Yang Wen-feng, Tan Guo-zhu, Fu Zheng, Yu Jin-ming
Department of Thoracic Surgery, Shandong Cancer Hospital, Jinan 250117, China.
Zhonghua Zhong Liu Za Zhi. 2009 Dec;31(12):925-8.
To evaluate the clinical value of (18)F-FDG PET-CT and enhanced CT imaging for staging of regional lymph node metastasis in non-small cell lung cancer (NSCLC) patients.
122 patients with proven or suspected NSCLC underwent integrated PET-CT and enhanced CT scan before surgery. The results of lymph node metastasis diagnosed by PET-CT and CT were compared and analyzed according to the results of histopathological examination.
PET-CT showed correctly lymph node staging in 80.3% of cases, overstaged in 13.1%, and understaged in 6.6%, while 55.8%, 26.2% and 18.0% by CT, respectively. The sensitivity, specificity, and accuracy of PET-CT for lymph node staging was 86.3%, 85.0% and 85.3%, respectively, while the corresponding data were 68.6%, 71.0% and 70.4% by CT, respectively (P < 0.01). 81.3% of false-negative and 71.6% false-positive lymph nodes by CT were interpreted correctly by PET-CT, while 57.1% of false-negative and 45.2% of false-positive lymph nodes by PET-CT were correctly diagnosed by CT. 5.9% of PET-CT-diagnosed negative lymph nodes were pathologically proven to be positive with small cancer foci and below 10 mm in diameter, while 8.2% of pathologically proven negative lymph nodes with inflammation, high FDG uptake and exceeding 10 mm (15 mm in subcarnial nodes) in diameter were false-positive on both PET-CT and CT imaging, therefore, these lymph nodes were still in the common blind area of diagnosis by both of PET-CT and CT.
Compared with enhanced CT, integrated PET-CT improves the accuracy and is helpful to correct some CT-diagnosed false-positive and false-negative lymph nodes. But CT is also beneficial supplementation to PET-CT for assessment of regional lymph node metastasis. The combination of PET-CT and CT can make up the shortage of both of them in staging of regional lymph nodes in NSCLC patients.
评估18F-FDG PET-CT及增强CT成像在非小细胞肺癌（NSCLC）患者区域淋巴结转移分期中的临床价值。
122例确诊或疑似NSCLC患者在手术前行PET-CT及增强CT扫描。根据组织病理学检查结果，对PET-CT及CT诊断的淋巴结转移结果进行比较分析。
PET-CT正确显示淋巴结分期的病例占80.3%，分期过高的占13.1%，分期过低的占6.6%；而CT分别为55.8%、26.2%和18.0%。PET-CT对淋巴结分期的敏感性、特异性和准确性分别为86.3%、85.0%和85.3%，而CT相应的数据分别为68.6%、71.0%和70.4%（P<0.01）。CT诊断为假阴性的淋巴结中81.3%和假阳性的淋巴结中71.6%被PET-CT正确判断，而PET-CT诊断为假阴性的淋巴结中57.1%和假阳性的淋巴结中45.2%被CT正确诊断。PET-CT诊断为阴性的淋巴结中5.9%经病理证实有直径小于10 mm的微小癌灶为阳性，而病理证实为阴性的淋巴结中8.2%因炎症、FDG摄取高且直径超过10 mm（纵隔淋巴结直径超过15 mm）在PET-CT及CT成像上均为假阳性，因此，这些淋巴结仍是PET-CT及CT诊断的共同盲区。
与增强CT相比，PET-CT联合成像提高了准确性，有助于纠正一些CT诊断的假阳性和假阴性淋巴结。但CT对PET-CT评估区域淋巴结转移也是有益的补充。PET-CT与CT联合可弥补二者在NSCLC患者区域淋巴结分期中的不足。
