~(18)FDG-PET在肺癌诊断中的价值

目的　研究氟脱氯葡萄糖F18 正电子发射计算机电子扫描 (1 8FDG PET)在鉴别肺部肿块性质和肺癌术前纵隔淋巴结转移分期中的应用价值。　方法　对 34例肺部肿块患者进行1 8FDG PET和CT检查 ,PET资料分别采用目测法和计算标准化摄取值 (SUV)的半定量法进行分析 ,并同病理结果对照。　结果　目测法1 8FDG PET诊断肺部肿块性质的敏感度、准确度分别是 93%、85 % ;CT分别为 6 3%、5 3% ,2种方法差异有显著性意义 (P <0 0 5 ) ;半定量法准确度为 74% ,与CT相比 ,差异也有显著性意义 (P <0 0 5 )。肺部恶性肿块的SUV是 4 4± 1 9,良性为 2 2± 1 7,2者差异有显著性意义 (P <0 0 5 )。1 8FDG PET和CT 2种检查方法术前对纵隔淋巴结转移的分期与病理结果符合率分别为10 0 %和 78% ,2者差异有显著性意义 (P <0 0 5 )。　结论　同CT相比 ,1 8FDG PET能更准确地鉴别肺部肿块性质及确定纵隔淋巴结转移分期 ,是一种较好的无创性肺癌诊断技术。     

18FDG-PET诊断非小细胞肺癌纵隔淋巴结转移的初步临床研究

目的：初步探讨^18FDG-PET对非小细胞肺癌(NSCIC)纵隔淋巴结转移的诊断价值和影响SUV值(standard uptake value)的可能相关因素。方法回顾性分析作了完全性切除的31例NSCLC患者。比较CT和^18FDG-PET对纵隔淋巴结转移的诊断作用。对可能影响原发癌灶和纵隔淋巴结SUV值的各种因素作单因素和多重回归与相关分析。结果：^18FDG-PET的敏感性优于CT；但两者的特异性无显著性差异。NSCLC原发癌灶最大SUV值仅与原发癌灶大小相关，而未发现纵隔淋巴结最大SUV值与纵隔淋巴结大小或其它因素相关。结论：^18FDG-PET在诊断NSCLC纵隔淋巴结转移方面敏感性明显高于CT。NSCLC原发癌灶最大SUV值仅与原发癌灶大小相关。     

食管癌与贲门癌患者术前内镜超声检查28例分析

目的 通过对比内镜超声及CT在食管癌、贲门癌术前进行T、N分期中的准确度,评价内镜超声的临床应用价值. 方法 对28例食管癌、贲门患者术前均行内镜超声扫描和CT扫描,并分别进行T、N分期,以术后病理为金标准,比较两者分期的准确性有无差异,同时对比两者对淋巴结转移的准确率(即真实性)的差异,判断内镜超声的应用价值. 结果 本组28例病例中,T分期准确率内镜超声为89.3%(25/28),高于CT的46.4%(13/28),差异有统计学意义(P=0.004,P＜0.01).N分期中,内镜超声与CT的准确率分别为82.1%(23/28)及50.0%(14/28),差异有统计学意义(P=0.035,P＜0.05).对转移淋巴结的分组统计中,内镜超声与CT的准确率分别为88.7%及72.2%,有显著性差异(χ2=7.031,P=0.008,P＜0.01).结论 内镜超声在食管癌、贲门癌术前分期中有重要作用,其T分期准确率明显高于传统CT扫描.以淋巴结短径、S/L(淋巴结短径/淋巴结长径)并结合淋巴结的超声显像特征进行分析,提高了判断淋巴结转移以及N分期的准确性.     

