PET-CT对肺癌纵隔淋巴结转移的诊断效能及相关影响因素的研究

目的 探究正电子发射计算机断层显像（PET-CT）对肺癌纵隔淋巴结转移的诊断效能，分析影响诊断效能的相关因素以及肺癌淋巴结转移的影响因素，为临床提供理论参考。方法 选取我院2019年1月—2020年12月收治的经手术病理证实的181例肺癌（476枚淋巴结）患者临床资料进行分析，均行PET-CT进行诊断，分析诊断的效能（灵敏度、特异性、准确性以及阳性/阴性预测值）；分析影响PET-CT诊断效能的因素，以及肺癌患者发生纵隔淋巴结转移的相关危险因素。结果 PET-CT诊断肺癌淋巴结转移的灵敏度65.75%（96/146），特异性89.39%（295/330），准确率82.14%（391/476），阳性预测值73.28%（96/131），阴性预测值85.51%（295/345），同手术病理结果相比，差异无统计学意义（P > 0.05）。真阳性淋巴结与假阳性淋巴结的短径、SUVmax值相比较，差异均无统计学意义（P > 0.05）；真阳性淋巴结与假阳性淋巴结的密度相比，差异有统计学意义（P < 0.05）。经Logistic回模型分析分析显示，肿瘤的病理类型为腺癌、中央型肺癌、低分化程度是肺癌患者发生纵隔淋巴结转移的危险因素（P < 0.05）。结论 PET-CT诊断肺癌纵隔淋巴结转移有较高的灵敏度、特异性、准确性；诊断的灵敏度受淋巴结的短径与SUVmax值影响，诊断的特异性受淋巴结的密度影响。纵隔淋巴结转移主要与病理类型、病灶部位、分化程度有关。

Study on efficiency of PET-CT in diagnosis of mediastinal lymph node metastasis of lung cancer and influencing factors

Objective To explore the diagnostic efficacy of positron emission tomography-computed tomography (PET-CT) for mediastinal lymph node metastasis of lung cancer, to analyze the factors that affect the diagnostic efficacy and lung cancer lymph node metastasis, and to provide a theoretical reference for clinical practice. Methods The clinical data of 181 patients with lung cancer (476 lymph nodes) confirmed by surgery and pathology who were admitted to our hospital from January 2019 to December 2020 were used for analysis. All patients were diagnosed by PET-CT. We analyzed diagnostic efficiency (sensitivity, specificity, accuracy, and positive/negative predictive value), factors affecting the diagnostic efficiency of PET-CT, and risk factors of mediastinal lymph node metastasis in patients with lung cancer. Results The sensitivity (65.75%, 96/146), specificity (89.39%, 295/330), accuracy rate (82.14%, 391/476), positive predictive value (73.28%, 96/131), and negative predictive value (85.51%, 295/345) of PET-CT in diagnosis of lung cancer lymph node metastasis were slightly different from those of the surgical pathological results (P > 0.05). There were no significant differences in short diameter and SUVmax between true and false positive lymph nodes (P > 0.05), but a significant difference in density was observed between true and false positive lymph nodes (P < 0.05). Logistic regression analysis identified the pathological type of adenocarcinoma, central lung cancer, and low differentiation as the risk factors for mediastinal lymph node metastasis in patients with lung cancer (P < 0.05). Conclusion PET-CT has high sensitivity, high specificity, and high accuracy in the diagnosis of mediastinal lymph node metastasis in lung cancer. The sensitivity of diagnosis is affected by the short diameter and SUVmax of lymph nodes, and the specificity of diagnosis is affected by the density of lymph nodes. Mediastinal lymph node metastasis is mainly associated with pathological type, the location of the lesion, and the degree of differentiation.