Dejima Hitoshi, Kuroda Hiroaki, Oya Yuko, Sakakura Noriaki, Inaba Yoshitaka, Tamaki Tsuneo, Yatabe Yasushi, Sakao Yukinori
Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
J Thorac Dis. 2018 Dec;10(12):6932-6941. doi: 10.21037/jtd.2018.11.40.
Volumetric parameters based on 3-dimensional reconstruction have recently been introduced for cancer staging. We aimed to improve the ability to diagnose hilar lymph node metastasis in patients with non-small cell lung cancer.
We evaluated 142 patients with non-small cell lung cancer who underwent right upper lobectomy and radical lymph node dissection. Metastatic involvement of right upper lobar lymph nodes was assessed using high-resolution computed tomography (HRCT) and 18F-2-floro-2-deoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT).
On receiver operating characteristic (ROC) curve analysis, the area under the curves (AUC) for short axis, maximum of standardized uptake value (SUV), total lesion glycolysis (TLG) and modified TLG (mTLG) were 0.79, 0.77, 0.76, and 0.87, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mTLG, using the optimal cut off value (2.45), for diagnosis of lobar lymph node metastasis were 71%, 88%, 44%, and 96%, respectively. Hilar asymmetric uptake (HAU) of FDG was larger in true-positive cases than in false-negative cases (P<0.01). Furthermore, the size of metastatic foci in the lymph node was smaller in false-negative cases (P=0.012).
Modified TLG is a good parameter to diagnose metastatic right upper lobar lymph nodes. Micrometastasis in the lymph node is difficult to predict using the current diagnostic method. However, more careful evaluation is required in patients with symmetric FDG accumulation at hilar region because hilar lymph nodes respond to various causes such as benign pulmonary diseases.
基于三维重建的容积参数最近已被引入用于癌症分期。我们旨在提高非小细胞肺癌患者肺门淋巴结转移的诊断能力。
我们评估了142例行右上叶切除术和根治性淋巴结清扫术的非小细胞肺癌患者。使用高分辨率计算机断层扫描（HRCT）和18F-2-氟-2-脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）评估右上叶淋巴结的转移情况。
在接受者操作特征（ROC）曲线分析中，短轴、标准化摄取值（SUV）最大值、总病变糖酵解（TLG）和改良TLG（mTLG）的曲线下面积（AUC）分别为0.79、0.77、0.76和0.87。使用最佳截断值（2.45）时，mTLG诊断叶淋巴结转移的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为71%、88%、44%和96%。FDG的肺门不对称摄取（HAU）在真阳性病例中比假阴性病例中更大（P<0.01）。此外，假阴性病例中淋巴结转移灶的大小更小（P=0.012）。
改良TLG是诊断右上叶转移性淋巴结的良好参数。使用当前诊断方法难以预测淋巴结中的微转移。然而，对于肺门区域FDG积聚对称的患者，需要更仔细的评估，因为肺门淋巴结会对各种原因（如良性肺部疾病）产生反应。
