多模态方法在非小细胞肺癌纵隔分期中的应用。PET-CT 的优缺点：一项随机试验。

Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial.

机构信息

Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

出版信息

Thorax. 2011 Apr;66(4):294-300. doi: 10.1136/thx.2010.154476. Epub 2010 Dec 17.

DOI:10.1136/thx.2010.154476

PMID:21169287

Abstract

BACKGROUND

Correct mediastinal staging is a cornerstone in the treatment of patients with non-small cell lung cancer. A large range of methods is available for this purpose, making the process of adequate staging complex. The objective of this study was to describe faults and benefits of positron emission tomography (PET)-CT in multimodality mediastinal staging.

METHODS

A randomised clinical trial was conducted including patients with a verified diagnosis of non-small cell lung cancer, who were considered operable. Patients were assigned to staging with PET-CT (PET-CT group) followed by invasive staging (mediastinoscopy and/or endoscopic ultrasound with fine needle aspiration (EUS-FNA)) or invasive staging without prior PET-CT (conventional work up (CWU) group). Mediastinal involvement (dichotomising N stage into N0-1 versus N2-3) was described according to CT, PET-CT, mediastinoscopy, EUS-FNA and consensus (based on all available information), and compared with the final N stage as verified by thoracotomy or a conclusive invasive diagnostic procedure.

RESULTS

A total of 189 patients were recruited, 98 in the PET-CT group and 91 in the CWU group. In an intention-to-treat analysis the overall accuracy of the consensus N stage was not significantly higher in the PET-CT group than in the CWU group (90% (95% confidence interval 82% to 95%) vs 85% (95% CI 77% to 91%)). Excluding the patients in whom PET-CT was not performed (n=14) the difference was significant (95% (95% CI 88% to 98%) vs 85% (95% CI 77% to 91%), p=0.034). This was mainly based on a higher sensitivity of the staging approach including PET-CT.

CONCLUSION

An approach to lung cancer staging with PET-CT improves discrimination between N0-1 and N2-3. In those without enlarged lymph nodes and a PET-negative mediastinum the patient may proceed directly to surgery. However, enlarged lymph nodes on CT needs confirmation independent of PET findings and a positive finding on PET-CT needs confirmation before a decision on surgery is made.

CLINICAL TRIAL NUMBER

NCT00867412.

摘要

背景

正确的纵隔分期是治疗非小细胞肺癌患者的基石。为此目的提供了多种方法，使得充分分期的过程变得复杂。本研究的目的是描述正电子发射断层扫描（PET-CT）在多模式纵隔分期中的优缺点。

方法

本研究是一项随机临床试验，纳入了经证实患有非小细胞肺癌且被认为可手术的患者。将患者分为接受 PET-CT 分期（PET-CT 组）加侵袭性分期（纵隔镜检查和/或内镜超声引导下细针抽吸（EUS-FNA））或不进行 PET-CT 分期（常规检查（CWU）组）。根据 CT、PET-CT、纵隔镜检查、EUS-FNA 和共识（基于所有可用信息）对纵隔受累（将 N 分期分为 N0-1 与 N2-3）进行描述，并与通过开胸手术或明确的有创诊断程序证实的最终 N 分期进行比较。

结果

共纳入 189 例患者，PET-CT 组 98 例，CWU 组 91 例。意向性治疗分析显示，共识 N 分期的总体准确性在 PET-CT 组与 CWU 组之间无显著差异（90%（95%置信区间 82%至 95%）与 85%（95%CI 77%至 91%））。排除未行 PET-CT 检查的患者（n=14）后，差异具有显著性（95%（95%置信区间 88%至 98%）与 85%（95%CI 77%至 91%），p=0.034）。这主要基于包括 PET-CT 在内的分期方法的更高敏感性。