正电子发射体层成像在肺癌诊断和分期中的价值

Application of positron emission tomography in diagnosis and staging for lung cancer

目的了解正电子发射体层成像(PET)在肺癌诊断和分期中的价值。方法收集1998年9月至2003年4月间行PET和CT检查,且诊断明确的肺部疾病患者的临床资料,对PET和CT检查结果与病理检查结果进行对比分析。结果在此期间共收集104例患者,其中肺癌64例(60%),肺部良性疾病40例(40%)。肺癌患者PET的标准摄取比值(SUV值)中位值为4.5(1.2～11.7),明显高于良性患者的1.0(0～7.7);且肺癌患者的SUV值与肺癌组织学类型、分化程度、临床分期和病灶大小均无关(P>0.05)。PET诊断肺癌的敏感性、特异性和准确性分别为88%、85%和87%;CT的敏感性、特异性和准确性分别为73%、28%、57%,PET的特异性和准确性显著高于CT(P<0.05)。对于胸腔淋巴结转移诊断的敏感性、特异性和准确性CT:N1期分别为33%、73%、59%,N2期分别为80%、79%、79%,N3期特异性及准确性均为97%;PET:N1期分别为33%、82%、65%,N2期分别为60%、83%、85%,N3期特异性及准确性均为85%;两者差异无统计学意义(P>0.05)。结论PET在鉴别肺内病灶良恶性质上有优势,对胸腔内淋巴结转移的诊断要结合CT结果综合判断。

Objective To determine the usefulness of positron emission tomography with fluoro-2-deoxyglucose (FDG-PET) in lung cancer. Methods From September 1999 to April 2003, patients with lung cancer or indeterminate lung lesions on chest CT scan were enrolled , and underwent FDG-PET scanning. Results Of 104 patients, 64 (60%) had malignancy and 40(40%) had a benign process. The standard uptake ratio (SUV) in patients with lung cancer was significantly higher than that in patients with benign disease, 4.5(1.2-11.7) and 1.0(0-7.7)respectively. The SUV was not related with histologic type, differentiation, staging and the size of lesion. The diagnostic sensitivity, specificity and accuracy of PET imaging for lung cancer were 88%, 85% and 87% respectively,and the diagnostic specificity and accuracy for lung cancer with PET were significant higher than those with CT scan. The specificity and accuracy of lung lesions with a diameter ≥1.5 cm with SUV method was better than that of lesions with a diameter <1.5 cm. In 6 false positive patients,4 were tuberculosis,1 fungal infection and 1 organic pneumonia. Both PET and CT scan were poorly sensitive and specific for detecting local lymph node metastasis. Conclusions PET had advantages in evaluation of lung lesions, and integrated PET and CT were recommended for detecting local lymph node metastasis.