Weder W, Schmid R A, Bruchhaus H, Hillinger S, von Schulthess G K, Steinert H C
Department of Surgery, University Hospital, Zürich, Switzerland.
Ann Thorac Surg. 1998 Sep;66(3):886-92; discussion 892-3. doi: 10.1016/s0003-4975(98)00675-4.
Accurate staging of non-small cell lung cancer is essential for treatment planning. We evaluated in a prospective study the role of whole-body 2-[18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in mediastinal nodal staging with a positive predictive value of 96%. The study was continued to further evaluate the value of whole-body FDG PET in detecting unexpected extrathoracic metastases (ETMs) in patients qualifying for surgical treatment by conventional staging.
One hundred patients underwent clinical evaluation, chest and upper abdominal computed tomography scan, mediastinoscopy (lymph nodes greater than 1 cm on computed tomography), and routine laboratory tests. In 94 patients with stage IIIa or less and 6 with suspected N3 a whole-body FDG PET was performed. If clinical signs of ETMs were present additional diagnostic methods were applied. All findings in the FDG PET were confirmed histologically or radiologically.
Unexpected ETMs were detected in 13 (14%) of 94 patients (stage IIIa or less) at 14 sites. In addition 6 of 94 patients were restaged up to N3 after PET. The suspected N3 disease (stage IIIb) on computed tomography was confirmed by PET in all 6 patients. There was no false positive finding of ETM. Weight loss was correlated with the occurrence of ETM: more than 5 kg, 5 of 13 patients (38%); more than 10 kg, 4 of 6 patients (67%). Pathologic laboratory findings were not predictive for ETM.
Whole-body FDG PET improves detection of ETMs in patients with non-small cell lung cancer otherwise elegible for operation. In 14% of patients (stage IIIa or less), ETMs were detected, and in total, 20% of the patients were understaged.
非小细胞肺癌的准确分期对于治疗方案的制定至关重要。我们在一项前瞻性研究中评估了全身2-[18F]氟-2-脱氧-D-葡萄糖（FDG）正电子发射断层扫描（PET）在纵隔淋巴结分期中的作用，其阳性预测值为96%。该研究继续进行，以进一步评估全身FDG PET在检测符合常规分期手术治疗的患者意外胸外转移（ETM）方面的价值。
100例患者接受了临床评估、胸部和上腹部计算机断层扫描、纵隔镜检查（计算机断层扫描上淋巴结大于1 cm）以及常规实验室检查。94例IIIa期或以下患者和6例疑似N3期患者进行了全身FDG PET检查。如果存在ETM的临床体征，则应用其他诊断方法。FDG PET的所有发现均经组织学或放射学证实。
94例（IIIa期或以下）患者中有13例（14%）在14个部位检测到意外ETM。此外，94例患者中有6例在PET检查后重新分期为N3期。计算机断层扫描上疑似N3期疾病（IIIb期）在所有6例患者中均经PET证实。ETM没有假阳性发现。体重减轻与ETM的发生相关：体重减轻超过5 kg，13例患者中有5例（38%）；体重减轻超过10 kg，6例患者中有4例（67%）。病理实验室检查结果不能预测ETM。
全身FDG PET可提高非小细胞肺癌患者意外ETM的检测率，这些患者原本适合手术。在14%的患者（IIIa期或以下）中检测到ETM，总共有20%的患者分期过低。
