Liu Qi, Peng Zhong-min, Liu Qing-wei, Yao Shu-zhan, Zhang Lin, Meng Long, Chen Jing-han
Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan 250021, China.
Chin Med J (Engl). 2006 Apr 20;119(8):634-9.
Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography (PET) of mediastinal masses in order to evaluate the ability of PET to predict the malignancy of these tumors. We compared histologic findings, videomediastinoscopy, computed tomography (CT), and PET-CT in patients with mediastinal disease.
Thirty-two patients were evaluated with CT, PET-CT and videomediastionoscopy, and all studies were performed within four weeks in each patient. (11)C-choline as a PET tracer was used to visualize masses. PET data were evaluated using the standardized uptake value (SUV) and were compared with pathologic data.
There were 13 men and 19 women aged from 21 to 74 (mean 45.2) years. Among the patients with mediastinal diseases, sarcoidosis was diagnosed in 12 patients, tuberculosis in 5 patients, lymphoma in 5 patients, and noncaseating granulomata without classical "sarcoid" finding in 3 patients. N2 or N3 nodal metastasis was revealed in 6 of 7 patients who had non-small cell lung cancer or suspected lung cancer, and one was negative (the pathological diagnosis was reactive hyperplasia). The accuracies for correctly diagnosing mediastinal masses for CT, PET-CT and videomediastinoscopy were 38% (12/32), 63% (20/32), and 91% (29/32) respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT (chi(2) = 11.130, P < 0.001). The SUVs were similar among these diseases. On the other hand, if the diagnostic classification was benign vs malignancy, the accuracies for CT, PET-CT and videomediastinoscopy were 53% (17/32), 75% (24/32), 100% (32/32) respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT (chi(2) = 22.042, P < 0.001). The SUV of malignant lesions (6.9, 3.2 - 9.8; n = 11) appeared to be higher than that of benign lesions (4.9, 2.9 - 8.3; n = 21), however, this difference was not statistically significant (P = 0.054).
To diagnose lesions located in the middle mediastinum, videomediastinoscopy possesses the highest diagnostic accuracy, and therefore remains the gold standard. PET-CT is valuable for differential diagnosis of benign vs malignant lesions, CT alone or PET alone (SUV) may provide misdiagnosis in a substantial proportion of patients with mediastinal masses.
中纵隔肿块包含多种肿瘤，但也可能提示淋巴结病，因此仍是一个有趣的诊断挑战。我们对纵隔肿块进行了正电子发射断层扫描（PET），以评估PET预测这些肿瘤恶性程度的能力。我们比较了纵隔疾病患者的组织学检查结果、电视纵隔镜检查、计算机断层扫描（CT）和PET-CT。
对32例患者进行了CT、PET-CT和电视纵隔镜检查，所有检查均在每位患者的四周内完成。使用（11）C-胆碱作为PET示踪剂来显示肿块。使用标准化摄取值（SUV）评估PET数据，并与病理数据进行比较。
患者中有13名男性和19名女性，年龄在21至74岁（平均45.2岁）之间。在纵隔疾病患者中，12例诊断为结节病，5例为结核病，5例为淋巴瘤，3例为无典型“结节病”表现的非干酪样肉芽肿。7例患有非小细胞肺癌或疑似肺癌的患者中，6例发现N2或N3淋巴结转移，1例为阴性（病理诊断为反应性增生）。CT、PET-CT和电视纵隔镜检查正确诊断纵隔肿块的准确率分别为38%（12/32）、63%（20/32）和91%（29/32）。电视纵隔镜检查的诊断准确率高于PET-CT（χ² = 11.130，P < 0.001）。这些疾病之间的SUV相似。另一方面，如果诊断分类为良性与恶性，则CT、PET-CT和电视纵隔镜检查的准确率分别为53%（17/32）、75%（24/32）、100%（32/32）。电视纵隔镜检查的诊断准确率高于PET-CT（χ² = 22.042，P < 0.001）。恶性病变的SUV（6.9，3.2 - 9.8；n = 11）似乎高于良性病变（4.9，2.9 - 8.3；n = 21），然而，这种差异无统计学意义（P = 0.054）。
对于诊断位于中纵隔的病变，电视纵隔镜检查具有最高的诊断准确率，因此仍是金标准。PET-CT对于良性与恶性病变的鉴别诊断有价值，单独的CT或单独的PET（SUV）可能会在相当一部分纵隔肿块患者中导致误诊。
