Veterans Affairs Medical Center, Nashville, Tennessee; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.
Ann Thorac Surg. 2014 Apr;97(4):1142-8. doi: 10.1016/j.athoracsur.2013.12.043. Epub 2014 Feb 25.
Fluorodeoxyglucose-positron emission tomography (FDG-PET) is recommended for diagnosis and staging of non-small cell lung cancer (NSCLC). Meta-analyses of FDG-PET diagnostic accuracy demonstrated sensitivity of 96% and specificity of 78% but were performed in select centers, introducing potential bias. This study evaluates the accuracy of FDG-PET to diagnose NSCLC and examines differences across enrolling sites in the national American College of Surgeons Oncology Group (ACOSOG) Z4031 trial.
Between 2004 and 2006, 959 eligible patients with clinical stage I (cT1-2 N0 M0) known or suspected NSCLC were enrolled in the Z4031 trial, and with a baseline FDG-PET available for 682. Final diagnosis was determined by pathologic examination. FDG-PET avidity was categorized into avid or not avid by radiologist description or reported maximum standard uptake value. FDG-PET diagnostic accuracy was calculated for the entire cohort. Accuracy differences based on preoperative size and by enrolling site were examined.
Preoperative FDG-PET results were available for 682 participants enrolled at 51 sites in 39 cities. Lung cancer prevalence was 83%. FDG-PET sensitivity was 82% (95% confidence interval, 79 to 85) and specificity was 31% (95% confidence interval, 23% to 40%). Positive and negative predictive values were 85% and 26%, respectively. Accuracy improved with lesion size. Of 80 false-positive scans, 69% were granulomas. False-negative scans occurred in 101 patients, with adenocarcinoma being the most frequent (64%), and 11 were 10 mm or less. The sensitivity varied from 68% to 91% (p=0.03), and the specificity ranged from 15% to 44% (p=0.72) across cities with more than 25 participants.
In a national surgical population with clinical stage I NSCLC, FDG-PET to diagnose lung cancer performed poorly compared with published studies.
氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）被推荐用于诊断和分期非小细胞肺癌（NSCLC）。FDG-PET 诊断准确性的荟萃分析显示，其敏感性为 96%，特异性为 78%，但这些分析是在特定中心进行的，可能存在偏倚。本研究评估了 FDG-PET 诊断 NSCLC 的准确性，并检查了美国外科医师学院肿瘤学组（ACOSOG）Z4031 试验中不同入组地点之间的差异。
2004 年至 2006 年，959 名符合条件的临床 I 期（cT1-2 N0 M0）已知或疑似 NSCLC 患者被纳入 Z4031 试验，其中 682 名患者基线时可进行 FDG-PET 检查。最终诊断通过病理检查确定。FDG-PET 摄取程度由放射科医生描述或报告的最大标准摄取值分为摄取活跃或不活跃。计算了整个队列的 FDG-PET 诊断准确性。根据术前大小和入组地点检查了准确性差异。
51 个城市的 51 个地点的 682 名参与者术前 FDG-PET 结果可用。肺癌患病率为 83%。FDG-PET 的敏感性为 82%（95%置信区间，79%至 85%），特异性为 31%（95%置信区间，23%至 40%）。阳性和阴性预测值分别为 85%和 26%。准确性随病变大小而提高。80 个假阳性扫描中，69%为肉芽肿。101 例出现假阴性扫描，其中最常见的是腺癌（64%），11 例小于或等于 10mm。敏感性从 68%到 91%不等（p=0.03），特异性从 15%到 44%不等（p=0.72），这取决于参与者超过 25 人的城市。
在一个具有临床 I 期 NSCLC 的全国性手术人群中，FDG-PET 诊断肺癌的表现不如已发表的研究。
