Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2010 Aug;195(2):370-6. doi: 10.2214/AJR.09.3772.
We aimed to compare the incremental value of FDG PET/CT over CT for the assessment of mediastinal nodal status between patients with non-small cell lung cancer (NSCLC) and idiopathic pulmonary fibrosis (IPF) and those with NSCLC but without IPF.
Forty-two patients with NSCLC and IPF (mean age, 66 years) were matched to 168 patients with NSCLC but without IPF (mean age, 65 years). Patients underwent surgical mediastinal nodal staging after both integrated PET/CT and contrast-enhanced CT scans had been obtained. Histopathologic nodal assessment served as the reference standard.
PET/CT had better specificity (91% [29/32 patients] vs 47% [15/32]; p = 0.0002) and accuracy (83% [35/42] vs 50% [21/42]; p = 0.001) than CT did in patients with IPF. In patients without IPF, PET/CT was better than CT alone with regard to sensitivity (62% [26/42] vs 40% [17/42]; p = 0.0067), specificity (96% [121/126] vs 84% [106/126]; p = 0.0002), and accuracy (88% [147/168] vs 73% [123/168]; p < 0.0001). Thus, the incremental accuracy of PET/CT, which was 33% (14/42) for patients with IPF and 14% (24/168) for patients without IPF (p = 0.0041), was mainly the result of improved specificity.
PET/CT offers significantly increased accuracy versus CT in mediastinal nodal staging in patients with NSCLC and IPF compared with patients with NSCLC but without IPF, mainly because of improved specificity.
本研究旨在比较正电子发射断层扫描/计算机断层扫描（PET/CT）与 CT 对特发性肺纤维化（IPF）合并非小细胞肺癌（NSCLC）患者与单纯 NSCLC 患者纵隔淋巴结状态评估的增量价值。
42 例合并 IPF 的 NSCLC 患者（平均年龄 66 岁）与 168 例单纯 NSCLC 患者（平均年龄 65 岁）相匹配。所有患者均在完成 PET/CT 与增强 CT 扫描后接受外科纵隔淋巴结分期。以组织病理学淋巴结评估为参考标准。
在合并 IPF 的患者中，与 CT 相比，PET/CT 的特异性（91%[29/32 例] vs. 47%[15/32 例]；p=0.0002）和准确性（83%[35/42 例] vs. 50%[21/42 例]；p=0.001）更高。在不合并 IPF 的患者中，与 CT 相比，PET/CT 在灵敏度（62%[26/42 例] vs. 40%[17/42 例]；p=0.0067）、特异性（96%[121/126 例] vs. 84%[106/126 例]；p=0.0002）和准确性（88%[147/168 例] vs. 73%[123/168 例]；p<0.0001）方面均表现更佳。因此，对于合并 IPF 的患者，PET/CT 较 CT 的增量准确性为 33%（14/42），而对于不合并 IPF 的患者为 14%（24/168）（p=0.0041），这主要是因为特异性提高。
与 CT 相比，PET/CT 可显著提高合并 IPF 的 NSCLC 患者与单纯 NSCLC 患者纵隔淋巴结分期的准确性，这主要归因于特异性的提高。