三种类型肺癌18氟脱氧葡萄糖摄取量的初步研究

目的探讨肺鳞癌、腺癌、细支气管肺泡癌对18氟脱氧葡萄糖(fluorine -18 fluorode～oxyglucose,FDG)摄取的差异以及影响肺癌摄取FDG的常见因素. 方法对82例肺癌患者行全身或肺部正电子发射体层显像(positron emission tomography,PET)检查,测定肿瘤组织FDG的标准摄取值(standard uptake value,SUV)、最大与平均标准摄取值(SUVmax、SUVmean)、正常肺组织的SUV(SUVlung). 结果 82例患者中,肿瘤组织对FDG的摄取能力均高于相应的正常肺组织(P＜0.01).肺鳞癌、腺癌、细支气管肺泡癌的SUVmax分别为8.42±4.05,5.91±3.91和 2.97±1.10;SUVmean 分别为6.12±2.90,4.35±3.10和 2.25±0.99,三者差异有显著性意义(P＜0.01).SUV与肿瘤的大小呈正相关(P＜0.01).血糖水平与正常肺组织的SUV对肿瘤的SUV有影响(P＜0.05).结论 (1)肺癌组织对FDG的摄取能力高于正常肺组织,而且不同组织类型的肺癌之间SUV值差异有显著性意义.(2)肿瘤的大小与FDG摄取量存在着正相关性.(3)临床上解释肺癌患者PET检查结果时应考虑到血糖等因素的影响.     

外周血GalNAcT mRNA的表达与早期肺癌微转移的研究

目的 观察早期肺癌患者外周血及淋巴结中GalNAc T mRNA的表达,探讨其作为肺癌微转移标志物的可行性.方法 应用巢式RT-PCR技术检测35例Ⅰ、Ⅱ期肺癌患者和12例肺部良性病变患者外周血及淋巴结手术标本,以及10例来志健康志愿者血液标本中GalNAc T mRNA的表达.结果 GalNAc T mRNA在经手术病理证实的35例Ⅰ期、Ⅱ期肺癌患者外周血标本中8例(22.86%)为阳性,43个肺门及纵隔淋巴结21个(46.67%)为阳性.而在12例良性肺部肿瘤及10名健康志愿者外周血均为阴性.在手术切除的43个淋巴结中,RT.PCR法检测到21个(48.84%)有微转移,而常规病理检查只有11个(25.58%)淋巴结有转移,两者差异有统计学分析意义(P＜0.05).结论 GalNAc T mRNA可作为RT-PCR法检测早期肺癌患者外周血微转移的分子标志物,其特异性高,但敏感性较低,有助于早期诊断肺癌转移.     

cⅠA期非小细胞肺癌纵隔淋巴结切除方式的临床研究

目的 探讨不同淋巴结切除方式在病理诊断为T1的cⅠA期非小细胞肺癌治疗中的作用.方法 根据淋巴结切除方式的不同,将1998年1月至2002年5月115例病理诊断为T1的cⅠA期非小细胞肺癌患者分为系统性纵隔淋巴结清扫组(清扫组)和纵隔淋巴结采样组(采样组),回顾性分析两组的并发症、N分期及预后之间的差异,评价各临床病理因素与预后的关系.结果 清扫组平均每例切除淋巴结(15.98±3.05)个,采样组平均每例切除淋巴结6.48±2.16个,两组差异有统计学意义(P＜0.01),但清扫组的手术时间、术后胸腔引流量及并发症发生率均多于采样组.两组在淋巴结分期的改变、总生存率与无病生存率等方面差异无统计学意义;进一步分析发现,当肿瘤直径＞2 cm时,清扫组与采样组的5年总生存率分别为78.2%和54.5%,无病生存率分别为75.1%和51.3%,清扫组均高于采样组(P＜0.05);当肿瘤直径≤2 cm时,两组的5年总生存率与无病生存率无明显差别.病理类型方面,大细胞癌和腺鳞癌5年总生存率低于腺癌和鳞状细胞癌(P＜0.05),有淋巴结转移的5年总生存率与无病生存率明显低于无淋巴结转移者(P均＜0.01).结论 对于术中确定为T1的cⅠA期非小细胞肺癌,当肿瘤直径≤2 cm时,选择纵隔淋巴结采样术可以相对减小创伤;当肿瘤直径＞2 cm时,选择系统性纵隔淋巴结清扫术可能更有助于长期生存.     

