PET/CT对非小细胞肺癌患者纵隔淋巴结转移的诊断效能

The diagnostic efficacy of PET/CT for mediastinal lymph node metastasis in non-small cell lung cancer patients

目的分析正电子发射断层显像/计算机体层摄影术(PET/CT)对非小细胞肺癌(NSCLC)患者纵隔淋巴结转移的诊断价值。方法回顾性分析2017年7月至2021年6月徐州医科大学附属宿迁医院收治的120例NSCLC患者的临床资料,均于术前行胸部CT及PET/CT检查(18F-FDG显像剂),且行全胸腔镜下肺叶切除+纵隔淋巴结清扫术。以手术所得病理结果为金标准,分析胸部CT、PET/CT检查对NSCLC患者纵隔淋巴结转移的诊断效能。结果手术病理结果显示,120例患者中有53例伴淋巴结转移(腺癌33例、鳞癌17例、腺鳞癌3例),其中pN1、pN2、pN3分期分别有15、32、6例;术前经胸部CT检查判断伴纵隔淋巴结转移的真阳性、真阴性、假阳性、假阴性分别为28、52、15、25例,经PET/CT检查分别为44、61、6、9例,PET/CT检查诊断纵隔淋巴结转移的灵敏度、特异度、准确度、阳性预测值、阴性预测值均高于胸部CT(均P<0.05);PET/CT检查淋巴结转移N分期与手术N分期的符合率[79.25%(42/53)]高于胸部CT检查[45.28%(24/53)](P<0.05);伴纵隔淋巴结转移患者的肺癌原发灶最大标准摄取值(SUV)高于无淋巴结转移患者(P<0.05)。结论PET/CT检查对NSCLC患者纵隔淋巴结转移具有较高的诊断价值,而对结果存在异议者需进一步行胸腔镜检查以明确诊断。

Objective To analyze the diagnostic value of positron emission tomography/computed tomography(PET/CT)for mediastinal lymph node metastasis in non-small cell lung cancer(NSCLC)patients.Methods A retrospective analysis was conducted on the clinical data of 120 NSCLC patients admitted to the Suqian Hospital Affiliated to Xuzhou Medical University from July 2017 to June 2021.All patients underwent preoperative chest CT and PET/CT examination(18F-FDG imaging agent),and underwent total thoracoscopic lobectomy+mediastinal lymph node dissection.Using the pathological results obtained from surgery as the gold standard,the diagnostic efficacy of chest CT and PET/CT examination for mediastinal lymph node metastasis in NSCLC patients was analyzed.Results The surgical pathological results showed that 53 out of 120 patients had lymph node metastasis(33 cases of adenocarcinoma,17 cases of squamous cell carcinoma,and 3 cases of adenocarcinoma),with 15,32,and 6 cases of pN1,pN2,and pN3 staging,respectively;Preoperative chest CT examination identified 28 cases of true positive,52 cases of true negative,15 cases of false positive,and 25 cases of false negative with mediastinal lymph node metastasis,while PET/CT examination identified 44 cases,61 cases,6 cases,and 9 cases,respectively.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of PET/CT in diagnosing mediastinal lymph node metastasis were higher than those of chest CT(all P<0.05);The consistency rate between PET/CT examination of lymph node metastasis N stage and surgical N stage[79.25%(42/53)]was higher than that of chest CT examination[45.28%(24/53)](P<0.05);The maximum standard uptake value(SUV)of lung cancer primary lesion in patients with mediastinal lymph node metastasis was higher than that in patients without lymph node metastasis(P<0.05).Conclusions PET/CT examination has high diagnostic value for mediastinal lymph node metastasis in NSCLC patients,and those who have objections to the results need further thoracoscopic examination to clarify the diagnosis.