Port Jeffrey L, Andrade Rafael S, Levin Matthew A, Korst Robert J, Lee Paul C, Becker David E, Altorki Nasser K
Department of Cardiothoracic Surgery, Weill-Cornell Medical Center, New York, NY 10021, USA.
J Thorac Cardiovasc Surg. 2005 Dec;130(6):1611-5. doi: 10.1016/j.jtcvs.2005.07.014.
Several studies have suggested that positron emission tomography is more accurate than computed tomography for the staging of non-small cell lung cancer and can reduce the rate of unnecessary thoracotomy in patients with potentially resectable disease. However, there are few data on the utility of positron emission tomography in the diagnosis of patients with tumors of 2 cm or less in size.
Patients with cT1/cT2 tumors of 2 cm or less in size were retrospectively reviewed. All had a computed tomographic scan, as well as a positron emission tomographic scan on a dedicated scanner, with a standard uptake value reported. A standard uptake value of 2.5 g/mL or greater was considered positive. The results of computed tomography and positron emission tomography were correlated with pathologic results after either resection (n = 60) or mediastinoscopy (n = 4).
Sixty-four patients (38 women; mean age, 66 years) had a mean tumor size of 1.4 cm (range, 0.7-2.0 cm). Forty-three patients had adenocarcinoma, 13 had adenocarcinoma-bronchioloalveolar carcinoma, 5 had squamous cell carcinoma, and 3 had other tumor types. Twenty-nine (45%) tumors had negative positron emission tomographic results. Both tumor size (>1 cm vs < or =1 cm) and cell type (adenocarcinoma-bronchioloalveolar carcinoma vs all other cell types) were significant predictors of positron emission tomography uptake in the primary tumor (P = .05 and .01, respectively). Nodal metastases were detected pathologically in 11 (17%) patients (5 N1 and 6 N2). Positron emission tomographic sensitivity and specificity for nodal metastases were only 45% and 89%, respectively. There was no statistically demonstrable survival difference between positron emission tomography-positive and positron emission tomography-negative tumors (3-year survival of 87% vs 100%, respectively).
Positron emission tomographic scanning has no demonstrable benefit in the diagnosis, staging, or prognosis of patients with tumors of 2 cm or less in size.
多项研究表明，在非小细胞肺癌分期方面，正电子发射断层扫描（PET）比计算机断层扫描（CT）更准确，并且可以降低具有潜在可切除疾病患者的不必要开胸手术率。然而，关于PET在诊断大小为2 cm或更小的肿瘤患者中的效用的数据很少。
对大小为2 cm或更小的cT1/cT2肿瘤患者进行回顾性研究。所有患者均进行了CT扫描以及在专用扫描仪上进行的PET扫描，并报告了标准摄取值。标准摄取值为2.5 g/mL或更高被视为阳性。CT和PET的结果与切除术后（n = 60）或纵隔镜检查后（n = 4）的病理结果相关。
64例患者（38例女性；平均年龄66岁），平均肿瘤大小为1.4 cm（范围0.7 - 2.0 cm）。43例患者为腺癌，13例为腺癌 - 细支气管肺泡癌，5例为鳞状细胞癌，3例为其他肿瘤类型。29个（45%）肿瘤的PET结果为阴性。肿瘤大小（>1 cm对≤1 cm）和细胞类型（腺癌 - 细支气管肺泡癌对所有其他细胞类型）都是原发肿瘤中PET摄取的重要预测因素（分别为P = 0.05和0.01）。病理检测发现11例（17%）患者有淋巴结转移（5例N1和6例N2）。PET对淋巴结转移的敏感性和特异性分别仅为45%和89%。PET阳性和PET阴性肿瘤之间在统计学上没有可证明的生存差异（3年生存率分别为87%和100%）。
PET扫描在诊断、分期或预后方面对大小为2 cm或更小的肿瘤患者没有明显益处。
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