Smith David E, Fernandez Aramburu Julian, Da Lozzo Alejandro, Montagne Juan A, Beveraggi Enrique, Dietrich Agustin
Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina.
Updates Surg. 2019 Dec;71(4):741-746. doi: 10.1007/s13304-019-00680-x. Epub 2019 Sep 24.
Positron emission tomography and computed tomography (PET-CT) is the non-invasive gold standard method for determining the oncological stage of patient with diagnosis of lung cancer. A correct preoperative staging is significant because only patients who do not have a history of regional or distant disease are those who will benefit from a surgical treatment. However, due to the different values of the PET-CT in terms of sensitivity and specificity to evaluate the mediastinal lymph node involvement, it is often necessary to perform a surgical mediastinal sampling through a cervical video mediastinoscopy (VM). Patient's risk factors which could modify the results of the PET scan, performing differences between non-invasive staging and the lymph node sampling due to VM are not yet clearly established in the literature. This knowledge will allow to identify in whom a surgical staging by sampling the mediastinal lymph nodes is needed. We included 234 patients with diagnosis of lung cancer who underwent a mediastinal lymph node staging by PET-CT images and histopathological results of mediastinal sampling by VM, analyzing the sensitivity and specificity of this non-invasive imaging study. We also analyzed variables that could modify the results of PET-CT, such as tumor type, location of the tumor and patient's history. We showed that those PET-CT presented an overall sensitivity and specificity of 93.8 and 62.7%, respectively, with negative and positive predictive values of 95.05 and 57.1%, respectively. The false-positive rate was 25% (57 of 234 patients). Analyzing risk factors involved in this false-positive rate (n = 57), we found that the only statistically significant factor that could explain these results was the histology of squamous carcinoma (p < 0.03). In this group of patients, it is essential to perform a mediastinal lymph node biopsy to know the real state of lymph node involvement.
正电子发射断层扫描和计算机断层扫描（PET-CT）是确定肺癌患者肿瘤分期的非侵入性金标准方法。正确的术前分期很重要，因为只有没有区域或远处疾病史的患者才能从手术治疗中获益。然而，由于PET-CT在评估纵隔淋巴结受累方面的敏感性和特异性存在差异，通常需要通过颈部视频纵隔镜检查（VM）进行手术纵隔取样。可能改变PET扫描结果的患者风险因素，以及VM导致的非侵入性分期与淋巴结取样之间的差异，在文献中尚未明确确立。这些知识将有助于确定哪些患者需要通过纵隔淋巴结取样进行手术分期。我们纳入了234例诊断为肺癌的患者，他们接受了PET-CT图像的纵隔淋巴结分期以及VM纵隔取样的组织病理学结果，分析了这项非侵入性影像学研究的敏感性和特异性。我们还分析了可能改变PET-CT结果的变量，如肿瘤类型、肿瘤位置和患者病史。我们发现，那些PET-CT的总体敏感性和特异性分别为93.8%和62.7%，阴性和阳性预测值分别为95.05%和57.1%。假阳性率为25%（234例患者中的57例）。分析导致该假阳性率的风险因素（n = 57），我们发现唯一能解释这些结果的具有统计学意义的因素是鳞状细胞癌的组织学类型（p < 0.03）。在这组患者中，进行纵隔淋巴结活检以了解淋巴结受累的真实情况至关重要。
