Sivrikoz C M, Ak I, Simsek F S, Döner E, Dündar E
Department of Thoracic Surgery, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey.
Thorac Cardiovasc Surg. 2012 Mar;60(2):116-21. doi: 10.1055/s-0030-1271148. Epub 2011 Jun 20.
In this study, we aimed to define the efficacy of F-18 FDG PET/CT for the detection of mediastinal lymph node metastases by comparing the mediastinal findings of F-18 FDG PET/CT with the histopathological results obtained either by mediastinoscopy or thoracotomy in patients with clinically operable non-small cell lung cancer (NSCLC).
This is a prospective, single-institution study of 68 consecutive patients with suspected or pathologically proven, localized, clinically resectable NSCLC (8 females and 60 males; mean age: 60.36 ± 1.01 years, range: 43-78 years). The patients underwent integrated PET/CT scanning at the same PET center. Standard cervical mediastinoscopy and extended mediastinoscopy were performed to sample the lymph nodes. During thoracotomy, complete mediastinal lymph node dissection was routinely performed.
Mediastinoscopy gave true positive results in 9 patients and true negative results in 57 patients. There were two false negative results. Mediastinoscopy had a sensitivity of 81.8% (95% CI: 63-82), a specificity of 100% (95% CI: 96-100), a PPV of 100% (95% CI: 77-100), a NPV of 96.6% (95% CI: 93-96), and an accuracy of 97% for the detection of mediastinal lymph node metastases. When PET/CT results were compared with postoperative pathological examination results, PET/CT correctly identified 48 out of 50 patients (96%) who did not have metastatic lymph node involvement. N2/N3 disease was correctly determined by PET/CT in 8 of 11 patients (72.7%) who had positive results on histological analysis. When only N2 and N3 nodal diseases were included in the calculation with the aim of making a comparison with mediastinoscopy (for mediastinal nodes), integrated PET/CT had a sensitivity of 72.7% (95% CI: 51-80), a specificity of 97.7% (95% CI: 92-99), a PPV of 88.9% (95% CI: 62-97), a NPV of 93.3% (95% CI: 88-95) and an accuracy of 92.6% (95% 83-95) for the detection of intrathoracic N2 and N3 nodal metastases.
Our data shows that due to its high sensitivity and accuracy, mediastinoscopy is still the most reliable method to evaluate mediastinal lymph nodes in patients with NSCLC.
在本研究中，我们旨在通过比较F-18 FDG PET/CT的纵隔检查结果与经纵隔镜检查或开胸手术获得的组织病理学结果，来确定F-18 FDG PET/CT在检测临床可手术的非小细胞肺癌（NSCLC）患者纵隔淋巴结转移方面的疗效。
这是一项在单一机构进行的前瞻性研究，连续纳入68例疑似或经病理证实的局限性、临床可切除的NSCLC患者（8例女性，60例男性；平均年龄：60.36±1.01岁，范围：43 - 78岁）。患者在同一PET中心接受PET/CT联合扫描。进行标准颈部纵隔镜检查和扩大纵隔镜检查以获取淋巴结样本。在开胸手术期间，常规进行完整的纵隔淋巴结清扫。
纵隔镜检查在9例患者中给出真阳性结果，在57例患者中给出真阴性结果。有2例假阴性结果。纵隔镜检查对纵隔淋巴结转移检测的敏感性为81.8%（95%CI：63 - 82），特异性为100%（95%CI：96 - 100），阳性预测值为100%（95%CI：77 - 100），阴性预测值为96.6%（95%CI：93 - 96），准确性为97%。当将PET/CT结果与术后病理检查结果进行比较时，PET/CT正确识别了50例无转移性淋巴结受累患者中的48例（96%）。PET/CT在组织学分析结果为阳性的11例患者中的8例（72.7%）中正确判定了N2/N3疾病。当仅将N2和N3淋巴结疾病纳入计算以与纵隔镜检查（针对纵隔淋巴结）进行比较时，PET/CT联合扫描对胸内N2和N3淋巴结转移检测的敏感性为72.7%（95%CI：51 - 80），特异性为97.7%（95%CI：92 - 99），阳性预测值为88.9%（95%CI：62 - 97），阴性预测值为93.3%（95%CI：88 - 95），准确性为92.6%（95%CI：83 - 95）。
我们的数据表明，由于其高敏感性和准确性，纵隔镜检查仍然是评估NSCLC患者纵隔淋巴结最可靠的方法。
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