Wang Zixing, Wang Yuyan, Sui Xin, Zhang Wei, Shi Ruihong, Zhang Yingqiang, Dang Yonghong, Qiao Zhen, Zhang Biao, Song Wei, Jiang Jingmei
Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100005, China.
Eur J Radiol. 2015 Jul;84(7):1371-7. doi: 10.1016/j.ejrad.2015.03.025. Epub 2015 Mar 28.
Widely used (18)F 2'-deoxy-2'-fluoro-d-glucose (FDG) positron emission tomography (PET) can be problematic with false positives in cancer imaging. This study aims to investigate the diagnostic accuracy of a candidate PET tracer, (18)F 2',3'-dideoxy-3'-fluoro-2-thiothymidine (FLT), in diagnosing pulmonary lesions compared with FDG.
After comprehensive search and study selection, a meta-analysis was performed on data from 548 patients pooled from 17 studies for evaluating FLT accuracy, in which data from 351 patients pooled from ten double-tracer studies was used for direct comparison with FDG. Weighted sensitivity and specificity were used as main indicators of test performance. Individual data was extracted and patient subgroup analyses were performed.
Overall, direct comparisons showed lower sensitivity (0.80 vs. 0.89) yet higher specificity (0.82 vs. 0.66) for FLT compared with FDG (both p<0.01). Patient subgroup analysis showed FLT was less sensitive than FDG in detecting lung cancers staged as T1 or T2, and those ≤2.0 cm in diameter (0.81 vs. 0.93, and 0.53 vs. 0.78, respectively, both p<0.05), but was comparable for cancers staged as T3 or T4, and those >2.0 cm in diameter (0.95 vs. 1.00, 0.96 vs. 0.88, both p>0.05). For benignities, FLT performed better compared with FDG in ruling out inflammation-based lesions (0.57 vs. 0.32, p<0.05), and demonstrated greater specificity regardless of lesion sizes.
Although FLT cannot replace FDG in detecting small and early lung cancers, it may help to prevent patients with larger or inflammatory lesions from cancer misdiagnosis or even over-treatment.
广泛应用的（18）F 2'-脱氧-2'-氟-D-葡萄糖（FDG）正电子发射断层扫描（PET）在癌症成像中可能存在假阳性问题。本研究旨在探讨候选PET示踪剂（18）F 2'，3'-二脱氧-3'-氟-2-硫代胸苷（FLT）与FDG相比在诊断肺部病变中的诊断准确性。
经过全面检索和研究筛选，对来自17项研究的548例患者的数据进行荟萃分析以评估FLT的准确性，其中来自10项双示踪剂研究的351例患者的数据用于与FDG进行直接比较。加权敏感性和特异性用作测试性能的主要指标。提取个体数据并进行患者亚组分析。
总体而言，直接比较显示，与FDG相比，FLT的敏感性较低（0.80对0.89），但特异性较高（0.82对0.66）（两者p<0.01）。患者亚组分析显示，FLT在检测T1或T2期肺癌以及直径≤2.0 cm的肺癌时比FDG敏感性低（分别为0.81对0.93和0.53对0.78，两者p<0.05），但对于T3或T4期肺癌以及直径>2.0 cm的肺癌，两者相当（0.95对1.00,0.96对0.88，两者p>0.05）。对于良性病变，与FDG相比，FLT在排除基于炎症的病变方面表现更好（0.57对0.32，p<0.05），并且无论病变大小，其特异性都更高。
虽然FLT在检测小的和早期肺癌方面不能替代FDG，但它可能有助于防止患有较大或炎症性病变的患者被误诊为癌症甚至过度治疗。
