Guerrera Francesco, Renaud Stéphane, Schaeffer Mickaël, Nigra Victor, Solidoro Paolo, Santelmo Nicola, Filosso Pier Luigi, Falcoz Pierre-Emmanuel, Ruffini Enrico, Oliaro Alberto, Massard Gilbert
Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy; Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.
Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France; Department of Thoracic Surgery, Nancy University Hospital, Nancy, France.
Ann Thorac Surg. 2017 Oct;104(4):1194-1199. doi: 10.1016/j.athoracsur.2017.05.002. Epub 2017 Jul 29.
Minimally invasive surgery, stereotactic radiotherapy, and radiofrequency ablation are commonly proposed in the case of pulmonary colorectal-metastasis as alternatives to conventional open surgery. Preoperative imaging assessment by computed tomography (CT) scan and fluorodeoxyglucose positron emission tomography (FDG-PET) are critical to guide oncologic radical treatment. Our aim was to investigate the accuracy of CT and FDG-PET for the evaluation of the number of pulmonary colorectal metastases and thoracic lymph nodal involvement (LNI).
Patients who underwent lung surgical resection for pulmonary colorectal metastases from 2004 to 2014 were analyzed. Concordance between histology, CT scan, and FDG-PET findings were assessed.
Data of 521 patients were analyzed. Of those, FDG-PET was performed in 435 (83.5%). A moderate agreement between both CT scan (kappa index: 0.42) and FDG-PET (kappa index: 0.42) findings and the histologically proven number of metastases was observed. The number of histologically proven metastases was correctly discriminated in 61.7% of cases with CT scan and in 61.8% of cases with FDG-PET. Multiple metastases were discovered in 20.9% of clinical single metastasis cases with CT scan, and in 24.4% of those cases with FDG-PET. One hundred fifty patients (29.1%) presented with pathologic LNI. A poor agreement was observed between LNI and CT scan findings (kappa index: 0.02), and a weak agreement was observed concerning LNI and FDG-PET findings (kappa index: 0.39).
Computed tomography and FDG-PET have limitations if the objective is to detect all malignant nodules and to discriminate the LNI in cases of pulmonary metastases of colorectal cancer.
对于肺结直肠癌转移病例，微创外科手术、立体定向放射治疗和射频消融通常被提议作为传统开放手术的替代方案。通过计算机断层扫描（CT）和氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）进行术前影像评估对于指导肿瘤根治性治疗至关重要。我们的目的是研究CT和FDG-PET在评估肺结直肠癌转移灶数量和胸段淋巴结受累（LNI）方面的准确性。
分析2004年至2014年因肺结直肠癌转移而接受肺手术切除的患者。评估组织学、CT扫描和FDG-PET检查结果之间的一致性。
分析了521例患者的数据。其中，435例（83.5%）进行了FDG-PET检查。观察到CT扫描（kappa指数：0.42）和FDG-PET（kappa指数：0.42）检查结果与组织学证实的转移灶数量之间存在中等程度的一致性。CT扫描在61.7%的病例中正确区分了组织学证实的转移灶数量，FDG-PET在61.8%的病例中正确区分了组织学证实的转移灶数量。CT扫描在20.9%的临床单转移病例中发现了多发转移，FDG-PET在24.4%的此类病例中发现了多发转移。150例患者（29.1%）出现病理性LNI。观察到LNI与CT扫描结果之间一致性较差（kappa指数：0.02），LNI与FDG-PET检查结果之间一致性较弱（kappa指数：0.39）。
如果目标是检测所有恶性结节并区分结直肠癌肺转移病例中的LNI，计算机断层扫描和FDG-PET存在局限性。
