Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, and National Hospital Organization Toneyama Hospital, Osaka, Japan.
Eur J Cardiothorac Surg. 2012 Jul;42(1):89-92. doi: 10.1093/ejcts/ezr287. Epub 2012 Jan 18.
Positron emission tomography with 2-[18F] fluoro-2-deoxy-D-glucose as a tracer and computed tomography (FDG-PET/CT) are utilized for the diagnosis of lymph node (LN) metastasis from lung cancer. In this study, we analyzed the diagnostic ability of FDG-PET for N staging by focusing on the clinical features of false-positive (FP) and false-negative (FN) cases.
From March 2006 to February 2010, 112 patients underwent preoperative examinations using FDG-PET/CT followed by radical resection with hilar and mediastinal dissection. We analyzed their clinicopathological characteristics based on preoperative FDG-PET/CT findings and post-operative histopathological diagnosis of resected LNs.
Based on the PET/CT results, 17 patients were misdiagnosed (9 FN and 8 FP). The sensitivity, specificity, accuracy and negative and positive predictive values for N1/N2 were 50.0, 94.5, 84.0, 93.0 and 58.3%, respectively, whereas those for N2 were 57.8, 90.3, 84.8, 90.3 and 61.1%, respectively. FP findings more frequently occurred in cases with elevated white blood cell (WBC) count (P=0.015) and smokers (P=0.04). In the FN group, the maximum standardized uptake value for the primary tumour was lower than that in the true-positive (TP) group (P=0.01). The short-axis sizes of 71 LNs differently diagnosed by PET/CT and histopathology findings were significantly smaller in the FN group than the TP group (P<0.001), whereas there was no difference between TP and FP. As for FN LNs in the TP group, there was no significant difference.
PET/CT showed a good ability to detect metastatic LNs, especially for N2 diagnosis. However, there were some limitations, especially in cases with elevated peripheral WBC count and/or smoking history.
正电子发射断层扫描（PET）使用 2-[18F]氟-2-脱氧-D-葡萄糖作为示踪剂和计算机断层扫描（FDG-PET/CT）用于诊断肺癌的淋巴结（LN）转移。在这项研究中，我们通过关注假阳性（FP）和假阴性（FN）病例的临床特征，分析了 FDG-PET 对 N 分期的诊断能力。
从 2006 年 3 月至 2010 年 2 月，112 名患者接受了 FDG-PET/CT 术前检查，随后进行了根治性切除手术，包括肺门和纵隔清扫。我们根据术前 FDG-PET/CT 检查结果和术后切除 LN 的组织病理学诊断，对患者的临床病理特征进行了分析。
根据 PET/CT 结果，有 17 例患者被误诊（9 例 FN 和 8 例 FP）。N1/N2 的敏感性、特异性、准确性、阴性和阳性预测值分别为 50.0%、94.5%、84.0%、93.0%和 58.3%，N2 的分别为 57.8%、90.3%、84.8%、90.3%和 61.1%。FP 结果更常发生在白细胞计数升高（WBC）（P=0.015）和吸烟者（P=0.04）的病例中。在 FN 组中，原发肿瘤的最大标准化摄取值（SUVmax）低于真阳性（TP）组（P=0.01）。在 PET/CT 和组织病理学结果不同诊断的 71 个 LN 中，FN 组的短轴直径明显小于 TP 组（P<0.001），而 TP 组与 FP 组之间无差异。对于 TP 组中的 FN LN，没有差异。
PET/CT 显示出检测转移性 LN 的良好能力，特别是对 N2 诊断。然而，存在一些局限性，特别是在白细胞计数升高和/或吸烟史的情况下。
