Nguyen Phan, Bhatt Manoj, Bashirzadeh Farzad, Hundloe Justin, Ware Robert, Fielding David, Ravi Kumar Aravind S
Department of Thoracic Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St Lucia, Queensland, Australia.
Respirology. 2015 Jan;20(1):129-37. doi: 10.1111/resp.12409. Epub 2014 Sep 28.
There is widespread adoption of FDG-PET/CT in staging of lung cancer, but no universally accepted criteria for classifying thoracic nodes as malignant. Previous studies show high negative predictive values, but reporting criteria and positive predictive values varies. Using Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) results as gold standard, we evaluated objective FDG-PET/CT criteria for interpreting mediastinal and hilar nodes and compared this to expert visual interpretation (EVI).
A retrospective review of all patients with lung cancer who had both FDG-PET/CT and EBUS-TBNA from 2008 to 2010 was performed. Scan interpretation was blinded to histology. Patients from 2008/2009 were used for the prediction set. The validation set analysed patients from 2010. Objective FDG-PET/CT criteria were SUVmax lymph node (SUVmaxLN), ratio SUVmaxLN/SUVmax primary lung malignancy, ratio SUVmaxLN/SUVaverage liver, ratio SUVmaxLN/SUVmax liver and ratio SUVmaxLN/SUVmax blood pool. A nuclear medicine physician reviewed all scans and classified nodal stations as benign or malignant.
Eighty-seven malignant lymph nodes and 41 benign nodes were in the prediction set. All objective FDG-PET/CT criteria analysed were significantly higher in the malignant group (P < 0.0001). EVI correctly classified 122/128 nodes (95.3%). Thirty-four malignant nodes and 19 benign nodes were in the validation set. The new proposed cut-off values of the objective criteria from the prediction set correctly classified 44/53 (83.0%) nodes: 28/34 (82.4%) malignant nodes and 16/19 (84.2%) benign nodes. EVI had 91% accuracy: 33/34 (97.1%) malignant nodes and 15/19 (79.0%) benign nodes.
Objective analysis of 18-F FDG PET/CT can differentiate between malignant and benign nodes but is not superior to EVI.
氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在肺癌分期中已被广泛应用，但对于将胸部淋巴结分类为恶性尚无普遍接受的标准。既往研究显示其具有较高的阴性预测值，但报告标准和阳性预测值各不相同。以支气管内超声引导下经支气管针吸活检（EBUS-TBNA）结果作为金标准，我们评估了用于解读纵隔和肺门淋巴结的客观FDG-PET/CT标准，并将其与专家视觉解读（EVI）进行比较。
对2008年至2010年期间同时接受FDG-PET/CT和EBUS-TBNA检查的所有肺癌患者进行回顾性研究。扫描解读对组织学结果保密。2008/2009年的患者用于预测集。验证集分析2010年的患者。客观的FDG-PET/CT标准包括淋巴结最大标准摄取值（SUVmaxLN）、SUVmaxLN/原发性肺恶性肿瘤SUVmax比值、SUVmaxLN/肝脏平均SUV比值、SUVmaxLN/肝脏SUVmax比值以及SUVmaxLN/血池SUVmax比值。一名核医学医师对所有扫描结果进行审查，并将淋巴结站分类为良性或恶性。
预测集中有87个恶性淋巴结和41个良性淋巴结。所有分析的客观FDG-PET/CT标准在恶性组中均显著更高（P < 0.0001）。EVI正确分类了122/128个淋巴结（95.3%）。验证集中有34个恶性淋巴结和19个良性淋巴结。预测集中新提出的客观标准临界值正确分类了44/53个（83.0%）淋巴结：28/34个（82.4%）恶性淋巴结和16/19个（84.2%）良性淋巴结。EVI的准确率为91%：33/34个（97.1%）恶性淋巴结和15/19个（79.0%）良性淋巴结。
对18-F FDG PET/CT进行客观分析能够区分恶性和良性淋巴结，但并不优于EVI。
