Schumacher T, Brink I, Mix M, Reinhardt M, Herget G, Digel W, Henke M, Moser E, Nitzsche E
Division of Nuclear Medicine, Albert Ludwigs University, Medical Center, Freiburg, Germany.
Eur J Nucl Med. 2001 Apr;28(4):483-8. doi: 10.1007/s002590100474.
The staging procedures for small cell lung cancer do not differ appreciably from those for other forms of lung cancer. For practical purposes, the TNM stages are usually collapsed into a simple binary classification: limited disease and extensive disease. This study was performed to answer the question of whether fluorine-18 labelled 2-deoxy-2-D-glucose positron emission tomography (FDG-PET) imaging permits appropriate work-up (including both primary and follow-up staging) of patients presenting with small cell lung cancer, as compared with currently recommended staging procedures. Thirty-six FDG-PET examinations were performed in 30 patients with histologically proven small cell lung cancer. Twenty-four patients were examined for primary staging while four were imaged for therapy follow-up only. Two patients underwent both primary staging and up to four examinations for therapy follow-up. Static PET imaging was performed according to a standard protocol. Image reconstruction was based on an ordered subset expectation maximization algorithm including post-injection segmented attenuation correction. Results of FDG-PET were compared with those of the sum of other staging procedures. Identical results from FDG-PET and the sum of the other staging procedures were obtained in 23 of 36 examinations (6x limited disease, 12x extensive disease, 5x no evidence of disease). In contrast to the results of conventional staging, FDG-PET indicated extensive disease resulting in an up-staging in seven patients. In one patient in whom there was no evidence for tumour on conventional investigations following treatment, FDG-PET was suggestive of residual viability of the primary tumour. Furthermore, discordant results were observed in five patients with respect to lung, bone, liver and adrenal gland findings, although in these cases the results did not affect staging as limited or extensive disease. Moreover, FDG-PET appeared to be more sensitive for the detection of metastatic mediastinal and hilar lymph nodes and bone metastases. Finally, all findings considered suspicious for tumour involvement on the other staging procedures were also detected by FDG-PET. It is concluded that FDG-PET has potential for use as a simplified staging tool for small cell lung cancer.
小细胞肺癌的分期程序与其他形式肺癌的分期程序并无明显差异。出于实际目的，TNM分期通常简化为简单的二元分类：局限期疾病和广泛期疾病。本研究旨在回答与当前推荐的分期程序相比，氟-18标记的2-脱氧-2-D-葡萄糖正电子发射断层扫描（FDG-PET）成像是否能对小细胞肺癌患者进行适当的检查（包括初始分期和随访分期）这一问题。对30例经组织学证实为小细胞肺癌的患者进行了36次FDG-PET检查。24例患者接受了初始分期检查，4例仅进行了治疗随访成像。2例患者既接受了初始分期检查，又进行了多达4次治疗随访检查。静态PET成像按照标准方案进行。图像重建基于有序子集期望最大化算法，包括注射后分段衰减校正。将FDG-PET的结果与其他分期程序结果的总和进行比较。在36次检查中的23次（局限期疾病6例、广泛期疾病12例、无疾病证据5例），FDG-PET与其他分期程序结果的总和相同。与传统分期结果相反，FDG-PET显示广泛期疾病，导致7例患者分期上调。在1例患者中，治疗后传统检查未发现肿瘤证据，但FDG-PET提示原发肿瘤有残余活性。此外，在5例患者的肺、骨、肝和肾上腺检查结果方面观察到不一致的情况，尽管在这些病例中结果并未影响局限期或广泛期疾病的分期。此外，FDG-PET似乎对检测纵隔和肺门转移淋巴结及骨转移更敏感。最后，FDG-PET也检测到了其他分期程序中所有被认为可疑有肿瘤累及的发现。结论是，FDG-PET有潜力作为小细胞肺癌的简化分期工具。
