Terauchi Takashi, Murano Takeshi, Daisaki Hiromitsu, Kanou Daisuke, Shoda Hiroko, Kakinuma Ryutaro, Hamashima Chisato, Moriyama Noriyuki, Kakizoe Tadao
Screening Technology and Development Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Ann Nucl Med. 2008 Jun;22(5):379-85. doi: 10.1007/s12149-008-0130-7. Epub 2008 Jul 4.
(18)F-2-deoxy-2-fluoro-D-glucose positron emission tomography (FDG-PET) is a promising screening modality targeting whole body. However, the validity of PET cancer screening remains to be assessed. Even the screening accuracy for whole-body screening using FDG-PET has not been evaluated. In this study, we investigated the screening accuracy of PET cancer screening.
A total of 2911 asymptomatic participants (1629 men and 1282 women, mean age 59.79 years) underwent both FDG-PET and other thorough examinations for multiple organs (gastrofiberscopy, total colonofiberscopy or barium enema, low-dose thin section computed tomography and sputum cytology, abdominal ultrasonography, an assay of prostate-specific antigen, mammography, mammary ultrasonography, Pap smear for the uterine cervix, and magnetic resonance imaging for the endometrium and ovaries) between February 2004 and January 2005, and followed sufficiently. The detection rate, sensitivity, specificity, and positive predictive value of FDG-PET were calculated using cancer data obtained from all examinations along with a 1 year follow-up.
From among 2911 participants FDG-PET found 28 cancers, 129 cancers were PET negative. PET-positive cancers comprised seven colorectal cancers, four lung cancers, four thyroid cancers, three breast cancers, two gastric cancers, two prostate cancers, two small intestinal sarcomas (gastrointestinal stromal tumors), one malignant lymphoma, one head and neck malignancy (nasopharyngeal carcinoid tumor), one thymoma, and one hepatocellular carcinoma. PET-negative cancers included 22 gastric cancers and 20 prostate cancers that were essentially difficult to detect using FDG-PET. The overall detection rate, sensitivity, specificity, and positive predictive value were estimated to be 0.96%, 17.83%, 95.15%, and 11.20%, respectively.
FDG-PET can detect a variety of cancers at an early stage as part of a whole-body screening modality. The detection rate of PET cancer screening was higher than that of other screening modalities, which had already shown evidence of efficacy. However, the sensitivity of PET cancer screening was lower than that of other thorough examinations performed at our institute. FDG-PET has some limitations, and cancer screening using only FDG-PET is likely to miss some cancers.
（18）F - 2 - 脱氧 - 2 - 氟 - D - 葡萄糖正电子发射断层扫描（FDG - PET）是一种很有前景的全身筛查方式。然而，PET癌症筛查的有效性仍有待评估。甚至FDG - PET全身筛查的准确性也尚未得到评估。在本研究中，我们调查了PET癌症筛查的准确性。
2004年2月至2005年1月期间，共有2911名无症状参与者（1629名男性和1282名女性，平均年龄59.79岁）接受了FDG - PET检查以及针对多个器官的其他全面检查（胃镜检查、全结肠镜检查或钡灌肠、低剂量薄层计算机断层扫描和痰细胞学检查、腹部超声检查、前列腺特异性抗原检测、乳房X线摄影、乳腺超声检查、子宫颈巴氏涂片检查以及子宫内膜和卵巢的磁共振成像），并进行了充分的随访。使用所有检查以及1年随访获得的癌症数据计算FDG - PET的检出率、敏感性、特异性和阳性预测值。
在2911名参与者中，FDG - PET发现了28例癌症，129例癌症PET检查为阴性。PET阳性的癌症包括7例结直肠癌、4例肺癌、4例甲状腺癌、3例乳腺癌、2例胃癌、2例前列腺癌、2例小肠肉瘤（胃肠道间质瘤）、1例恶性淋巴瘤、1例头颈部恶性肿瘤（鼻咽类癌肿瘤）、1例胸腺瘤和1例肝细胞癌。PET阴性的癌症包括22例胃癌和20例前列腺癌，这些癌症使用FDG - PET基本上难以检测到。总体检出率、敏感性、特异性和阳性预测值分别估计为0.96%、17.83%、95.15%和11.20%。
作为全身筛查方式的一部分，FDG - PET能够在早期检测出多种癌症。PET癌症筛查的检出率高于其他已显示出疗效证据的筛查方式。然而，PET癌症筛查的敏感性低于我们研究所进行的其他全面检查。FDG - PET存在一些局限性，仅使用FDG - PET进行癌症筛查可能会遗漏一些癌症。
