Yang Wenfeng, Fu Zheng, Yu Jinming, Yuan Shuanghu, Zhang Baijiang, Li Daotang, Xing Ligang, Zhao Dongbo, Mu Dianbin, Sun Xiaorong, Fang Yufang, Huang Yong, Li Wanhu
Department of Thoracic Surgery, Shandong Cancer Hospital and Institute, Jinan 250117, Shandong Province, China.
Lung Cancer. 2008 Jul;61(1):35-43. doi: 10.1016/j.lungcan.2007.11.007. Epub 2008 Jan 4.
To compare the diagnostic efficacies of integrated (18)F FDG PET/CT images and contrast-enhanced helical CT images in locoregional lymph node metastasis in the patients with non-small cell lung cancer (NSCLC).
From June 2005 to June 2007, 122 potentially operable patients with proven or suspected non-small cell lung cancer underwent integrated PET/CT and contrast-enhanced CT scans followed by surgical nodal staging. The results of reviewing PET/CT and enhanced CT images for the locoregional lymph node metastasis were compared in relation to pathologic findings.
Preoperative nodal staging was compared with postoperative histopathological staging, 80% (98 of 122) of patients correctly staged, 13% (16 of 122) of patients were overstaged, and 7% (8 of 122) were understaged by PET/CT, while those values for CT were 56% (68 of 122), 26% (32 of 122), and 18% (22 of 122), respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for lymph nodes were 86%, 85%, 85%, 64%, 95%, respectively; compared with 69%, 71%, 70%, 43%, 88% for CT (P=0.000, 0.000, 0.000, 0.001, 0.001, respectively). 81% false-negative interpretations and 72% false-positive interpretations on CT were corrected by PET/CT. 57% false-negative interpretations and 45% false-positive interpretations on PET/CT were corrected by CT. 6 % (9 of 153) positive lymph nodes and 8% (40 of 486) negative nodes at pathology were incorrectly diagnosed both by PET/CT and CT.
Integrated PET/CT improves the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value than enhanced CT in the assessment of locoregional lymph nodes, and provides more efficient and accurate data of nodal staging, with a better effect on diagnosis and therapy in non-small cell lung cancer.
比较18F FDG PET/CT融合图像与对比增强螺旋CT图像对非小细胞肺癌（NSCLC）患者局部区域淋巴结转移的诊断效能。
2005年6月至2007年6月，122例经证实或怀疑为非小细胞肺癌且可能适合手术的患者接受了PET/CT融合扫描及对比增强CT扫描，随后进行手术淋巴结分期。将PET/CT和增强CT图像对局部区域淋巴结转移的检查结果与病理结果进行比较。
将术前淋巴结分期与术后组织病理学分期进行比较，PET/CT对80%（122例中的98例）患者分期正确，13%（122例中的16例）患者分期过高，7%（122例中的8例）患者分期过低；而CT的相应比例分别为56%（122例中的68例）、26%（122例中的32例）和18%（122例中的22例）。PET/CT对淋巴结的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为86%、85%、85%、64%、95%；而CT的相应值分别为69%、71%、70%、43%、88%（P值分别为0.000、0.000、0.000、0.001、0.001）。PET/CT纠正了CT上81%的假阴性判读和72%的假阳性判读。CT纠正了PET/CT上57%的假阴性判读和45%的假阳性判读。病理检查为阳性的淋巴结中有6%（153个中的9个）以及病理检查为阴性的淋巴结中有8%（486个中的40个）被PET/CT和CT均误诊。
在评估局部区域淋巴结方面，PET/CT融合成像比增强CT提高了敏感性、特异性、准确性、阳性预测值和阴性预测值，能提供更有效、准确的淋巴结分期数据，对非小细胞肺癌的诊断和治疗有更好的效果。
