Chang Cheng-Yu, Chang Shu-Ju, Chang Shih-Chieh, Yuan Mei-Kang
Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Clin Respir J. 2013 Jan;7(1):1-6. doi: 10.1111/j.1752-699X.2012.00290.x. Epub 2012 Apr 26.
Early detection trials with chest radiography and sputum cytology were ineffective in decreasing lung cancer mortality. The advent of low-dose spiral chest computed tomography (LDCT) provided clinicians with a new tool that could be with early diagnosis; however, this also raised significant concerns regarding the systematic use of LDCT with its high false-positive rate for benign nodules. At this time, there is limited information about the true role of PET (positron emission tomography) for early detection of lung cancer.
We used systematic methods, including Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, to identify relevant studies, assess study eligibility, evaluate study methodological quality, and summarize findings regarding diagnostic accuracy and outcome.
In total, only seven eligible studies were selected from 82 potentially relevant studies. The sensitivity of 18F-FDG-PET for the detection of T1 lung cancers ranged between 68% and 95%. The rate of detection tended to be lower for carcinoid tumors, adenocarcinoma and bronchoalveolar cell carcinomas. FDG-PET using SUV (standardized uptake value) level can predict the outcome of the screening detected lung cancer. A combination of FDG-PET and LDCT may improve screening for lung cancer in high-risk patients.
PET or PET/CT may be used as a useful tool for early detection of lung cancer in high-risk population based on the existing information. However, there is still limited information with regards to evidence of survival benefits from PET screening in high-risk patients.
胸部X线摄影和痰细胞学的早期检测试验在降低肺癌死亡率方面效果不佳。低剂量螺旋胸部计算机断层扫描（LDCT）的出现为临床医生提供了一种可用于早期诊断的新工具；然而，这也引发了对系统使用LDCT的重大担忧，因为其对良性结节的假阳性率很高。目前，关于正电子发射断层扫描（PET）在肺癌早期检测中的真正作用的信息有限。
我们采用系统的方法，包括系统评价和Meta分析的首选报告项目声明，来识别相关研究、评估研究资格、评价研究方法质量，并总结关于诊断准确性和结果的研究发现。
总共从82项潜在相关研究中仅筛选出7项符合条件的研究。18F-FDG-PET检测T1期肺癌的敏感性在68%至95%之间。类癌肿瘤、腺癌和支气管肺泡细胞癌的检测率往往较低。使用标准化摄取值（SUV）水平的FDG-PET可以预测筛查发现的肺癌的预后。FDG-PET与LDCT联合使用可能会改善高危患者的肺癌筛查。
根据现有信息，PET或PET/CT可作为高危人群肺癌早期检测的有用工具。然而，关于PET筛查高危患者生存获益证据的信息仍然有限。
