在肺部炎症性疾病患病率较高的地区，18F-氟脱氧葡萄糖正电子发射断层显像（FDG PET）成像在非小细胞肺癌术前分期中区分N0或N1期与N2期的附加价值。
The additional value of FDG PET imaging for distinguishing N0 or N1 from N2 stage in preoperative staging of non-small cell lung cancer in region where the prevalence of inflammatory lung disease is high.
作者信息
Turkmen Cuneyt, Sonmezoglu Kerim, Toker Alper, Yilmazbayhan Dilek, Dilege Sukru, Halac Metin, Erelel Mustafa, Ece Turhan, Mudun Ayse
机构信息
Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey.
出版信息
Clin Nucl Med. 2007 Aug;32(8):607-12. doi: 10.1097/RLU.0b013e3180a1ac87.
PURPOSE
The aim of this study was to evaluate the efficacy of PET imaging and compare it with the performance of CT in mediastinal and hilar lymph node staging in potentially operable non-small cell lung cancer (NSCLC).
METHODS
Fifty-nine patients with potentially resectable NSCLC who underwent preoperative PET and CT imaging were enrolled into this prospective study. All patients underwent surgical evaluation by means of mediastinoscopy with mediastinal lymph node sampling (14 patients) or thoracotomy (45 patients).
RESULTS
The prevalence of lymph node metastases was 53%. Overall, the sensitivity, specificity, accuracy, PPV, and NPV of PET were 79%, 76%, 78%, 86%, and 76% for N0 and N1 lymph nodes and 76%, 79%, 80%, 67%, and 83% for N2 lymph nodes, while those values for CT were 66%, 43%, 58%, 68%, and 43% for N0 and N1 stations and 43%, 66%, 54%, 41%, and 66% for N2 lymph nodes, respectively. PET correctly differentiated cases with mediastinal lymph node involvement (N2) from those without such involvement (N0 or N1) in 76% of cases. Statistical analysis of the diagnostic accuracy of nodal involvement showed that PET improves diagnostic accuracy significantly in the detection of both N0 or N1 and N2 status in the individual patient based on analysis, compared with CT (P < 0.01 and P < 0.01, respectively). When preoperative nodal staging was compared with postoperative histopathological staging, 38 (65%) patients were correctly staged, 9 (15%) were overstaged, and 12 (20%) were understaged by PET, while 29 patients (49%) were correctly staged, 13 (22%) were overstaged, and 17 (29%) were understaged by CT.
CONCLUSION
It has been clearly shown that PET is more accurate than CT for the differentiation of N0 or N1 from N2 disease in patients with NSCLC. However, PET imaging alone does not appear to be sufficient to replace mediastinoscopy for mediastinal staging in patients with lung cancer, especially in geographic regions with high granulomatous or inflammatory mediastinal disease prevalence.
目的
本研究旨在评估正电子发射断层显像（PET）成像的疗效，并将其与计算机断层扫描（CT）在潜在可手术的非小细胞肺癌（NSCLC）纵隔和肺门淋巴结分期中的表现进行比较。
方法
59例接受术前PET和CT成像检查的潜在可切除NSCLC患者被纳入这项前瞻性研究。所有患者均通过纵隔镜检查及纵隔淋巴结取样（14例患者）或开胸手术（45例患者）进行手术评估。
结果
淋巴结转移的发生率为53%。总体而言，PET对N0和N1淋巴结的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为79%、76%、78%、86%和76%，对N2淋巴结的这些值分别为76%、79%、80%、67%和83%；而CT对N0和N1区域淋巴结的这些值分别为66%、43%、58%、68%和43%，对N2淋巴结的这些值分别为43%、66%、54%、41%和66%。PET在76%的病例中正确区分了纵隔淋巴结受累（N2）的病例与未受累（N0或N1）的病例。对淋巴结受累诊断准确性的统计分析表明，与CT相比，基于分析，PET在个体患者中检测N0或N1以及N2状态时显著提高了诊断准确性（分别为P < 0.01和P < 0.看你提供的原文最后P < 0.01这里应该是有遗漏，我按照原文翻译了，你可以检查下是否正确。01）。当将术前淋巴结分期与术后组织病理学分期进行比较时，PET正确分期38例（65%）患者，过度分期9例（15%），分期不足12例（20%）；而CT正确分期29例（49%）患者，过度分期13例（22%），分期不足17例（29%）。
结论
已清楚表明，在NSCLC患者中，PET在区分N0或N1与N2疾病方面比CT更准确。然而，单独的PET成像似乎不足以替代纵隔镜检查用于肺癌患者的纵隔分期，特别是在肉芽肿性或炎症性纵隔疾病患病率较高的地区。
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