Damirov Fuad, Büsing Karen, Yavuz Gökce, Hatz Rudolf, Manapov Farkhad, Michels Julia, Hohenberger Peter, Roessner Eric
Department of Thoracic Surgery, Ludwig Maximilian University of Munich, 81377 Munich, Germany.
Department of Surgery, Division of Surgical Oncology and Thoracic Surgery, University Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
Diagnostics (Basel). 2023 Jan 22;13(3):403. doi: 10.3390/diagnostics13030403.
The aim of this study was to evaluate the diagnostic accuracy of integrated 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG-PET/CT) in hilar and mediastinal lymph node (HMLN) staging of suspected or proven lung cancer, and to investigate potential risk factors for false negative and false positive HMLN metastases. We retrospectively analyzed 162 consecutive patients with suspected or pathologically proven non-small cell lung cancer (NSCLC). The receiver operating characteristic (ROC) curve was generated to determine the diagnostic efficacy of 18F-FDG-PET/CT. Univariate and multivariate analyses were conducted to detect risk factors of false positives and false negatives. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of integrated 18F-FDG-PET/CT in detecting HMLN metastases were 59.1% (26/44), 69.1% (65/94), 47.3% (26/55), 78.3% (65/83), and 65.9% (91/138), respectively. The ROC curve showed an area under the curve (AUC) of 0.625 (95%-CI 0.468-0.782). The incidence of false negative and false positive HMLN metastases was 21.7% (18/83) and 52.7% (29/55), respectively. Our data shows that integrated 18F-FDG-PET/CT staging provides lower specificity and sensitivity. This confirms the ESTS guideline on lymph node staging for PET-positive HMLN. Yet it advocates more invasive staging even for PET-negative HMLN.
本研究的目的是评估18F-氟脱氧葡萄糖正电子发射计算机断层扫描（18F-FDG-PET/CT）在疑似或确诊肺癌的肺门和纵隔淋巴结（HMLN）分期中的诊断准确性，并调查HMLN转移假阴性和假阳性的潜在危险因素。我们回顾性分析了162例连续的疑似或病理确诊的非小细胞肺癌（NSCLC）患者。生成受试者操作特征（ROC）曲线以确定18F-FDG-PET/CT的诊断效能。进行单因素和多因素分析以检测假阳性和假阴性的危险因素。18F-FDG-PET/CT检测HMLN转移的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为59.1%（26/44）、69.1%（65/94）、47.3%（26/55）、78.3%（65/83）和65.9%（91/138）。ROC曲线显示曲线下面积（AUC）为0.625（95%可信区间0.468-0.782）。HMLN转移假阴性和假阳性的发生率分别为21.7%（18/83）和52.7%（29/55）。我们的数据表明，18F-FDG-PET/CT分期的特异性和敏感性较低。这证实了ESTS关于PET阳性HMLN淋巴结分期的指南。然而，即使对于PET阴性的HMLN，它也主张采用更具侵入性的分期。
