Department of Thoracic Surgery, Saku Central Hospital Advanced Care Center, Saku, Japan.
Department of Thoracic Surgery, Saku Central Hospital Advanced Care Center, Saku, Japan.
Clin Lung Cancer. 2021 May;22(3):218-224. doi: 10.1016/j.cllc.2020.05.002. Epub 2020 May 14.
2-[F] Fluoro-d-deoxyglucose (FDG) positron emission tomography (PET) is a relevant diagnostic procedure for staging lung cancer. However, accurate evaluation of lymph node metastases by PET is controversial because of false-positive FDG uptake.
A total of 245 patients with lung cancer were retrospectively analyzed. Standardized maximum uptake values (SUV) of the primary tumor and lymph nodes were compared to pathologic lymph node metastases to correlate PET findings with clinicopathologic variables and patient outcomes.
The SUV values of metastatic lymph nodes were significantly higher than those of lymph nodes without metastases (P = .0036). When SUV ≥ 4 was defined as PET positive for metastasis, the sensitivity, specificity, and accuracy were 48.1%, 79.8%, and 73.1%, respectively. Multivariate logistic regression analysis showed that age > 75 years, bilateral hilar FDG uptake, and no lymph node swelling were significant factors related to false-positive lymph node metastases. Smoking status, FDG uptake in the primary tumor, and concurrent lung diseases were not significant factors.
Metastatic lymph nodes show higher FDG uptake than false-positive lymph nodes, and older patient age, bilateral hilar FDG uptake, and no swollen nodes are associated with no metastases. Patients with lymph node metastases have worse survival than those with false-positive FDG-PET findings. However, abnormal FDG uptake in the lymph node is an important prognostic factor.
2-[F]氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）是一种用于分期肺癌的相关诊断程序。然而，由于 FDG 摄取的假阳性，PET 对淋巴结转移的准确评估存在争议。
回顾性分析了 245 例肺癌患者。将原发肿瘤和淋巴结的标准化最大摄取值（SUV）与病理淋巴结转移进行比较，以将 PET 结果与临床病理变量和患者预后相关联。
转移性淋巴结的 SUV 值明显高于无转移淋巴结（P =.0036）。当 SUV≥4 定义为转移的 PET 阳性时，其敏感性、特异性和准确性分别为 48.1%、79.8%和 73.1%。多变量逻辑回归分析表明，年龄>75 岁、双侧肺门 FDG 摄取和无淋巴结肿大是与假阳性淋巴结转移相关的显著因素。吸烟状况、原发肿瘤 FDG 摄取和同时存在的肺部疾病不是显著因素。
转移性淋巴结的 FDG 摄取高于假阳性淋巴结，年龄较大、双侧肺门 FDG 摄取和无淋巴结肿大与无转移相关。有淋巴结转移的患者比有假阳性 FDG-PET 结果的患者生存更差。然而，淋巴结中异常的 FDG 摄取是一个重要的预后因素。
