Cattoni Maria, Vallières Eric, Brown Lisa M, Sarkeshik Amir A, Margaritora Stefano, Siciliani Alessandra, Imperatori Andrea, Rotolo Nicola, Farjah Farhood, Wandell Grace, Costas Kimberly, Mann Catherine, Hubka Michal, Kaplan Stephen, Farivar Alexander S, Aye Ralph W, Louie Brian E
Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA.
Eur J Cardiothorac Surg. 2017 May 1;51(5):874-879. doi: 10.1093/ejcts/ezw422.
The clinical utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and somatostatin receptor scintigraphy (SRS) in pulmonary carcinoids staging is unclear. This study aims to determine the role of FDG-PET and SRS in detecting hilar-mediastinal lymph node metastasis from these tumours.
We retrospectively collected the data of 380 patients who underwent lung resection for primary pulmonary carcinoid in seven centres between 2000 and 2015. Patients without nodal sampling ( n = 78) were excluded. In 302 patients [35% men, median age 58 (interquartile range 47-68) years] the results of preoperative computed tomography (CT) scan, FDG-PET and SRS were analysed and compared to the pathological findings after resection to determine the respective utility of these two nuclear tests.
The sensitivity, specificity and negative predictive value in detecting N1 and N2 disease were respectively 33% and 46%, 93% and 90%, 88% and 95% for computed-tomography-scan, 38% and 60%, 93% and 95%, 88% and 95% for FDG-PET, 22% and 33%, 95% and 98%, 84% and 87% for SRS. The diagnostic accuracy for N1 and N2 disease of CT scan was not significantly different from that of FDG-PET ( P = 1.0 and P = 0.37 for N1 and N2 disease respectively) and of SRS ( P = 0.47 and P = 0.35 for N1 and N2 disease respectively). The sensitivity and specificity of these imaging tests were also similar when analysed by typical vs atypical histology.
CT scan, FDG-PET and SRS showed similar performance in terms of nodal staging for pulmonary carcinoid. These findings suggest that additional nuclear imaging beyond CT scan is not required as long as a lymphadenectomy or nodal sampling is completed at resection.
氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）和生长抑素受体闪烁显像（SRS）在肺类癌分期中的临床应用尚不清楚。本研究旨在确定FDG-PET和SRS在检测这些肿瘤肺门-纵隔淋巴结转移中的作用。
我们回顾性收集了2000年至2015年间在7个中心接受原发性肺类癌肺切除术的380例患者的数据。排除未进行淋巴结采样的患者（n = 78）。对302例患者[35%为男性，中位年龄58岁（四分位间距47 - 68岁）]的术前计算机断层扫描（CT）、FDG-PET和SRS结果进行分析，并与切除后的病理结果进行比较，以确定这两种核素检查各自的效用。
在检测N1和N2疾病方面，计算机断层扫描的敏感性、特异性和阴性预测值分别为33%和46%、93%和90%、88%和95%；FDG-PET分别为38%和60%、93%和95%、88%和95%；SRS分别为22%和33%、95%和98%、84%和87%。CT扫描对N1和N2疾病的诊断准确性与FDG-PET（N1疾病P = 1.0，N2疾病P = 0.37）和SRS（N1疾病P = 0.47，N2疾病P = 0.35）相比无显著差异。按典型与非典型组织学分析时，这些影像学检查的敏感性和特异性也相似。
CT扫描、FDG-PET和SRS在肺类癌淋巴结分期方面表现相似。这些发现表明，只要在切除时完成淋巴结清扫或淋巴结采样，就不需要在CT扫描之外进行额外的核素成像检查。
