Scott W J, Gobar L S, Terry J D, Dewan N A, Sunderland J J
Department of Surgery, Creighton University Medical Center/St Joseph Hospital, Omaha, NE 68131, USA.
J Thorac Cardiovasc Surg. 1996 Mar;111(3):642-8. doi: 10.1016/s0022-5223(96)70317-3.
We compared the abilities of positron emission tomography and computed tomography to detect N2 or N3 lymph node metastases (N2 or N3) in patients with lung cancer. Positron emission tomography detects increased rates of glucose uptake, characteristic of malignant cells. Patients with peripheral tumors smaller than 2 cm and a normal mediastinum were ineligible. All patients underwent computed tomography, positron emission tomography, and surgical staging. The American Thoracic Society lymph node map was used. Computed and positron emission tomographic scans were read by separate radiologists blinded to surgical staging results. Lymph nodes were "positive" by computed tomography if larger than 1.0 cm in short-axis diameter. Standardized uptake values were recorded from areas on positron emission tomography corresponding to those from which biopsy specimens were taken; if greater than 4.2, they were called "positive." Seventy-five lymph node stations (2.8 per patient) were analyzed in 27 patients. Computed tomography incorrectly staged the mediastinum as positive for metastases in three patients and as negative for metastases in three patients. Sensitivity and specificity of computed tomographic scans were 67% and 83%, respectively. Positron emission tomography correctly staged the mediastinum in all 27 patients. When analyzed by individual node station, there were four false positive and four false negative results by computed tomography (sensitivity = 60%, specificity = 93%, positive predictive value = 60%). Positron emission tomography mislabeled one node station as positive (100% sensitive, 98% specific, positive predictive value 91%). The differences were significant when the data were analyzed both for individual lymph node stations (p = 0.039) and for patients (p = 0.031) (McNemar test). Positron emission tomography and computed tomography are more accurate than computed tomography alone in detecting mediastinal lymph node metastases from non-small-cell lung cancer.
我们比较了正电子发射断层扫描（PET）和计算机断层扫描（CT）检测肺癌患者N2或N3淋巴结转移的能力。PET可检测到葡萄糖摄取增加，这是恶性细胞的特征。外周肿瘤小于2cm且纵隔正常的患者不符合条件。所有患者均接受了CT、PET和手术分期。采用美国胸科学会淋巴结图谱。由对手术分期结果不知情的独立放射科医生解读CT和PET扫描结果。若短轴直径大于1.0cm，则CT显示淋巴结“阳性”。记录PET上与活检标本取材部位相对应区域的标准化摄取值；若大于4.2，则称为“阳性”。对27例患者的75个淋巴结站（每位患者2.8个）进行了分析。CT将3例患者的纵隔错误分期为转移阳性，3例患者的纵隔错误分期为转移阴性。CT扫描的敏感性和特异性分别为67%和83%。PET对所有27例患者的纵隔分期均正确。按单个淋巴结站分析时，CT有4例假阳性和4例假阴性结果（敏感性 = 60%，特异性 = 93%，阳性预测值 = 60%）。PET将1个淋巴结站错误标记为阳性（敏感性100%，特异性98%，阳性预测值91%）。当对单个淋巴结站（p = 0.039）和患者（p = 0.031）的数据进行分析时（McNemar检验），差异具有统计学意义。在检测非小细胞肺癌纵隔淋巴结转移方面，PET和CT联合比单纯CT更准确。
