Booth Karen, Hanna Gerard G, McGonigle Niall, McManus Kieran G, McGuigan James, O'Sullivan Joe, Lynch Tom, McAleese Jonathan
Department of Thoracic Surgery, Royal Victoria Hospital, Belfast.
Ulster Med J. 2013 May;82(2):75-81.
PET/CT scanning can determine suitability for curative therapy and inform decision making when considering radical therapy in patients with non-small cell lung cancer (NSCLC). Metastases to central mediastinal lymph nodes (N2) may alter such management decisions. We report a 2 year retrospective series assessing N2 lymph node staging accuracy with PET/CT compared to pathological analysis at surgery.
Patients with NSCLC attending our centre (excluding those who had induction chemotherapy) who had staging PET/CT scans and pathological nodal sampling between June 2006 and June 2008 were analysed. For each lymph node assessed pathologically, the corresponding PET/CT status was determined. 64 patients with 200 N2 lymph nodes were analysed.
Sensitivity of PET/CT scans for indentifying involved N2 lymph nodes was 39%, specificity 96% and overall accuracy 90%. For individual lymph node analysis, logistic regression demonstrated a significant linear association between PET/CT sensitivity and time from scanning to surgery (p=0.031) but not for specificity and accuracy. Those scanned <9 weeks before pathological sampling were significantly more sensitive (64% >9 weeks, 0% ≥ 9 weeks, p=0.013) and more accurate (94% <9 weeks, 81% ≥ 9 weeks, p=0.007). Differences in specificity were not seen (97% <9 weeks, 91% ≥ 9 weeks, p=0.228). No significant difference in specificity was found at any time point.
We recommend that if a PET/CT scan is older than 9 weeks, and management would be altered by the presence of N2 nodes, re-staging of the mediastinum should be undertaken.
正电子发射断层显像/X线计算机体层摄影（PET/CT）扫描可确定非小细胞肺癌（NSCLC）患者是否适合进行根治性治疗，并为考虑根治性治疗时的决策提供依据。中央纵隔淋巴结转移（N2）可能会改变此类治疗决策。我们报告了一项为期2年的回顾性研究系列，评估PET/CT对N2淋巴结分期的准确性，并与手术病理分析结果进行比较。
分析2006年6月至2008年6月期间在本中心就诊的NSCLC患者（不包括接受诱导化疗的患者），这些患者均进行了分期PET/CT扫描及病理淋巴结取样。对于每个经病理评估的淋巴结，确定其相应的PET/CT状态。分析了64例患者的200个N2淋巴结。
PET/CT扫描识别受累N2淋巴结的敏感性为39%，特异性为96%，总体准确率为90%。对于单个淋巴结分析，逻辑回归显示PET/CT敏感性与扫描至手术的时间之间存在显著线性关联（p=0.031），但特异性和准确率不存在这种关联。在病理取样前<9周进行扫描的患者敏感性显著更高（<9周为64%，≥9周为0%，p=0.013），准确率也更高（<9周为94%，≥9周为81%，p=0.007）。未观察到特异性的差异（<9周为97%，≥9周为91%，p=0.228）。在任何时间点均未发现特异性有显著差异。
我们建议，如果PET/CT扫描时间超过9周，且N2淋巴结的存在会改变治疗方案，则应重新进行纵隔分期。