非小细胞肺癌淋巴结清扫方式临床研究

目的 比较非小细胞肺癌不同纵隔淋巴结清扫方式间的差异,为规范化开展肺癌淋巴结清扫临床研究提供依据.方法 在202例Ⅰa-Ⅲa期肺癌中进行前瞻性临床对照试验,比较常规清扫(RMLD)和全纵隔骨骼化清扫(SCLD)两种术式,分析手术经过和术后病理分期情况.结果 RMLD 107例,SCLD 95例.两组术前一般情况、临床分期及肺切除方式无明显差异,SCLD组平均扫除淋巴结组数显著高于RMLD组(8.9组对6.2组,P＜0.001),术后总体并发症(14.7%对14.0%,P=0.884)和病死率(2.1%对1.9%,P=0.904)无差异,但SCLD组分别有3例(3.2%)右侧乳糜胸和左侧喉返神经损伤发生.术后病理证实两组组织学类型及分期无明显差异,RNLD和SCLD组pN2分别占27.1%和24.2%(P=0.888),跳跃性纵隔转移率(RMLD 9.3%对SCLD 7.4%,P=0.613)以及纵隔多组转移率(RMLD 15.0%对SCLD 16.8%,P=0.714)亦无明显差异.分析纵隔各组淋巴结转移率发现上叶肺癌下纵隔转移率＜5%,而中、下叶肺癌上、下纵隔转移率均＞10%;cT1病例以及低度恶性肿瘤无一发生纵隔转移.结论 对非小细胞肺癌行常规纵隔清扫可达到与全纵隔骨骼化清扫同样的分期效果,后者手术风险并不高于常规清扫,但应避免右侧乳糜胸和左侧喉返神经损伤的发生;上叶肺癌仅需扫除上纵隔淋巴结而无需常规清扫下纵隔;早早期肺癌以及低度恶性肿瘤没有必要进行常规纵隔清扫.     

非小细胞肺癌淋巴结Beclin 1表达与淋巴结转移的关系

目的探索非小细胞肺癌患者肿瘤组织及周围正常组织Beclin 1水平与淋巴结转移的关系。方法收集我院2011年9月至2016年9月共204例非小细胞肺癌手术患者手术标本,其中男116例、女88例,平均年龄(55.3±11.2)岁。根据肺癌淋巴结转移与否将患者分为无淋巴结转移组(N0组),有肺叶间和叶内淋巴结转移,无纵隔淋巴结转移组(N1组),纵隔淋巴结转移组(N2组)。采用Western blotting法检测标本Beclin 1水平,统计分析患者肿瘤组织及淋巴结标本Beclin 1水平差异。结果 204例肺癌患者中,鳞癌36例、腺癌168例。N0组、N1组、N2组三组患者肿瘤组织中Beclin 1水平逐渐降低,差异有统计学意义(P0.05)。三组患者肺门及肺内淋巴结Beclin 1(N1 Beclin 1)水平对比,N1组和N2组较N0组明显偏低,差异有统计学意义(P0.01)。三组患者纵隔淋巴结Beclin 1(N2 beclin 1)水平对比,N2组较N0组及N1组明显偏低,差异有统计学意义(P0.01)。N1组N1Beclin 1水平低于N2组,差异有统计学意义(P0.01)。N2组N1 Beclin 1水平略低于N2,但差异无统计学意义(P0.05)。结论 Beclin 1水平可成为判断肺部肿瘤良恶性的一个参考指标,淋巴结Beclin 1水平可作为协助判断肺癌是否存在淋巴结转移的一个重要参考指标。     

T_1、T_2肺鳞癌及腺癌淋巴结转移特点及其临床意义

目的　研究T1、T2 肺鳞及腺癌淋巴结转移频度、分布范围及特点 ,为广泛清扫提供依据。　方法　按Naruke肺癌淋巴结分布图对 2 5 4例T1、T2 肺鳞癌及腺癌施行了手术切除及广泛肺内、叶间及纵隔淋巴结清扫术并对其进行统计分析。　结果　清除淋巴结 16 85组。N1淋巴结转移率 2 0 0 % ,N2 淋巴结转移率为 10 2 %。T1、T2 间淋巴结转移率差异有非常显著性意义 (P <0 0 1)。T1鳞癌无N2 转移 ,N2 转移在鳞癌、腺癌分别为 2 2 0 %和 40 9% ,差异有非常显著性意义 (P <0 0 1)。6 4 3%的鳞癌为某 1组N2 转移 ,腺癌≥ 3组转移占 46 2 % ,跳跃式转移占N2 转移的 5 7 5 %。N2 阳性上叶肺癌下纵隔转移占 13 6 % ,N2 阳性的下叶肺癌上纵隔转移占 5 1 6 %。　结论　随着瘤体增大 ,淋巴结转移频度增加 ,腺癌比鳞癌淋巴结转移更加活跃 ,任何部位的肺癌都可跨区域纵隔转移。除T1鳞癌外 ,只有广泛清扫同侧肺内及纵隔淋巴结才能达到根治。     

