Line Bruce R, White Charles S
Division of Nuclear Medicine, Department of Radiology, University of Maryland Medical System, 22 South Green Street, Baltimore, MD 21201, USA.
Curr Treat Options Oncol. 2004 Feb;5(1):63-73. doi: 10.1007/s11864-004-0007-5.
The dissemination of positron emission tomography (PET) technology has enabled a functional approach to the evaluation of lung cancer that complements the anatomic assessment provided by chest radiography, computed tomography (CT) scanning, and magnetic resonance imaging. PET has excellent sensitivity and good specificity for the determination of malignancy in the solitary pulmonary nodule, but these data must be weighed against the evidence of instances of false-positive results because of inflammatory lesions and false-negative results in small- or low-metabolism neoplasms. Therefore, PET may not be advisable when these scenarios apply. Furthermore, in a patient with a very high pretest likelihood of lung cancer (eg, a new or enlarging spiculated nodule in a long-time smoker), the value of PET is less certain because a negative result may be discounted. PET has altered the approach to the staging of lung cancer. It adds value to the evaluation of the mediastinum and extrathoracic structures compared to conventional methods by upstaging or downstaging a substantial proportion of patients. If the staging assessment is negative on PET, the use of mediastinoscopy may be obviated in selected cases. Histologic confirmation of positive PET findings should be obtained before excluding patients from curative resection. PET provides incremental information to CT in the evaluation of persistent and recurrent disease, and response measured on PET appears more accurate as a predictor of ultimate survival. The more recent development of PET-CT permits fusion of anatomic and functional information. Early investigations suggest that this strategy provides superior results compared to either technique alone.
正电子发射断层扫描（PET）技术的推广使得对肺癌的评估采用了一种功能方法，该方法补充了胸部X线摄影、计算机断层扫描（CT）和磁共振成像所提供的解剖学评估。PET在确定孤立性肺结节的恶性肿瘤方面具有出色的敏感性和良好的特异性，但这些数据必须与因炎症性病变导致假阳性结果以及小肿瘤或低代谢肿瘤导致假阴性结果的证据相权衡。因此，在这些情况适用时，PET可能并不适用。此外，在肺癌预测试验可能性非常高的患者中（例如，长期吸烟者出现新的或增大的毛刺状结节），PET的价值不太确定，因为阴性结果可能会被忽视。PET改变了肺癌分期的方法。与传统方法相比，它通过对相当一部分患者进行分期上调或下调，为纵隔和胸外结构的评估增加了价值。如果PET分期评估为阴性，在某些情况下可能无需进行纵隔镜检查。在将患者排除在根治性切除之前，应获得PET阳性结果的组织学确认。在评估持续性和复发性疾病时，PET为CT提供了额外信息，并且PET上测量的反应作为最终生存的预测指标似乎更准确。PET-CT的最新发展允许融合解剖学和功能信息。早期研究表明，与单独使用任何一种技术相比，这种策略能提供更好的结果。
