Kodama Hiroshi, Yamakado Koichiro, Takaki Haruyuki, Suzawa Naohisa, Yamada Tomomi, Takeda Kan
Department of Radiology, Mie University School of Medicine, Tsu, Japan.
Nucl Med Commun. 2013 Jul;34(7):689-93. doi: 10.1097/MNM.0b013e328361cd28.
The aim of the study was to evaluate prospectively the clinical impact of 2-(F)-fluoro-2-deoxy-D-glucose (F-FDG) PET/computed tomography (CT) on the pretreatment assessment of patients with colorectal lung metastasis before radiofrequency (RF) ablation.
The institutional review board approved this prospective study. The eligibility criteria for lung RF ablation were the presence of five or fewer colorectal lung metastases with a maximum tumor size of 3 cm and absence of extrapulmonary lesions. Lung RF ablation candidates who underwent pretreatment PET/CT studies were included. The incidence of detection of unexpected recurrent lesions on PET/CT was evaluated, along with its impact on subsequent treatments. Factors linked with the incidence of unexpected recurrent lesions were evaluated using univariate and multivariate analyses.
Between October 2008 and June 2011, 60 patients were enrolled. Among the unexpected abnormal F-FDG accumulations found in 13 patients (21.7%), presence of extrapulmonary lesions was proved in 12 patients (20.0%, 12/60), prompting treatment strategy changes. One false-positive case was found (1.7%, 1/60). The sensitivity, specificity, and accuracy in detecting unexpected lesions by PET/CT were, respectively, 100, 97.9, and 98.3%. Elevation of the serum carcinoembryonic antigen level (>6.0 ng/ml) was the only significant factor linked with unexpected lesions in both univariate (P=0.02) and multivariate analyses (P=0.02).
A PET/CT study should be performed in patients with colorectal lung metastasis before selecting them for lung RF ablation, especially when the carcinoembryonic antigen level is elevated.
本研究旨在前瞻性评估2-(F)-氟-2-脱氧-D-葡萄糖（F-FDG）正电子发射断层显像/计算机断层扫描（PET/CT）对结直肠癌肺转移患者射频（RF）消融术前评估的临床影响。
机构审查委员会批准了这项前瞻性研究。肺RF消融的入选标准为结直肠癌肺转移灶为5个或更少，最大肿瘤直径为3 cm，且无肺外病变。纳入接受PET/CT预处理研究的肺RF消融候选者。评估PET/CT上意外复发病变的检出率及其对后续治疗的影响。采用单因素和多因素分析评估与意外复发病变发生率相关的因素。
2008年10月至2011年6月，共纳入60例患者。在13例患者（21.7%）中发现意外的异常F-FDG积聚，其中12例患者（20.0%，12/60）被证实存在肺外病变，促使治疗策略改变。发现1例假阳性病例（1.7%，1/60）。PET/CT检测意外病变的敏感性、特异性和准确性分别为100%、97.9%和98.3%。血清癌胚抗原水平升高（>6.0 ng/ml）是单因素分析（P=0.02）和多因素分析（P=0.02）中与意外病变相关的唯一显著因素。
对于结直肠癌肺转移患者，在选择进行肺RF消融之前应进行PET/CT检查，尤其是当癌胚抗原水平升高时。
