Kelly Rosemary F, Tran Thao, Holmstrom Amy, Murar Jozef, Segurola Romualdo J
University of Minnesota, Minneapolis, USA.
Chest. 2004 Apr;125(4):1413-23. doi: 10.1378/chest.125.4.1413.
This retrospective study of patients who were referred for surgical resection of non-small cell lung cancer (NSCLC) assessed the accuracy and cost-effectiveness of positron emission tomography (PET) with radiolabeled [18F]-2-fluoro-deoxy-D-glucose (FDG) in staging mediastinal lymph nodes (MLNs).
From January 2001 to September 2002, 90 patients with suspected or proven NSCLC who had been referred for curative resection were retrospectively reviewed. All patients were without evidence of metastatic disease. Sixty-nine of the 90 patients had undergone thoracic FDG-PET imaging as part of their evaluation and are the focus of this study. Sensitivity, specificity, accuracy, and positive and negative predictive values for metastasis to the MLN were calculated for CT scanning vs FDG-PET scanning. Four algorithms for staging MLN with mediastinoscopy and/or FDG-PET scan were compared.
Sixty-nine patients underwent preoperative CT and FDG-PET scans, and 32 of 69 patients underwent mediastinoscopy. Fifty-seven patients underwent thoracotomy with complete mediastinal lymphadenectomy. Sensitivity, specificity, accuracy, and positive and negative predictive values for CT scans and FDG-PET scans were 46%, 86%, 78%, 43%, and 87%, and 62%, 98%, 91%, 89% and 92%, respectively. Mediastinoscopy was accurate in 32 of 32 patients (100%). Routine mediastinoscopy remains the most economically reasonable strategy with excellent sensitivity. Selective FDG-PET imaging improved the sensitivity of noninvasive staging for patients with normal MLNs on CT scans.
Selective use of FDG-PET imaging improves staging accuracy compared to CT scanning alone and makes it a cost-effective adjunct to the preoperative staging of NSCLC. However, in patients with adenocarcinoma and MLNs of < 1 cm, FDG-PET scanning cannot yet replace mediastinoscopy.
本项针对因非小细胞肺癌（NSCLC）接受手术切除的患者的回顾性研究，评估了使用放射性标记的[18F]-2-氟-脱氧-D-葡萄糖（FDG）的正电子发射断层扫描（PET）在纵隔淋巴结（MLN）分期中的准确性和成本效益。
对2001年1月至2002年9月间90例因疑似或确诊NSCLC而被转诊进行根治性切除的患者进行回顾性分析。所有患者均无转移疾病证据。90例患者中有69例接受了胸部FDG-PET成像作为评估的一部分，这69例患者是本研究的重点。计算了CT扫描与FDG-PET扫描对MLN转移的敏感性、特异性、准确性以及阳性和阴性预测值。比较了使用纵隔镜检查和/或FDG-PET扫描对MLN进行分期的四种算法。
69例患者接受了术前CT和FDG-PET扫描，69例患者中有32例接受了纵隔镜检查。57例患者接受了开胸手术并进行了完整的纵隔淋巴结清扫术。CT扫描和FDG-PET扫描的敏感性、特异性、准确性以及阳性和阴性预测值分别为46%、86%、78%、43%和87%，以及62%、98%、91%、89%和92%。纵隔镜检查在32例患者中的32例（100%）结果准确。常规纵隔镜检查仍然是最经济合理的策略，具有出色的敏感性。选择性FDG-PET成像提高了CT扫描显示MLN正常的患者的非侵入性分期的敏感性。
与单独的CT扫描相比，选择性使用FDG-PET成像提高了分期准确性，并使其成为NSCLC术前分期的一种具有成本效益的辅助手段。然而，对于腺癌且MLN小于1 cm的患者，FDG-PET扫描尚不能取代纵隔镜检查。
