Department of General Thoracic Surgery, Hospital Clinico y Provincial of Barcelona, University of Barcelona, Barcelona, Spain.
Eur J Cardiothorac Surg. 2010 May;37(5):1168-74. doi: 10.1016/j.ejcts.2009.12.013. Epub 2010 Jan 29.
This study sought to assess the real incidence of pN2 among patients with non-small-cell lung cancer (NSCLC) (cN0) with negative mediastinal uptake of 2-deoxy-2-(18F)-fluoro-o-glucose (FDG).
During 30 consecutive months (January 2007-May 2009), all patients with NSCLC scheduled for surgery in our unit had a preoperative FDG-positron emission tomography (PET)/computed tomography (CT) in our institution, after a dedicated chest CT (n=259). Only patients with both FDG-PET/CT and negative dedicated chest CT scan (N1 and N2 nodes <1cm) were prospectively included (n=125). Patients with cN1/cN2/cN3 and patients who had undergone preoperative chemo-radiotherapy were excluded. No invasive surgical staging was carried out in this group and curative resection plus systematic mediastinal dissection was performed except in the event of unexpected oncological contraindication. All variables were collected prospectively and, when pathological information was obtained, all the cases were carefully reviewed.
Mediastinal assessment by FDG-PET/CT, negative predictive value (NPV) was 85.6%, confidence interval (CI): [77-91]; false negatives (FNs) for mediastinal lymph nodes involvement was 14.4% (18 cases). The pN2 stations most frequently involved were: 4R (six cases), seven (six cases) and five (five cases). Multiple-level pN2 occurred in six (4.8%) cases. Occult (pN2) lymph nodes were more frequent in women (p<0.01), adenocarcinoma (p<0.05) and pN1 (p<0.05). Pathological N2 prevalence for pN1 was 34 (27.7%). Considering pathological staging as the gold standard, the agreement was 70% and 47.5% for stage IA and IB (Kappa's index: 0.72 and 0.76) and, in all patients, 47% (Kappa's index: 0.27). In general, down-staging is more frequent than up-staging.
Mediastinal staging of NSCLC by FDG-PET/CT showed a considerable incidence of FNs. NPV is lower than previously reported and the preoperative mediastinal staging by 18FDG-PET/CT may jeopardise the accurate treatment for early stage NSCLC patients.
本研究旨在评估正电子发射断层扫描（PET）/计算机断层扫描（CT）评估非小细胞肺癌（NSCLC）患者（cN0）的纵隔摄取情况，以评估 2-脱氧-2-（18F）-氟-D-葡萄糖（FDG）阴性的 pN2 真实发生率。
在 30 个月的时间里（2007 年 1 月至 2009 年 5 月），我院所有拟行手术的 NSCLC 患者均在我院行术前 FDG-PET/CT 检查（n=259）。前瞻性纳入仅行 FDG-PET/CT 且阴性的专用胸部 CT 扫描（N1 和 N2 节点<1cm）的患者（n=125）。排除 cN1/cN2/cN3 患者和接受术前放化疗的患者。该组未进行任何有创性外科分期，行根治性切除术加系统纵隔清扫术，除非有意外的肿瘤学禁忌证。前瞻性收集所有变量，获得病理信息后，仔细审查所有病例。
FDG-PET/CT 评估纵隔，阴性预测值（NPV）为 85.6%，置信区间（CI）：[77-91]；假阴性（FN）为 14.4%（18 例）。最常涉及的 pN2 站为：4R（6 例）、7（6 例）和 5（5 例）。6 例（4.8%）出现多水平 pN2。隐匿性（pN2）淋巴结在女性中更常见（p<0.01），腺癌中更常见（p<0.05），pN1 中更常见（p<0.05）。pN1 的病理 N2 发生率为 34 例（27.7%）。考虑到病理分期为金标准，IA 期和 IB 期的一致性为 70%和 47.5%（Kappa 指数：0.72 和 0.76），在所有患者中，一致性为 47%（Kappa 指数：0.27）。总体而言，降期比升期更常见。
FDG-PET/CT 对 NSCLC 的纵隔分期显示出相当高的 FN 发生率。NPV 低于以往报道，18FDG-PET/CT 术前纵隔分期可能危及早期 NSCLC 患者的准确治疗。
