Dewan N A, Reeb S D, Gupta N C, Gobar L S, Scott W J
Department of Medicine, Creighton University, Omaha, NE 68131, USA.
Chest. 1995 Aug;108(2):441-6. doi: 10.1378/chest.108.2.441.
Positron emission tomography (PET) utilizing 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) has been demonstrated to be highly accurate in differentiating benign from malignant pulmonary nodules. Transthoracic fine-needle aspiration biopsy (TTNA) is generally the initial procedure of choice in the evaluation of peripheral lesions suspected to be malignant. Our objective was to determine whether PET-FDG imaging, a noninvasive test, was equally efficacious as TTNA in the evaluation of lung lesions suspected to be malignant.
Thirty-three patients with 35 lung lesions who had undergone both PET-FDG imaging and TTNA were retrospectively selected from an ongoing prospective study of PET-FDG imaging in the evaluation of solitary pulmonary nodules.
Diagnostic efficacy was determined by calculating sensitivity, specificity, positive and negative predictive value, and overall predictive accuracy for both PET-FDG imaging and TTNA in differentiating benign from malignant lesions. Complication rate also was documented for the two tests.
The PET imaging correctly identified all 26 malignant lesions, including 21 lesions diagnosed by TTNA and 7 of the 9 benign lung lesions. The TTNA was positive for malignancy in 21 lung lesions and missed the diagnosis of malignancy in 5 lesions. Diagnostic sensitivity, specificity, positive and negative predictive value, and overall predictive accuracy was 100, 78, 93, 100, and 94% for PET imaging and 81, 100, 100, 64, and 86 for TTNA, respectively. Pneumothorax was documented in 16 patients (46%), and 9 patients (26%) required a chest tube. There were no complications with PET imaging.
We conclude that PET imaging of the lung is as efficacious as TTNA, with less risk, and offers an alternate noninvasive option in the evaluation and management of lung lesions suspected to be malignant.
利用2-[氟-18]-氟-2-脱氧-D-葡萄糖(FDG)的正电子发射断层扫描(PET)已被证明在鉴别良性与恶性肺结节方面具有高度准确性。经胸细针穿刺活检(TTNA)通常是评估疑似恶性外周病变的首选初始检查方法。我们的目的是确定PET-FDG成像这种非侵入性检查在评估疑似恶性肺病变时是否与TTNA同样有效。
从一项正在进行的关于PET-FDG成像评估孤立性肺结节的前瞻性研究中,回顾性选取33例有35个肺病变且同时接受了PET-FDG成像和TTNA检查的患者。
通过计算PET-FDG成像和TTNA在鉴别良性与恶性病变方面的敏感性、特异性、阳性和阴性预测值以及总体预测准确性来确定诊断效能。同时记录两种检查的并发症发生率。
PET成像正确识别了所有26个恶性病变,包括TTNA诊断出的21个病变以及9个良性肺病变中的7个。TTNA在21个肺病变中显示为恶性阳性,漏诊了5个恶性病变。PET成像的诊断敏感性、特异性、阳性和阴性预测值以及总体预测准确性分别为100%、78%、93%、100%和94%,而TTNA分别为81%、100%、100%、64%和86%。16例患者(46%)出现气胸,9例患者(26%)需要放置胸管。PET成像未出现并发症。
我们得出结论,肺部PET成像与TTNA同样有效,风险更低,并且在评估和管理疑似恶性肺病变方面提供了一种替代性的非侵入性选择。