Shim Sung Shine, Lee Kyung Soo, Kim Byung-Tae, Chung Myung Jin, Lee Eun Jung, Han Joungho, Choi Joon Young, Kwon O Jung, Shim Young Mog, Kim Seonwoo
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Radiology. 2005 Sep;236(3):1011-9. doi: 10.1148/radiol.2363041310. Epub 2005 Jul 12.
To evaluate prospectively the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) with use of fluorodeoxyglucose (FDG), compared with that of stand-alone CT, for the preoperative staging of non-small cell lung cancer, with surgical and histologic findings used as the reference standard.
Institutional review board approval and patient informed consent were obtained. From November 2003 to February 2004, 106 patients (78 men, 28 women; mean age, 56 years) with non-small cell lung cancer underwent curative surgical resection (tumor resection and lymph node dissection) after stand-alone CT followed by integrated FDG PET/CT. Tumor stages were determined by using the TNM and American Joint Committee on Cancer staging systems. Histopathologic results served as the reference standard. Statistically significant differences in tumor staging between integrated PET/CT and stand-alone CT were determined with P < .05 obtained by using the McNemar test or with a generalized estimating equation.
The primary tumor was correctly staged in 84 patients (79%) at stand-alone CT and in 91 patients (86%) at integrated FDG PET/CT (P = .25). For the depiction of malignant nodes, the sensitivity, specificity, and accuracy of CT were 70% (23 of 33 nodal groups), 69% (248 of 360), and 69% (271 of 393), respectively, whereas those of PET/CT were 85% (28 of 33), 84% (302 of 360), and 84% (330 of 393) (P = .25, P < .001, and P < .001, respectively). There were 112 false-positive interpretations at CT for 54 hilar, 16 subcarinal, 29 paratracheal, 10 subaortic, and two pulmonary ligament nodal groups and one upper paratracheal group, compared with only 58 false-positive interpretations at PET/CT for 32 hilar, seven subcarinal, 13 lower paratracheal, and six subaortic nodal groups. There were 10 false-negative interpretations at CT for four hilar, two lower paratracheal, and two subcarinal nodal groups, one prevascular and retrotracheal group, and one inferior pulmonary group, but only five false-negative interpretations at PET/CT (one each for paratracheal, subaortic, subcarinal, inferior pulmonary, and hilar nodal groups).
Integrated FDG PET/CT is significantly better than stand-alone CT for lung cancer staging and provides enhanced accuracy and specificity in nodal staging.
前瞻性评估使用氟脱氧葡萄糖（FDG）的正电子发射断层显像（PET）与计算机断层扫描（CT）融合技术相对于单纯CT用于非小细胞肺癌术前分期的准确性，以手术和组织学检查结果作为参考标准。
获得机构审查委员会批准并取得患者知情同意。2003年11月至2004年2月，106例非小细胞肺癌患者（78例男性，28例女性；平均年龄56岁）在接受单纯CT检查后，再行FDG PET/CT融合检查，然后接受根治性手术切除（肿瘤切除及淋巴结清扫）。使用TNM和美国癌症联合委员会分期系统确定肿瘤分期。组织病理学结果作为参考标准。采用McNemar检验或广义估计方程，以P <.05确定PET/CT与单纯CT在肿瘤分期上的统计学显著差异。
单纯CT对84例患者（79%）的原发肿瘤分期正确，FDG PET/CT对91例患者（86%）的原发肿瘤分期正确（P =.25）。对于恶性淋巴结的显示，CT的敏感性、特异性和准确性分别为70%（33个淋巴结组中的23个）、69%（360个中的248个）和69%（393个中的271个），而PET/CT的敏感性、特异性和准确性分别为85%（33个中的28个）、84%（360个中的302个）和84%（393个中的330个）（分别为P =.25、P <.001和P <.001）。CT对54个肺门、16个隆突下、29个气管旁、10个主动脉弓下和2个肺韧带淋巴结组以及1个气管上组有112例假阳性判断，而PET/CT对32个肺门、7个隆突下、13个气管下和6个主动脉弓下淋巴结组仅有58例假阳性判断。CT对4个肺门、2个气管下和2个隆突下淋巴结组、1个血管前和气管后组以及1个下肺组有10例假阴性判断，而PET/CT仅有5例假阴性判断（气管旁、主动脉弓下、隆突下、下肺和肺门淋巴结组各1例）。
FDG PET/CT融合技术在肺癌分期方面明显优于单纯CT，在淋巴结分期中提供了更高的准确性和特异性。
