Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Nuclear Medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
In Vivo. 2021 May-Jun;35(3):1829-1836. doi: 10.21873/invivo.12444.
BACKGROUND/AIM: Preoperative fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) is a non-invasive and useful diagnostic tool to evaluate mediastinal lymph node (LN) metastasis in lung cancer. However, there are often false-positive LN cases in FDG PET-CT. This study aimed to explore the clinical characteristics and outcome of pathologic N0 non-small cell lung cancer patients with false-positive mediastinal LN on FDG PET-CT.
We enrolled 147 patients who underwent preoperative FDG PET-CT scan and mediastinal LN dissection. These patients were re-evaluated for post-operative pathologic nodal metastasis and divided into a false-positive group and a group of others.
Among 40 patients diagnosed with clinical N1-3 on FDG PET-CT, 19 (47.5%) patients were pathologic N0, meaning false-positive LN by PET-CT. Preoperative absolute platelet count and platelet-lymphocyte ratio were significantly higher in patients with pathologic N0. The presence of lymphatic invasion was significantly lower in patients with pathologic N0 than in the group of others. Recurrence-free survival was significantly shorter in patients with false positive LN than in patients with true positive LN or true negative LN at the same pathologic stage.
Higher absolute platelet count and PLR, lower proportion of lymphatic invasion and shorter recurrence-free survival were associated with false positive mediastinal LN on preoperative FDG PET-CT.
背景/目的：氟-18 氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET-CT）是一种非侵入性且有用的诊断工具，可用于评估肺癌纵隔淋巴结（LN）转移。然而，FDG PET-CT 中常有假阳性 LN 病例。本研究旨在探讨 FDG PET-CT 显示假阳性纵隔 LN 的病理 N0 非小细胞肺癌患者的临床特征和结局。
我们纳入了 147 例接受术前 FDG PET-CT 扫描和纵隔 LN 解剖的患者。这些患者术后均重新评估病理淋巴结转移情况，并分为假阳性组和其他组。
在 40 例 FDG PET-CT 诊断为临床 N1-3 的患者中，19 例（47.5%）患者病理 N0，即 PET-CT 显示假阳性 LN。术前绝对血小板计数和血小板-淋巴细胞比值在病理 N0 患者中显著升高。与其他组相比，病理 N0 患者的淋巴血管侵犯发生率显著降低。在相同病理分期时，假阳性 LN 患者的无复发生存率明显短于真阳性 LN 或真阴性 LN 患者。
术前 FDG PET-CT 显示假阳性纵隔 LN 与较高的绝对血小板计数和 PLR、较低的淋巴血管侵犯比例和较短的无复发生存率相关。
