum level of VEGF between healthy cases and patients with digestive system tumor after intervention（p>0.05）.2.There were no significant differences in the expression of PCNA and VEGF between the different group of sex,age,histopathological type and metastatic status in 15 patients with digestive system malignant tumor before intervention（p>0.05）.3.There was no correlation between the serum level of PCNA and the age,diameter,SUV_maxax of primary tumor and lymph node metastasis of digestive system tumor patients（p>0.05）.There was a positive correlation between the serum level of VEGF and the maximum diameter of primary lesions in patients with digestive system tumor（r=0.707,p<0.05）.There was also a positive correlation between the SUV_maxax value of primary tumor and the serum level of VEGF（r=0.749,p<0.05）.There was no correlation between age,lymph node metastasis of the digestive system tumor patients and the serum VEGF before interventional treatment（p>0.05）.There was no significant correlation between the serum level of PCNA and VEGF in digestive system tumor patients before and after interventional therapy（p>0.05）.Summary:1.The expression of PCNA in digestive system tumor patients with recurrence and metastasis after intervention was significantly higher than that before intervention.It indicates that PCNA may be involved in the proliferation and recurrence of tumor cells.2.The serum VEGF level in patients with digestive system malignancy before intervention was higher than that in the healthy control group.It suggests that the increasd serum level of VEGF may be related to the occurrence and development of digestive system malignant tumors.3.The serum level of VEGF was associated with the SUV_maxax value of primary lesions in patients with digestive system tumor,suggesting that the expression of VEGF may be related to the level of glucose metabolism in tumor.The serum VEGF level was related to the maximum diameter of primary lesions in patients with digestive system tumors,it may be that VEGF expression is related to the tumor proliferation and metastasis.4.There was no significant correlation between the serum level of PCNA and VEGF in digestive system tumor patients before and after interventional therapy.Conclusion:1.¹⁸F-FDG PET/CT imaging can accurately diagnose primary tumors,metastatic lymph nodes and distant metastases of digestive system malignant tumors.It is beneficial to choose a reasonable treatment plan for patients with malignant tumor.2.¹⁸F-FDG PET/CT imaging has a higher detection rate of recurrence and metastatic lesions in digestive system malignancy patients after intervention.It is superior to CT examination and has important reference value for the formulation of next treatment plan for patients.3.The serum level of PCNA is associated with recurrence and metastasis after intervention of digestive system tumors.The serum level of VEGF is closely related to the occurrence,metastasis and glucose metabolism of digestive system malignant tumor.4.There was no significant correlation between the serum expression levels of PCNA and VEGF in patients with digestive system malignant tumor before and after intervention.It needs further research and verification.