1 Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
2 Department of Radiology, Division of Functional and Diagnostic Imaging Research, Kobe University Graduate School of Medicine, Kobe, Japan.
AJR Am J Roentgenol. 2018 Jul;211(1):185-192. doi: 10.2214/AJR.17.18935. Epub 2018 Apr 18.
The purpose of this study was to prospectively compare the capabilities of integrated FDG PET/CT and conventional staging for identification of TNM factors, evaluation of the TNM and Veterans Administration Lung Study Group (VALSG) stages, and selection of patients with stage I small cell lung carcinoma (SCLC).
Fifty-nine patients (mean age, 69.6 ± 7.8 [SD] years; range, 40-84 years) with pathologically diagnosed SCLC underwent integrated F-FDG PET/CT and conventional staging with enhanced brain MRI. TNM and VALSG stages were evaluated by two different reader groups. Kappa statistics and chi-square test result were determined for evaluations of interobserver agreement of all factors and for each clinical stage for both methods. Diagnostic accuracy of identification of each factor and clinical stage was statistically compared by McNemar test.
Interobserver agreements for all factors and each clinical stage were assessed as almost perfect for PET/CT (0.83 ≤ κ ≤ 0.93; p < 0.001) and substantial and almost perfect (0.63 ≤ κ ≤ 0.96; p < 0.001) for conventional staging plus enhanced brain MRI. The diagnostic accuracy of PET/CT for N factor and TNM stage (N, 89.8% [53/59]; TNM stage, 88.1% [52/59]) was significantly higher than that of conventional staging plus enhanced brain MRI (N, 67.8% [40/59], p = 0.0002; TNM stage, 72.9% [43/59], p = 0.004).
Integrated FDG PET/CT with contrast-enhanced brain MRI is potentially equal to or more effective than conventional staging plus enhanced brain MRI for T, N, and M assessment and TNM and VALSG staging of SCLC.
本研究旨在前瞻性比较 FDG PET/CT 与传统分期在识别 TNM 因素、评估 TNM 和退伍军人肺癌研究组（VALSG）分期以及选择 I 期小细胞肺癌（SCLC）患者方面的能力。
59 例经病理诊断为 SCLC 的患者（平均年龄 69.6 ± 7.8 [SD] 岁；范围 40-84 岁）接受了 F-FDG PET/CT 与增强脑 MRI 的综合分期。由两个不同的读者组评估 TNM 和 VALSG 分期。通过 Kappa 统计量和卡方检验确定两种方法对所有因素和每个临床分期的观察者间一致性评价。通过 McNemar 检验比较两种方法在识别每个因素和临床分期的诊断准确性。
对于所有因素和每个临床分期，PET/CT 的观察者间一致性评估为几乎完美（0.83 ≤ κ ≤ 0.93；p < 0.001），而常规分期加增强脑 MRI 的一致性评估为高度一致和几乎完美（0.63 ≤ κ ≤ 0.96；p < 0.001）。PET/CT 对 N 因素和 TNM 分期（N 期，89.8% [53/59]；TNM 期，88.1% [52/59]）的诊断准确性显著高于常规分期加增强脑 MRI（N 期，67.8% [40/59]，p = 0.0002；TNM 期，72.9% [43/59]，p = 0.004）。
FDG PET/CT 与增强脑 MRI 联合应用在 T、N、M 评估以及 SCLC 的 TNM 和 VALSG 分期方面，与常规分期加增强脑 MRI 相比具有潜在的等效性或更优的效果。
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