Department of Pulmonary Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
J Thorac Oncol. 2011 Oct;6(10):1704-12. doi: 10.1097/JTO.0b013e3182286d0b.
In computed tomography lung cancer screening programs, up to 30% of all resections are futile.
To investigate whether a preoperative positron emission tomography (PET) after a conclusive or inconclusive nonsurgical workup will reduce the resection rate for benign disease in test-positive participants of a lung cancer screening program.
¹⁸F-Fluorodeoxyglucose-PET scans were made in 220 test positives. Nodules were classified as positive, indeterminate, or negative based on visual comparison with background activity. Gold standard for a positive PET was the presence of cancer in the resection specimen or the detection of cancer during more than 2 years follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated at participant level and 95% confidence intervals (CIs) constructed.
The sensitivity of PET to detect cancer was 84.2% (95% CI: 77.6-90.7%), the specificity 75.2% (95% CI: 67.1-83.3), the positive predictive value 78.9% (95% CI: 71.8-86.0), and the NPV 81.2% (95% CI: 73.6-88.8). The resection rate for benign disease was 23%, but 26% of them had a diagnosis with clinical consequences. A preoperative PET after an inconclusive nonsurgical workup reduced the resection rate for benign lesions by 11 to 15%, at the expense of missing 12 to 18% lung cancer cases. A preoperative PET after a conclusive nonsurgical workup reduced the resection rate by 78% at the expense of missing 3% lung cancer cases.
A preoperative PET scan in participants with an inconclusive nonsurgical workup is not recommended because of the very low NPV, but after a conclusive nonsurgical workup, the resection rate for benign disease can be decreased by 72%.
在计算机断层扫描肺癌筛查计划中，多达 30%的切除手术是徒劳的。
研究术前正电子发射断层扫描（PET）对非手术检查结果不确定或明确的肺癌筛查计划中检测阳性者的良性疾病切除率是否有影响。
对 220 名检测阳性者进行 ¹⁸F-氟脱氧葡萄糖-PET 扫描。根据与背景活动的视觉比较，将结节分为阳性、不确定或阴性。正电子的金标准是切除标本中存在癌症或在超过 2 年的随访中检测到癌症。在参与者水平和 95%置信区间（CI）计算灵敏度、特异性、阳性预测值和阴性预测值（NPV）。
PET 检测癌症的灵敏度为 84.2%（95%CI：77.6-90.7%），特异性为 75.2%（95%CI：67.1-83.3%），阳性预测值为 78.9%（95%CI：71.8-86.0%），NPV 为 81.2%（95%CI：73.6-88.8%）。良性疾病的切除率为 23%，但其中 26%有临床意义的诊断。在非手术检查结果不确定的情况下进行术前 PET 检查可将良性病变的切除率降低 11-15%，但会错过 12-18%的肺癌病例。在非手术检查结果明确的情况下进行术前 PET 检查可将良性病变的切除率降低 78%，但会错过 3%的肺癌病例。
在非手术检查结果不确定的情况下，不建议对参与者进行术前 PET 扫描，因为其 NPV 非常低，但在非手术检查结果明确的情况下，良性疾病的切除率可降低 72%。
