Cancer Res Treat. 2003 Jun;35(3):232-8. doi: 10.4143/crt.2003.35.3.232.
Mediastinal staging of non-small cell lung cancer can be markedly improved by FDG-PET scan, but the problem of false staging of mediastinal nodes by PET scan in non-small cell lung cancer has not yet been overcome. The aim of this study was to identify the mechanism underlying the false staging of mediastinal nodes by FDG-PET in the case of non-small cell lung cancer.
To evaluate the factors determining the FDG uptake in mediastinal nodes, FDG-PET was performed preoperatively, and mediastinal dissection with pulmonary resection was performed in 62 patients with NSCLC. GLUT-1 expression was studied by immunohistochemistry of the mediastinal nodes (n=111, true positive
There was no significant difference in size among the 4 nodal groups (TP, TN, FP, FN), nor in the tumor ratio of the metastatic nodes between the TP and FN groups. The labeling index and staining intensity of the TP group were higher than those of the FN group (Mann-Whitney test, p=.001, p=.007) in the case of the metastatic nodes. The level of follicular hyperplasia of the FP group was higher than that of the TN group in the case of the non-metastatic nodes (p=.000).
These results suggest that in mediastinal staging of non-small cell lung cancer by FDG-PET, the FN node is associated with low uptake of FDG due to low expression of GLUT-1, and that the FP node is associated with a high level of follicular hyperplasia as a result of there being a reactive change to an inflammatory and/or immune reaction. This is the first report on the mechanism underlying the false results that are sometimes obtained, and which constitute a major problem in the clinical application of FDG-PET to the mediastinal staging of non-small cell lung cancer.
氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET 扫描）可显著提高非小细胞肺癌的纵隔分期准确性，但 FDG-PET 扫描在非小细胞肺癌中对纵隔淋巴结分期的假阳性问题仍未得到解决。本研究旨在确定非小细胞肺癌中 FDG-PET 扫描导致纵隔淋巴结假阳性分期的机制。
为了评估决定纵隔淋巴结 FDG 摄取的因素，对 62 例 NSCLC 患者进行了术前 FDG-PET 检查，并进行了纵隔解剖和肺切除术。使用抗 GLUT-1 抗体对纵隔淋巴结（n=111，真阳性
在 4 组淋巴结（TP、TN、FP、FN）之间，淋巴结大小无显著差异，TP 组和 FN 组之间转移性淋巴结的肿瘤比也无差异。在转移性淋巴结中，TP 组的标记指数和染色强度高于 FN 组（Mann-Whitney 检验，p=.001，p=.007）。在非转移性淋巴结中，FP 组的滤泡增生水平高于 TN 组（p=.000）。
这些结果表明，在 FDG-PET 对非小细胞肺癌的纵隔分期中，FN 淋巴结由于 GLUT-1 表达水平低，FDG 摄取量低，与假阴性结果有关，而 FP 淋巴结由于炎症和/或免疫反应的反应性变化，滤泡增生水平较高，与假阳性结果有关。这是首次报道 FDG-PET 用于非小细胞肺癌纵隔分期时假阳性结果的发生机制，这也是 FDG-PET 在非小细胞肺癌纵隔分期中临床应用的一个主要问题。
