Kim Byung-Tae, Lee Kyung Soo, Shim Sung Shine, Choi Joon Young, Kwon O Jung, Kim Hojoong, Shim Young Mog, Kim Jhingook, Kim Seonwoo
Department of Nuclear Medicine, Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
Radiology. 2006 Nov;241(2):501-9. doi: 10.1148/radiol.2412051173. Epub 2006 Sep 11.
To prospectively evaluate the sensitivity and specificity of integrated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) (PET/CT) for the preoperative diagnosis of mediastinal nodal metastasis in stage T1 non-small cell lung cancer (NSCLC), with surgical and histologic results as reference standards.
Institutional review board approval and informed consent were obtained. From June 2003 to February 2005, 150 patients (89 men and 61 women; mean age, 59 years) with stage T1 NSCLC at stand-alone CT underwent integrated PET/CT and surgical staging. Two observers (one radiologist and one nuclear medicine physician) evaluated prospectively and in consensus the mediastinal nodes by analyzing both PET (functional) and CT (anatomic) images. Nodal stages were determined by using the American Joint Committee on Cancer staging system and surgical and histologic findings as the reference standard. Statistical evaluation of malignant lymph nodes was performed on per-nodal-station and per-person bases.
A total of 568 mediastinal nodal stations were evaluated. Nodes were positive for malignancy in 34 (23%) of 150 patients and 55 (10%) of 568 nodal stations. For depiction of malignant nodes, the respective sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of integrated PET/CT were 42% (23 of 55), 100% (513 of 513), 100% (23 of 23), 94% (513 of 545), and 94% (536 of 568) on per-nodal-station basis and 47% (16 of 34), 100% (116 of 116), 100% (16 of 16), 87% (116 of 134), and 88% (132 of 150) on a per-patient basis.
Integrated FDG PET/CT provides high specificity and positive predictive value of mediastinal nodal staging in stage T1 NSCLC, although the sensitivity is low.
以手术和组织学结果作为参考标准，前瞻性评估18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）与计算机断层扫描（CT）联合检查（PET/CT）对T1期非小细胞肺癌（NSCLC）纵隔淋巴结转移的术前诊断的敏感性和特异性。
获得机构审查委员会批准并取得患者知情同意。2003年6月至2005年2月，150例T1期NSCLC患者（89例男性，61例女性；平均年龄59岁）在接受独立CT检查后接受PET/CT联合检查及手术分期。两名观察者（一名放射科医生和一名核医学医生）通过分析PET（功能）和CT（解剖）图像，前瞻性地并达成共识地评估纵隔淋巴结。使用美国癌症联合委员会分期系统以及手术和组织学检查结果作为参考标准来确定淋巴结分期。对每个淋巴结站和每位患者的恶性淋巴结进行统计学评估。
共评估了568个纵隔淋巴结站。150例患者中有34例（23%）的淋巴结为恶性，568个淋巴结站中有55个（10%）为恶性。对于恶性淋巴结的显示，PET/CT联合检查在每个淋巴结站基础上的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为42%（55个中的23个）、100%（513个中的513个）、100%（23个中的23个）、94%（545个中的513个）和94%（568个中的536个），在每位患者基础上分别为47%（34个中的16个）、100%（116个中的116个）、100%（16个中的16个）、87%（134个中的116个）和88%（150个中的132个）。
FDG PET/CT联合检查对T1期NSCLC纵隔淋巴结分期具有较高的特异性和阳性预测值，尽管敏感性较低。
