（18）F-FDG PET/CT 对肺鳞癌或腺癌患者纵隔转移性淋巴结的评估作用。
The role of (18)F-FDG PET/CT for evaluation of metastatic mediastinal lymph nodes in patients with lung squamous-cell carcinoma or adenocarcinoma.
机构信息
Department of PET/CT, The Affiliated Tumor Hospital of Harbin Medical University, 150 Haping Road, Nangang District, Harbin 150081, Heilongjiang Province, China.
Department of Radiological Diagnosis, The Affiliated Tumor Hospital of Harbin Medical University, 150 Haping Road, Nangang District, Harbin, Heilongjiang Province, China.
出版信息
Lung Cancer. 2014 Jul;85(1):53-8. doi: 10.1016/j.lungcan.2014.04.004. Epub 2014 Apr 18.
OBJECTIVES
To evaluate the efficacy of (18)F-FDG PET/CT in depicting metastatic mediastinal lymph nodes in patients with lung squamous-cell carcinoma (LSCC) or lung adenocarcinoma (LAC) in a tuberculosis-endemic country.
METHODS
This study retrospectively reviewed patients with LSCC or LAC, who underwent preoperative (18)F-FDG PET/CT to assess mediastinal lymph node metastasis. Patients with the short-axis of mediastinal lymph node≤15mm were included. PET/CT interpretation was analyzed in two ways. Firstly, with CT for anatomical localization, lymph nodes showing greater (18)F-FDG uptake than vessel pool on PET were regarded malignant. Secondly, lymph nodes with positive uptake on PET were considered malignant, only when nodes had neither calcification nor higher attenuation than vessel pool on CT.
RESULTS
One hundred and sixteen LSCCs and 234 LACs were evaluated. With CT for anatomical localization, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET were 78.6%, 45.5%, 53.4%, 31.4% and 87.0% in LSCC group, and 61.8%, 66.3%, 65.0%, 42.9% and 80.9% in LAC group. PET showed higher specificity and accuracy in LAC group compared with LSCC group (p=0.001 and p=0.038, respectively). Considering calcification or high attenuation on CT, the sensitivity, specificity, accuracy, PPV and NPV of PET/CT were 71.4%, 67.0%, 68.1%, 40.8% and 88.1% in LSCC group, and 54.4%, 86.1%, 76.9%, 61.7% and 82.2% in LAC group. Compared with PET, PET/CT possessed higher specificity and accuracy in LSCC group (p=0.000 and p=0.000, respectively), and higher specificity, accuracy and PPV in LAC group (p=0.000, p=0.000 and p=0.022, respectively).
CONCLUSIONS
(18)F-FDG PET displays limited efficacy in assessing mediastinal lymph node metastasis with the short-axis diameter <15mm in LSCC and LAC groups and higher false-positivity in LSCC group. The specificity and accuracy in LSCC and LAC groups are enhanced by interpreting attenuation characteristic on CT.
目的
评估（18）F-FDG PET/CT 在评估结核病流行国家的肺鳞癌（LSCC）或肺腺癌（LAC）患者纵隔转移性淋巴结中的疗效。
方法
本研究回顾性分析了接受术前（18）F-FDG PET/CT 评估纵隔淋巴结转移的 LSCC 或 LAC 患者。纳入短轴直径≤15mm 的纵隔淋巴结患者。PET/CT 解读采用两种方法进行。首先，采用 CT 进行解剖定位，PET 上摄取（18）F-FDG 高于血管池的淋巴结被认为是恶性的。其次，当淋巴结既无钙化又无高于 CT 上血管池的衰减时，PET 上显示阳性摄取的淋巴结被认为是恶性的。
结果
共评估了 116 例 LSCC 和 234 例 LAC。采用 CT 进行解剖定位，PET 在 LSCC 组中的灵敏度、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为 78.6%、45.5%、53.4%、31.4%和 87.0%，在 LAC 组中的灵敏度、特异性、准确性、PPV 和 NPV 分别为 61.8%、66.3%、65.0%、42.9%和 80.9%。PET 在 LAC 组中的特异性和准确性均高于 LSCC 组（p=0.001 和 p=0.038）。考虑到 CT 上的钙化或高衰减，PET/CT 在 LSCC 组中的灵敏度、特异性、准确性、PPV 和 NPV 分别为 71.4%、67.0%、68.1%、40.8%和 88.1%，在 LAC 组中的灵敏度、特异性、准确性、PPV 和 NPV 分别为 54.4%、86.1%、76.9%、61.7%和 82.2%。与 PET 相比，PET/CT 在 LSCC 组中的特异性和准确性更高（p=0.000 和 p=0.000），在 LAC 组中的特异性、准确性和 PPV 更高（p=0.000、p=0.000 和 p=0.022）。
结论
（18）F-FDG PET 在评估 LSCC 和 LAC 组中短轴直径<15mm 的纵隔淋巴结转移方面显示出有限的疗效，且 LSCC 组的假阳性率较高。通过解释 CT 上的衰减特征，LSCC 和 LAC 组的特异性和准确性得到提高。
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