肺癌术前^18F-FDG PET／CT对纵隔淋巴结外科分期的临床价值

Clinical value of surgical staging with preoperative 18F-FDG PET/CT evaluation for mediastinal lymph nodes in lung cancer

目的探讨肺癌术前^18F—FDG PET／CT对纵隔淋巴结转移外科分期的诊断价值。方法回顾分析68例肺癌患者术前^18F-FDG PET／CT及CT对纵隔淋巴结转移的诊断及分期结果，并与术后病理结果对照。统计学分析采用X^2检验和t检验。结果68例患者共切除纵隔淋巴结222枚，其中84枚（37．8％）病理检查证实为转移。^18F—FDGPET／CT与CT诊断纵隔淋巴结转移的灵敏度、特异性、准确性、阳性及阴性预测值分别为71．4％（60／84）、66．7％（92／138）、68．5％（152／222）、56．6％（60／106）、79．3％（92／116）与48．8％（41／84）、49．3％（68／138）、49．1％（109／222）、36．9％（41／111）、61．3％（68／111），差异均有统计学意义（X^2=8．96、8．57、17．19、8．43及8．88，P均〈0．05）；^18F—FDGPET／CT与CT对纵隔淋巴结的分期与病理分期的一致率分别为73．5％（50／68）及41．2％（28／68），差异有统计学意义（Ⅳ。=14．55，P〈0．01）；其中^18F—FDGPET／CT对N1及N2期淋巴结诊断的准确性分别为66．7％（10／15）和79．2％（19／24），明显高于CT的13．3％（2／15）和45．8％（11／24）掰2=8．89和5．69，P均〈0．05。淋巴结短径≥10mm组SUVmax明显高于短径〈10mm组（5．5±2．8与2．2±0．9，t=5．17，P〈0．05）。结论术前^18F—FDGPET／CT对肺癌纵隔淋巴结的诊断和分期优于cT，其对适宜手术病例优化治疗决策具有临床指导意义。

Objective To investigate the clinical value of preoperative ^18F-FDG PET/CT for surgi- cal staging by evaluating mediastinal lymphadenopathy in lung cancer. Methods Sixty-eight patients with lung cancer underwent both ^18F-FDG PET/CT and chest CT. The results of PET/CT and CT were compared with pathological results.X^2 and t tests were used for data analysis. Results A total of 222 mediastinal lymph nodes were resected in 68 patients and 84 （37.8%） were confirmed as metastases by pathology. The sensitivity, specificity, accuracy, positive and negative predictive values for PET/CT and CT were 71.4% （60/84） vs 48.8% （41/84）, 66.7% （92/138） vs 49.3% （68/138）, 68.5% （152/222） vs 49. 1% （ 109/222 ）, 56.6 % （60/106 ） vs 36.9 % （41 / 111 ）, 79.3 % （92/116 ） vs 61.3 % （68/111 ）, respectively （X^2 = 8.96, 8.57, 17.19, 8.43, 8.88, all P 〈 0.05）. The staging consistency of PET/CT with pathology was 73.5 % （50/68）, which was significantly higher than that of CT with pathology （41.2% （28/68） ; X2 = 14. 55, P 〈 0.01 ）. The identification of N1 and N2 disease was, respectively, 66. 7% （ 10/15 ） and 79.2% （ 19/24 ） by PET/CT, 13.3 % （2/15） and 45.8% （11/24） by CT （X2 = 8.89 and 5.69, both P 〈 0.05 ）. The SUVm^x of lymph nodes greater than and equal to 10 mm in short diameter was significantly higher than those with short diameters less than 10 mm （5.5 ±2.8 vs 2.2 ±0.9, t =5.17, P 〈0. 05）. Conclusion Preoperative ^18F-FDG PET/CT is more accurate for evaluating mediastinal lymphadnoepathy and staging in patients with lung cancer than CT, and therefore is more valuable for optimizing the best treatment strategies.