Department of Radiology, Gentofte University Hospital, Niels Andersens vej 65, 2900 Hellerup, Denmark.
Thorax. 2011 Apr;66(4):315-9. doi: 10.1136/thx.2010.136747. Epub 2010 Dec 17.
In lung cancer screening the ability to distinguish malignant from benign nodules is a key issue. This study evaluates the ability of positron emission tomography (PET) and volume doubling time (VDT) to discriminate between benign and malignant nodules.
From the Danish Lung Cancer Screening Trial, participants with indeterminate nodules who were referred for a 3-month rescan were investigated. Resected nodules and indolent nodules (ie, stable for at least 2 years) were included. Between the initial scan and the 3-month rescan, participants were referred for PET. Uptake on PET was categorised as most likely benign to malignant (grades I-IV). VDT was calculated from volume measurements on repeated CT scans using semiautomated pulmonary nodule evaluation software. Receiver operating characteristic (ROC) analyses were used to determine the sensitivity and specificity of PET and VDT.
A total of 54 nodules were included. The prevalence of lung cancer was 37%. In the multivariate model both PET (OR 2.63, p<0.01) and VDT (OR 2.69, p<0.01) were associated with lung cancer. The sensitivities and specificities of both PET and VDT were 71% and 91%, respectively. Cut-off points for malignancy were PET>II and VDT<1 year, respectively. Combining PET and VDT resulted in a sensitivity of 90% and a specificity of 82%; ROC cut-off point was either PET or VDT indicating malignancy.
PET and VDT predict lung cancer independently of each other. The use of both PET and VDT in combination is recommended when screening for lung cancer with low-dose CT.
在肺癌筛查中，能够区分良恶性结节是一个关键问题。本研究评估正电子发射断层扫描（PET）和体积倍增时间（VDT）区分良恶性结节的能力。
从丹麦肺癌筛查试验中，选择了因不确定结节而被转诊进行 3 个月复查的参与者进行研究。包括切除结节和惰性结节（即至少稳定 2 年）。在初次扫描和 3 个月复查之间，参与者被转诊进行 PET 检查。PET 摄取分为最可能良性到恶性（等级 I-IV）。VDT 是使用半自动化肺部结节评估软件从重复 CT 扫描的体积测量中计算出来的。使用接收者操作特征（ROC）分析来确定 PET 和 VDT 的敏感性和特异性。
共纳入 54 个结节。肺癌的患病率为 37%。在多变量模型中，PET（OR 2.63，p<0.01）和 VDT（OR 2.69，p<0.01）均与肺癌相关。PET 和 VDT 的敏感性和特异性分别为 71%和 91%。恶性肿瘤的截断值分别为 PET>II 和 VDT<1 年。PET 和 VDT 的联合使用可提高敏感性至 90%，特异性为 82%；ROC 截断值为 PET 或 VDT 表示恶性肿瘤。
PET 和 VDT 可独立预测肺癌。在使用低剂量 CT 进行肺癌筛查时，建议同时使用 PET 和 VDT。
