Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong Province, China.
Clin Lung Cancer. 2012 Jul;13(4):312-20. doi: 10.1016/j.cllc.2011.09.005. Epub 2011 Dec 17.
Carbon-11 ((11)C)-choline positron emission tomography/computed tomography (PET/CT) is a new diagnostic method for detecting lung cancer. To prove whether it is superior to enhanced CT, we compared the diagnostic efficacy of these 2 approaches in 108 patients with pulmonary lesions and drew the conclusion that (11)C-choline PET/CT is not better at diagnosing primary lesions but is better at lymph node staging. This helps us to fully understand (11)C-choline PET/CT.
This study compares the diagnostic abilities of integrated (11)C-choline PET/CT imaging and contrast-enhanced helical CT imaging in pulmonary lesions and locoregional lymph node metastases in patients with lung cancer.
One hundred eight patients with proven or suspected lung cancer underwent integrated (11)C-choline PET/CT and contrast-enhanced CT, followed by surgical resection and nodal staging.
The (11)C-choline PET/CT and CT diagnoses of pulmonary lesions and locoregional lymph node metastases were compared with pathologic findings, which revealed benign lesions in 26 patients (tuberculoma [8 patients], inflammatory pseudotumor [7 patients], hamartoma [6 patients], sclerosing hemangioma [4 patients], and pulmonary sequestration [1 patient]) and lung cancers in 82 patients (adenocarcinoma [39 patients], squamous cell carcinoma [23 patients], carcinoid [7 patients], small-cell lung cancer [5 patients], adenosquamous carcinoma [5 patients], and large-cell lung cancer [3 patients]). The accuracy, sensitivity, and specificity of (11)C-choline PET/CT for diagnosing lung cancer were 82.4%, 85.4%, and 73.1%, respectively, compared with 73.1%, 76.8%, and 61.5%, respectively, for CT. Differences between (11)C-choline PET/CT and CT in diagnosing lung cancer were not statistically significant (p = .503, .118, and .375, respectively). We used receiver operating characteristic (ROC) curve for analysis, finding the ROC of standard uptake value (SUV(max)) for diagnosing lung cancer. The cutoff value of SUV(max) was 3.54. Preoperative nodal staging was compared with postoperative histopathologic staging. (11)C-choline PET/CT correctly staged 80.5% of patients, 12.2% were overstaged, and 7.3% were understaged; for CT these values were 58.5%, 24.4%, and 17.1%, respectively. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (11)C-choline PET/CT for lymph nodes were 83.8%, 82.4%, 84.1%, 50.3%, and 96.1%, respectively, compared with 69.3%, 63.7%, 71.2%, 30.2%, 91.0%, respectively, for CT.
Differences in the accuracy, sensitivity, specificity, PPV, and NPV between (11)C-choline PET/CT and CT are thus statistically significant for nodal staging (p = .003, .007, .000, .000, and .004, respectively). Although (11)C-choline PET/CT is not significantly better at diagnosing pulmonary lesions than is enhanced CT, (11)C-choline PET/CT has improved sensitivity, specificity, accuracy, PPV, and NPV relative to enhanced CT in the evaluation of locoregional lymph nodes.
¹¹C-胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）是一种用于检测肺癌的新诊断方法。为了证明它是否优于增强 CT，我们比较了这两种方法在 108 例肺部病变患者中的诊断效果，并得出¹¹C-胆碱 PET/CT 诊断原发性病变并不优于增强 CT，但淋巴结分期更好的结论。这有助于我们全面了解¹¹C-胆碱 PET/CT。
本研究比较了¹¹C-胆碱 PET/CT 与增强螺旋 CT 在肺癌患者肺部病变和局部淋巴结转移中的诊断能力。
108 例经证实或疑似肺癌患者接受了¹¹C-胆碱 PET/CT 和增强 CT 检查，随后进行了手术切除和淋巴结分期。
¹¹C-胆碱 PET/CT 和 CT 对肺部病变和局部淋巴结转移的诊断结果与病理结果进行了比较，其中 26 例患者为良性病变（结核瘤[8 例]、炎性假瘤[7 例]、错构瘤[6 例]、硬化性血管瘤[4 例]和肺隔离症[1 例]），82 例患者为肺癌（腺癌[39 例]、鳞状细胞癌[23 例]、类癌[7 例]、小细胞肺癌[5 例]、腺鳞癌[5 例]、大细胞肺癌[3 例]）。¹¹C-胆碱 PET/CT 诊断肺癌的准确性、敏感性和特异性分别为 82.4%、85.4%和 73.1%，而 CT 分别为 73.1%、76.8%和 61.5%。¹¹C-胆碱 PET/CT 和 CT 诊断肺癌的差异无统计学意义（p =.503，.118，.375）。我们使用了接收器工作特征（ROC）曲线进行分析，得出了用于诊断肺癌的标准摄取值（SUV(max)）的 ROC。SUV(max)的截断值为 3.54。术前淋巴结分期与术后组织病理学分期进行了比较。¹¹C-胆碱 PET/CT 正确分期 80.5%的患者，12.2%的患者分期过高，7.3%的患者分期过低；CT 分别为 58.5%、24.4%和 17.1%。¹¹C-胆碱 PET/CT 对淋巴结的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 83.8%、82.4%、84.1%、50.3%和 96.1%，而 CT 分别为 69.3%、63.7%、71.2%、30.2%、91.0%。
¹¹C-胆碱 PET/CT 与 CT 在淋巴结分期方面的准确性、敏感性、特异性、PPV 和 NPV 差异具有统计学意义（p =.003，.007，.000，.000，和.004）。尽管¹¹C-胆碱 PET/CT 在诊断肺部病变方面并不优于增强 CT，但¹¹C-胆碱 PET/CT 在评价局部淋巴结方面具有更高的敏感性、特异性、准确性、PPV 和 NPV。
