Lee Benjamin Enoch, von Haag Derek, Lown Teri, Lau Derick, Calhoun Royce, Follette David
Division of Cardiothoracic Surgery, University of California at Davis, Cancer Center, Sacramento, Calif 95817, USA.
J Thorac Cardiovasc Surg. 2007 Mar;133(3):746-52. doi: 10.1016/j.jtcvs.2006.10.043.
Pretreatment staging of patients with non-small cell lung cancer is critically important in determining an appropriate treatment plan. As positron emission tomography (PET) and computed tomography (CT) are proven complementary modalities in clinical staging, recent advances in PET technology have brought forth integrated PET/CT as the new standard. We tested the hypothesis that improvements in PET technology have not increased the sensitivity or specificity of PET in the staging of non-small cell lung cancer to an extent that surgical staging is no longer required.
This is a retrospective, single-institution review of 336 patients from 1995 to 2005 with biopsy-proven non-small cell lung cancer who underwent [18F] fluoro-2-deoxy-D-glucose-PET before mediastinal lymph node sampling by cervical mediastinoscopy or thoracotomy. Clinical records, histopathologic reports, and PET findings were reviewed. Data were analyzed by the Pearson chi2 test.
Within the study population, 210 patients had routine PET and 126 had integrated PET/CT. For detecting mediastinal metastases the sensitivities of PET versus integrated PET/CT were 61.1% versus 85.7% (P < .05), specificities were 94.3% versus 80.6% (P < .001), positive predictive values were 68.8% versus 55.8%, negative predictive values were 92.1% versus 95.2%, and overall accuracy was 88.6% versus 81.7%.
Improvements in PET technology have increased integrated PET/CT sensitivity at the cost of significantly decreased specificity. Although it may appear that integrated PET/CT incurs fewer false negative results, the dramatic increase in false positive results reinforces the notion that integrated PET/CT should be used only as an adjunct to clinical staging and that surgical staging remains the gold standard in non-small cell lung cancer.
非小细胞肺癌患者的治疗前分期对于确定合适的治疗方案至关重要。由于正电子发射断层扫描（PET）和计算机断层扫描（CT）在临床分期中已被证明是互补的检查方式，PET技术的最新进展催生了一体化PET/CT成为新标准。我们检验了这样一个假设：PET技术的改进并未使PET在非小细胞肺癌分期中的敏感性或特异性提高到不再需要手术分期的程度。
这是一项对1995年至2005年间336例经活检证实为非小细胞肺癌患者的回顾性单机构研究，这些患者在通过颈部纵隔镜检查或开胸手术进行纵隔淋巴结采样之前接受了[18F]氟-2-脱氧-D-葡萄糖-PET检查。回顾了临床记录、组织病理学报告和PET检查结果。数据采用Pearson卡方检验进行分析。
在研究人群中，210例患者进行了常规PET检查，126例患者进行了一体化PET/CT检查。对于检测纵隔转移，PET与一体化PET/CT的敏感性分别为61.1%和85.7%（P <.05），特异性分别为94.3%和80.6%（P <.001），阳性预测值分别为68.8%和55.8%，阴性预测值分别为92.1%和95.2%，总体准确率分别为88.6%和81.7%。
PET技术的改进提高了一体化PET/CT的敏感性，但代价是特异性显著降低。尽管一体化PET/CT似乎产生的假阴性结果较少，但假阳性结果的大幅增加强化了这样一种观念，即一体化PET/CT仅应作为临床分期的辅助手段使用，手术分期仍然是非小细胞肺癌的金标准。
