Department of Thoracic and Cardiovascular Surgery, CHU Nantes, l'institut du thorax, Nantes, France.
Eur J Cardiothorac Surg. 2009 Oct;36(4):731-6. doi: 10.1016/j.ejcts.2009.05.044. Epub 2009 Jul 25.
Mediastinal lymph node staging determines the treatment strategy for non-small-cell lung cancer. This study aims to evaluate prospectively the accuracy of preoperative integrated 18-fluoro-2-deoxy-D-glucose positron emission tomography-computerised tomography ((18)FDG PET-CT) for mediastinal lymph node staging.
Preoperative integrated (18)FDG PET-CT was used to analyse mediastinal lymph nodes in patients with non-small-cell lung cancer. Nodal stations were identified according to the American Thoracic Society mapping system. Lymph nodes with a standardised uptake value (SUVmax) >3 were considered to be positive. The mediastinal lymph nodes were harvested during lung resection and the results of integrated (18)FDG PET-CT were compared to the mediastinal lymph node histology results.
A total of 51 patients were enrolled in this study. The mean interval between integrated (18)FDG PET-CT and surgery was 31+/-15.8 days (range: 2-78 days). The mean mediastinal lymph node harvested and station number per patient during surgery were 11.8+/-5.6 (range: 2-27) and 3.8+/-1 (range: 2-6), respectively. The incidence of N2 pathological disease was 19.6%. The integrated (18)FDG PET-CT sensitivity and specificity were 40+/-30% and 85+/-11%, respectively. The positive and negative predictive values were 40+/-30% and 85+/-11%, respectively. False-positive results (six patients) were mainly due to inflammatory lymph nodes. False-negative results (six patients) were mainly due to infra-centimetrical, malignant lymph node invasion.
The sensitivity of integrated (18)FDG PET-CT for mediastinal lymph node staging in patients selected for surgery is low. When positive mediastinal lymph nodes are detected, invasive mediastinal staging must be performed. On the other hand, the specificity is high: patients with negative integrated (18)FDG PET-CT can be operated upon without invasive mediastinal staging.
纵隔淋巴结分期决定了非小细胞肺癌的治疗策略。本研究旨在前瞻性评估术前整合 18-氟-2-脱氧-D-葡萄糖正电子发射断层扫描-计算机断层扫描（18FDG PET-CT）在纵隔淋巴结分期中的准确性。
术前整合 18FDG PET-CT 用于分析非小细胞肺癌患者的纵隔淋巴结。根据美国胸科学会的图谱系统确定淋巴结站。标准摄取值（SUVmax）>3 的淋巴结被认为是阳性的。在肺切除术中采集纵隔淋巴结，并将整合 18FDG PET-CT 的结果与纵隔淋巴结组织学结果进行比较。
本研究共纳入 51 例患者。整合 18FDG PET-CT 与手术之间的平均间隔时间为 31+/-15.8 天（范围：2-78 天）。手术期间患者平均采集的纵隔淋巴结数量和站位数分别为 11.8+/-5.6（范围：2-27）和 3.8+/-1（范围：2-6）。N2 病理性疾病的发生率为 19.6%。整合 18FDG PET-CT 的灵敏度和特异性分别为 40+/-30%和 85+/-11%。阳性和阴性预测值分别为 40+/-30%和 85+/-11%。假阳性结果（6 例）主要是由于炎症性淋巴结。假阴性结果（6 例）主要是由于小于 1 厘米的恶性淋巴结侵犯。
在选择手术的患者中，整合 18FDG PET-CT 对纵隔淋巴结分期的灵敏度较低。当检测到阳性纵隔淋巴结时，必须进行有创性纵隔分期。另一方面，特异性较高：阴性整合 18FDG PET-CT 的患者可以进行手术而无需进行有创性纵隔分期。
