^(18)F-FDG PET/CT在419例肺外科患者中的应用经验

Application of ^(18)F-FDG PET/CT in Pulmonary Disease:A Report of 419 Cases

背景与目的我国是肺癌的高发国家,PET/CT在我国的肺外科临床应用价值仍处在探索阶段。本研究总结病理证实的419例肺部肿瘤或肿瘤样病变的患者资料,探讨PET/CT在这一领域的应用价值。方法 2007年12月-2011年8月北京大学肿瘤医院胸外一科单个医疗组对594例肺部肿瘤或肿瘤样病变的患者在诊治过程的不同阶段进行了PET/CT检查,以获得病理的419例患者为研究对象,结合临床、病理及随访,分析PET/CT在良恶性定性,肺癌TNM分期,疗效评价及疗后随访中的应用价值。结果全组419例患者中病理证实为良性者63例,恶性者356例,其中原发性肺癌338例,肺转移瘤18例。PET/CT对恶性肿瘤定性诊断(SUVmax>2.5)的敏感性为85.0%,特异性为52.4%,准确性79.2%,阳性预测值89.2%,阴性预测值42.9%。338例患者中治疗前行PET/CT者275例,共发现远处转移46例(46/275,16.7%),较传统检查(38/275,13.8%)多发现8例。对临床怀疑术后复发者(89例)行PET/CT,发现复发43例(43/89,48.3%),较传统检查(37/89,41.6%)多发现6例。对手术的168例患者作了T及N分期相关性的研究,发现SUVmax与肿瘤直径正相关(P<0.05)。清扫淋巴结共计610组,PET/CT诊断肺癌淋巴结转移的敏感性为36.3%,特异性为93.9%,准确性为84.3%,阳性预测值为54.4%,阴性预测值为88.0%。全组有10例患者化疗前后均作了PET/CT,SUVmax随肿瘤降期而下降,下降平均百分比为37.5%(P<0.05)。结论 PET/CT是现阶段除组织学外另一种可选的判断肺部良恶性病变的方法。PET/CT在肺癌M分期中的作用优于传统检查;也可作为术后复查的常规手段之一。PET/CT对淋巴结转移的诊断特异性较好,但敏感性不高。PET/CT在肺癌化疗评效中有积极意义。

Background and objective The application and the value of PET/CT in lung cancer are on the way to development. e aim of this study is to summarize the data from 419 patients with pulmonary tumor or tumor-like disease and to explore the appliance of PET/CT. Methods From Dec 2007 to Aug 2011, 594 patients with pulmonary tumor or tumor-like disease underwent PET/CT examination during the di erent course of treatment, which were treated by single surgery team from Peking University Cancer Hospital. Of these patients, 419 cases diagnosed pathologically were included into study. The clinicapathological and follow-up data were collected to analyze the value of PET/CT in diagnosis, TNM staging, therapy response evaluation and pos herapy monitoring. Results Four hundred and nineteen cases comprised of 63 benign and 356 malignant, of which, 338 were primary lung cancer, and 18 were metastases. e SUVmax cuto was de ned as 2.5 to di erentiate the benign and malignant disease. PET/CT obtained the role of diagnosis with sensitivity as 85.0%, speci city as 52.4%, accuracy rate as 79.2%, positive predictive value as 89.2% and negative predictive value as 42.9%, respectively. Of 338 primary cases, 275 underwent PET/CT at initial diagnosis, in which, 46 （16.7%） distant metastasis were found, including 8 additional metastasis not found by conventional utilities. Six of 43 recurrences were found by PET/CT following conventionalexamination. In T staging, SUVmax is positively correlated with diameter of tumors （P0.05）. In N staging, 610 stations of lymph nodes were resected from 168 cases, with 37 stations predicted as positive by PET/CT and 102 stations pathologically proven positive, therefore, calculating the sensitivity as 36.3%, speci city as 93.9%, accuracy rate as 84.3%, positive predictive value as 54.4% and negative predictive value as 88.0%, respectively. Ten patients underwent PET/CT scan for chemotherapy response evaluation, with SUVmax changing following T downstaging. Conclusion PET/CT is one optional method for diagnosis of pulmonary tumors. In TNM staging, PET/CT showed the superiority than conventional utilities in M staging, but possesses the high speci city but inferior sensitivity in N staging. erefore, PET/CT should be used as routine examination for postoperation follow-up. Furthermore, PET/CT performed the outstanding role in chemotherapy response evaluation.