^(18)F-脱氧葡萄糖PET-CT在鉴别周围性非小细胞肺癌阳性前哨淋巴结中的价值

Application of ^(18)F-deoxyglucose PET-CT in diagnosing positive sentinel lymph nodes of peripheral non-small cell lung cancer

目的分析^(18)F--脱氧葡萄糖(^(18)F--FDG)正电子发射型计算机断层显像(PET-CT)诊断的阳性淋巴结与应用染料法诊断的前哨淋巴结(SLN)在周围性非小细胞肺癌(NSCLC)淋巴结转移中的灵敏度、特异度和准确性以及两者间的关联性,探讨PET-CT在肺癌SLN中的应用价值及对纵隔淋巴结清扫的影响。方法选择2012年7月至2014年6月期间在山东省肿瘤医院可手术切除的周围性NSCLC患者60例,所有患者手术前行PET-CT检查判断淋巴结转移情况。术中肺癌SLN应用亲脂的异舒泛蓝染料法进行识别后单独送快速病理检验。常规行肺切除术,再将所探测的非前哨淋巴结分别切除,行常规苏木精-伊红(HE)病理检查及免疫组织化学检查,PET-CT和SLN最终以病理诊断为金标准。结果在60例接受手术切除的周围性NSCLC患者中,术中有37例应用异舒泛蓝染料法成功识别出蓝染SLN,SLN检出率达61.7%(37/60)。共清扫出蓝染SLN 85枚,有18例患者中共52枚SLN未查到转移癌细胞,其中有15例患者在术前经PET-CT诊断为N0,有4例患者(22.2%)发生非前哨淋巴结(non-SLN)转移;有19例患者中共33枚SLN查到转移癌细胞,其中有15例患者共25枚SLN在术前经PET-CT诊断为阳性,PET-CT诊断SLN的灵敏度为78.9%(15/19),特异度为83.3%(15/18),阳性预测值为83.3%(15/18),阴性预测值为78.9%(15/19),符合率为81.1%(30/37)。结论PET-CT能较准确的鉴别阳性SLN。PET-CT对NSCLC的临床分期和术后病理分期的符合率高。将PET-CT和SLN技术结合,可以促进对区域淋巴结转移的准确评估和淋巴结清扫术的正确选择,从而对患者预后和术后治疗方式产生重要影响。

Objective To analyze the sensitivity, specificity and accuracy as well as correlation of positive lymph nodes diagnosed by ^18F-deoxyglucose positron emission computed tomography（PET-CT） and sentinel lymph nodes （SLN） detected using blue dyes in lymph node metastasis of peripheral now small cell cancer （NSCLC）, and investigate the value of PET-CT in SLN of lung cancer and its significance with mediastinal lymph nodes dissection. Methods Sixty patients with resectable peripheral NSCLC were randomly selected from Shandong Province Cancer Hospital between July 2012 and June 2014 in this study. All patients underwent integrated PET-CT before operation for lymph node staging. The first lymph nodes to stain blue with oleophilic isosulfan blue dye defined as SLN were sent separately for fast pathological examination at thoracotomy, then all the non-SLN detected intraoperatively were also sent for hematoxylin-eosin（H-E） staining and immunohistochemical examination after pneumectomy. Pathological diagnosis was served as golden standard for comparing PET-CT with SLN. Results At thoracotomy, SLNs were successful identified in 37 of 60 peripheral NSCLC patients injected with isosulfan blue dye, and the rate of SLN detection was 61.7%. Eighty-five blue-stained SLNs were resected. Of them, 52 SLNs in 18 patients were proved negative, while 15 of these 18 patients were diagnosed NO by PET-CT before operation, and 4 patients（22.2%） had only non-SLN metastasis. Thirty-three SLNs in 19 patients were proved positive, while 15 patients including 25 SLNs were diagnosed positive by PET-CT before operation, with the sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of PET-CT for SLN diagnosis of 78.9%（15/19）, 83.3% （15/18） , 83.3% （15/18）, 78.9% （15/19）and 81.1%（30/37）, respectively. Conclusions Integrated PET-CT diagnoses SLN quite precisely. PET-CT shows high coincidence rate for clinical staging and postoperative pathological staging in NSCLC. Combined PET-CT and SLN procedure facilitates the precise estimation of localized lymph node involved as well as the determination of relevant pattern of lymphadenectomy, which may accordingly have important impact on the prognosis and postoperative treament in NSCLC patients.