99mTc-tetrofosmin SPECT诊断肺部肿瘤和纵隔淋巴结转移的临床价值

背景与目的肺癌切除术前准确的肿瘤分期是手术成功的前提,因此有必要无创性诊断肺部肿瘤及其侵犯的真实范围。本研究的目的是评价99mTc-tetrofosmin SPECT（99mTc-TF SPECT）这种功能显像在诊断肺部肿瘤及纵隔淋巴结转移中的临床应用价值。方法对33例肺部肿块患者于术前或穿刺前一周内行胸部99mTc-TF SPECT显像,以病理结果为参照,计算99mTc-TF SPECT和CT诊断肺癌及纵隔淋巴结转移的灵敏度、特异性和准确性,并加以比较。结果99mTc-TF SPECT诊断肺癌的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为95.7%、80.0%、90.9%、91.7%和88.9%,CT分别为73.9%、70.0%、72.7%、85.0%和53.8%;99mTc-TF SPECT诊断纵隔淋巴结转移的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为93.3%、75.0%、87.0%、87.5%和85.7%,CT则分别为60.0%、75.0%、65.2%、81.8%和50.0%。99mTc-TF SPECT诊断肺癌的灵敏度明显高于CT（P〈0.05）。结论99mTc-TF能在术前无创地探测肺癌的原发灶和纵隔淋巴结转移灶,在肺癌的诊断和分期中具有重要的临床实用价值。

Clinical significance of 99mTc-tetrofosmin SPECT in the diagnosis of lung neoplasms and mediastinal lymph node involvement

Background and objective An accurate pre-operative tumor staging is the premise for a successful operation, for which a non-invasive evaluation of the nature of lung nodules and the real extent of them is necessary. As the pioneer of functional images, nuclear medicine continues to introduce novel radiopharmaceuticals and new techniques for cancer imaging, including tetrofosmin (TF). The aim of this study is to evaluate the clinical usefulness of ~ 99m Tc-tetrofosmin SPECT (~ 99m Tc-TF SPECT) in the diagnosis of lung cancer and mediastinal lymph node involvement. Methods Thirty-three patients with pulmonary neoplasms took both CT scan and ~ 99m Tc-TF SPECT in one week before their operations or puncture biopsy. Then the sensitivity, specificity and accuracy were acquired according to the pathological outcomings and the results of ~ 99m Tc-TF SPECT and CT were compared in detection of lung cancer and mediastinal lymph node metastasis, respectively. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ~ 99m Tc-TF SPECT for lung cancer were 95.7%, 80.0%, 90.9%, 91.7%, 88.9%, and 73.9%, 70.0%, 72.7% , 85.0% , 53.8% by CT, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ~ 99m Tc-TF SPECT for mediastinal lymph node metastasis were 93.3%, 75.0%, 87.0% , 87.5%, 85.7%, while those of CT were 60.0%, 75.0%, 65.2%, 81.8%, 50.0% respectively. The sensitivity of ~ 99m Tc-TF SPECT was significantly higher than that of CT for lung neoplasms (P<0.05). Conclusion ~ 99m Tc-TF SPECT is a useful non-invasive presurgical tool to evaluate primary lung cancers and mediastinal lymph node involvement, and it will play a favorable clinical role in diagnosis and staging of lung cancer.