CT和正电子发射计算机断层摄影显像对确定非小细胞肺癌纵隔淋巴结转移的临床价值

目的 比较正电子发射计算机断层摄影显像（PET）和CT显像在判定可切除非小细胞肺癌（NSCLC）患者纵隔淋巴结有无转移上的临床价值。方法 68例可切除非小细胞肺癌患者于手术前常规进行PET和CT胸部显像，判定纵隔淋巴结有无转移。1个月以内行开胸手术纵隔淋巴结清扫或标准电视纵隔镜淋巴结活检以获取纵隔淋巴结病理标本，对切除的纵隔淋巴结进行常规石蜡切片HE染色和PCNA／Ki67免疫组织化学染色，病理学检查结果与手术前的影像学CT检查进行比较。结果 有纵隔淋巴结转移者52例，无纵隔淋巴结转移者16例。CT显像诊断纵隔淋巴结的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为76．9％（40／52）、50％（8／16）、70．6％（48／68）、83．3％（40／48）、40％（8／20）。PET显像诊断纵隔淋巴结的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为92．3％（48／52）、87．5％（14／16）、91．2％（62／68）、96％（48／50）、77．7％（14／18）。CT＋PET的敏感性为98％（51／52）。结论 在诊断非小细胞肺癌纵隔淋巴结转移上，PET明显优于CT，CT＋PET能提高检查非小细胞肺癌纵隔淋巴结的敏感性。

Clinical value of computed tomography and fluorine-18 fluorodeoxyglucose positron remission tomography in diagnosis of mediastinal metastasis of non small cell lung cancer

Objective To compare the clinical values of computed tomography (CT) and fluorine-18 fluorodeoxyglucose positron remission tomography (FDG-PET) in diagnosis of mediastinal metastasis of non-small cell lung cancer (NSCLC). Methods Sixty patients with respectable NSCLC underwent CT and FDG-PET with an interval of 2 weeks and then underwent thoracotomy for clearance of the lymph nodes or biopsy of the mediastinal lymph nodes via mediastinoscopy. The specimens of mediastinal lymph node underwent HE staining and PCNA/Ki67 immunohistochemical staining. The sensitivity, specificity, accuracy, positive prediction value, and negative prediction value in diagnosis of metastasis of mediastinal lymph nodes of these 2 procedures were compared. Results The sensitivity, specificity, accuracy, positive prediction value, and negative prediction value in diagnosis of metastasis of mediastinal lymph nodes were 92.3%, S87.5%, 91.2%, 96.0%, and 77.7% respectively for FDG-PET, and were 76.9%, 50.0%, 70.6%, 83.3%, and 40.0% respectively for CT. The sensitivity rate was 98% for CT plus FDG-PET. Conclusion PET is superior to CT in diagnosis of metastasis of NSCLC to mediastinal lymph nodes. PET+CT significantly increases the sensitivity in diagnosis.