de Langen Adrianus J, Raijmakers Pieter, Riphagen Ingrid, Paul Marinus A, Hoekstra Otto S
Department of Nuclear Medicine and PET Research, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
Eur J Cardiothorac Surg. 2006 Jan;29(1):26-9. doi: 10.1016/j.ejcts.2005.10.002. Epub 2005 Dec 6.
Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) seems to be superior to computed tomography (CT) in staging the mediastinum in patients with non-small-cell lung cancer (NSCLC). However, recent results suggest that FDG-PET performance characteristics are conditional for nodal size as shown by CT: FDG-PET is more sensitive but less specific with lymph node enlargement on CT. The association between size and the probability of malignancy needs to be known to predict the post-test probabilities after PET, and finally, stratify patients for mediastinoscopy or thoracotomy depending on the PET and CT results. Therefore, we performed a meta-analysis of available studies reporting on the prevalence of metastatic involvement for different size categories of enlarged lymph nodes in patients with NSCLC and were able to include 14 studies. The prevalence of metastatic involvement and conditional test performance of CT and FDG-PET were calculated for lymph nodes measuring 10-15 mm, 16-20 mm and >20 mm. We found a post-test probability for N2 disease of 5% for lymph nodes measuring 10-15 mm on CT in patients with a negative FDG-PET result, suggesting that these patients should be planned for thoracotomy because the yield of mediastinoscopy will be extremely low. For patients with lymph nodes measuring > or =16 mm on CT and a negative FDG-PET result a post-test probability for N2 disease of 21% was found, suggesting that these patients should be planned for mediastinoscopy prior to possible thoracotomy to prevent too many unnecessary thoracotomies in this subset.
18氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在非小细胞肺癌（NSCLC）患者的纵隔分期方面似乎优于计算机断层扫描（CT）。然而，最近的结果表明，FDG-PET的性能特征取决于CT显示的淋巴结大小：FDG-PET对CT显示的淋巴结肿大更敏感，但特异性较低。为了预测PET检查后的验后概率，并最终根据PET和CT结果对患者进行纵隔镜检查或开胸手术分层，需要了解淋巴结大小与恶性概率之间的关联。因此，我们对现有的关于NSCLC患者不同大小类别的肿大淋巴结转移累及患病率的研究进行了荟萃分析，共纳入14项研究。计算了直径为10 - 15mm、16 - 20mm和>20mm的淋巴结的转移累及患病率以及CT和FDG-PET的条件检测性能。我们发现，对于CT显示淋巴结直径为10 - 15mm且FDG-PET结果为阴性的患者，N2疾病的验后概率为5%，这表明这些患者应计划进行开胸手术，因为纵隔镜检查的阳性率将极低。对于CT显示淋巴结直径≥16mm且FDG-PET结果为阴性的患者，N2疾病的验后概率为21%，这表明这些患者应在可能的开胸手术前计划进行纵隔镜检查，以避免该亚组中过多不必要的开胸手术。
