全身PET/CT和VEGF-C检查对非小细胞肺癌诊治的应用价值

目的：探讨全身PET/CT和血浆血管内皮生长因子-C（VEGF-C）在非小细胞肺癌（NSCLC）诊断和治疗选择中的临床应用价值。方法：收集2005年1月17日～2007年1月17日86例病理确诊的NSCLC患者的PET/CT资料并留取血清样本备用。比较PET/CT、胸部CT、支气管镜活检及经皮肺穿刺切割活检4种不同方法对NSCLC的诊断敏感性;分析SUV值（standardized uptake value）和延迟相SUV对NSCLC的诊断价值;比较PET/CT与常规检查的TNM分期在淋巴结和远处转移中的检出率和检出分布上的差异。用双抗体夹心ELISA法试剂盒测定血清VEGF-C浓度辅助胸部CT评价N分期。结果：入组研究NSCLC患者86例,男性67例,女性19例;腺癌41例、鳞癌37例、混合型腺癌5例及大细胞癌3例。PET/CT和胸部CT、支气管镜活检、经皮肺穿切割活检术对NSCLC患者肺部原发病变的诊断敏感性分别为90.89%（78/86）、76.47%（60/86）、80%（36/45）和90%（45/50）,PET/CT与胸部CT在诊断敏感性上差异显著（P=0.02）。86例NSCLC患者PET/CT初始相SUV均值为8.27±4.90,其中46例患者延迟相SUV均值为8.35±5.29,高于其初始相SUV均值7.62±4.50（P=0.003）。PET/CT对N1、N2、N3分别检出10、24、26例,合计检出率为69.77%（60/86）;胸部CT/VEGF-C分别检出9、29、6例,合计53.88%（46/86）,PET/CT组与CT/VEGF-C组在阳性检出率和淋巴结分布上差异均非常显著（P=0.006和P=0.004）。本组PET/CT诊断Ⅳ期肺癌38例,与常规检查组诊断29例,两组在阳性发现率上无显著差异（P=0.211）,在分布上两组差异也不显著（P=0.712）。结论：PET/CT对NSCLC原发肿瘤的诊断敏感性显著优于胸部CT,延迟相SUV值对SUV初始值诊断NSCLC有重要参考价值。PET/CT对NSCLC的TNM分期比常规检查分期可能对治疗帮助更大。

The value of integrated positron emission tomography/computer tomography (PET/CT) in the diagnosis and treatment of non-small cell lung cancer

Objective：The purpose of this study was to explore the value of the integrated positron emission tomography/computer tomography（PET/CT） in the diagnosis and selection of treatment methods of non-small cell lung cancer（NSCLC）.Methods：Retrospective review of eighty-six patients with histopathological diagnoses of lung cancer between January 17,2005 and January 17,2007 was performed.All of these patients＇ radiologic reports and serum samples which were used to detect the concentration of VEGF-C by sandwich enzyme-linked immunosorbent assay to assist the diagnosis of lymph node with chest CT were collected.The TNM staging difference between PET/CT and conventional examinations in recall ratio and distribution and the accuracy and agreement of PET/CT,chest CT,flexible bronchoscope and transthoracic needle cutting biopsy on NSCLC were compared.The role of the early-phase standardized uptake value（SUV） and the delayed-phase SUV in diagnosis of NSCLC was also evaluated.Results：Eighty-six patients with NSCLC were enrolled in this study.There were 67 male,19 female,41 adenocarcinoma,37 squamous cell carcinoma,5 adenocarcinoma with mixed subtypes and 3 large cell carcinoma.The diagnostic sensitivity of PET/CT,chest CT,flexible bronchoscope and transthoracic needle cutting biopsy for diagnosis of NSCLC were 90.89%（78/86）,76.47%（60/86）,80%（36/45）,and 90%（45/50）,respectively.There was significant difference in PET/CT and chest CT（P=0.02）.The mean of delayed-phase SUV（8.35±5.29） was significantly higher than that of the early-time SUV（7.62±4.50） in 46 patients（P=0.003）.PET/CT correctly detected the N1 lymph nodes in 10 patients,N2 in 24 patients and N3 in 26 patients,while chest CT/VEGF-C detected N1 in 9 patients,N2 in 29 patients and N3 in 6 patients,respectively.There was a significant difference in lymph nodes recall ratio and distribution（P=0.006 and P=0.004）.Thirty-eight patients with stage Ⅳ NSCLC were correctly diagnosed by PET/CT compared with 29 patients by c