纤维蛋白原联合多层螺旋CT术前预测结直肠癌淋巴结转移

目的 建立联合纤维蛋白原(FIB)水平的最佳形态学标准评估结直肠癌术前淋巴结转移.方法 纳入连续的690例接受根治术的结直肠癌患者,所有患者术前均使用多层螺旋CT(MSCT)行全腹增强扫描.若发现异常局域淋巴结则测量其最大短轴轴径(MSAD)、最大长轴轴径(MLAD)以及轴径比(MSAD/MLAD),并计算每个分界值预测结直肠癌淋巴结转移的准确度、敏感度、特异度、阳性预测值和阴性预测值;联合术前血清FIB水平鉴别转移性或炎性淋巴结;MSCT联合FIB和单用MSCT两种策略的预测结果与术后病理检查结果进行比较.结果 本研究纳入有异常淋巴结显示的患者100例,其中转移性淋巴结与非转移性淋巴结的影像特点比较差异无统计学意义(P>0.05).MSAD的最佳分界值为6 mm,其诊断淋巴结转移的敏感度为46.8%,特异度为68.4%,准确度为55.0%,阳性预测值为70.7%,阴性预测值为44.1%.MLAD的最佳分界值为8 mm,其诊断淋巴结转移的敏感度为43.5%,特异度为63.2%,准确度为51.0%,阳性预测值为65.9%,阴性预测值为40.7%.以高纤维蛋白原血症(FIB≥3.5 g/L)鉴别诊断MSAD<6 mm或MLAD<8 mm的转移性小淋巴结,其诊断价值有统计学意义(Kappa=0.256,P=0.047).MSAD(6 mm)联合高纤维蛋白原血症与单用MSAD(6 mm)相比敏感度更高 (79.0%比46.8%,P<0.001),但准确度相似 (66.0%比55.0%,P>0.05),特异度更低(44.7%比68.4%,P=0.037).与单用MLAD(8 mm)相比,联合高纤维蛋白原血症敏感度(80.6%比43.5%,P<0.001)和准确度 (66.0%比51.0%,P=0.031)都更高,且特异度没有明显降低(42.1%比63.2%,P>0.05).结论 本研究推荐采用MSAD≥6 mm或MLAD≥8 mm作为结直肠癌淋巴结转移的诊断标准.此外,联合高纤维蛋白原血症对淋巴结转移进行鉴别,可以提高术前分期的敏感度和准确度.     

Lymph node staging in non-small cell lung cancer: evaluation by [18F]FDG positron emission tomography (PET)

BACKGROUND: A study was undertaken to investigate the accuracy of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D- glucose (FDG) in the thoracic lymph node staging of non-small cell lung cancer (NSCLC). METHODS: Forty six patients with focal pulmonary tumours who underwent preoperative computed tomographic (CT) and FDG- PET scanning were evaluated retrospectively. Thirty two patients had NSCLC and 14 patients had a benign process. The final diagnosis was established by means of histopathological examination at thoracotomy, and the nodal classification in patients with lung cancer was performed by thorough dissection of the mediastinal nodes at surgery. RESULTS: FDG-PET was 80% sensitive, 100% specific, and 87.5% accurate in staging thoracic lymph nodes in patients with NSCLC, whereas CT scanning was 50% sensitive, 75% specific, and 59.4% accurate. The absence of lymph node tumour involvement was identified by FDG-PET in all 12 patients with NO disease compared with nine by CT scanning. Lymph node metastases were correctly detected by FDG-PET in three of five patients with N1 disease compared with two by CT scanning, in nine of 11 with N2 disease compared with six by CT scanning, an in all four with N3 nodes compared with two by CT scanning. CONCLUSIONS: FDG-PET provides a new and effective method for staging thoracic lymph nodes in patients with lung cancer and is superior to CT scanning in the assessment of hilar and mediastinal nodal metastases. With regard to resectability, FDG-PET could differentiate reliably between patients with N1/N2 disease and those with unresectable N3 disease.     

Positron emission tomography for detection of lymph node metastases in lung cancer

Although radiography, computed tomography (CT), and magnetic resonance imaging are still the methods of choice for the study of lung cancer, they have certain limitations in the evaluation of mediastinal lymph node metastases. Positron emission tomography (PET) with 18F-fluoro-2-deoxy-D-glucose (FDG) has recently emerged as a practical and useful imaging modality in patients with lung cancer. We evaluated the usefulness of FDG-PET in the detection of mediastinal lymph node metastases and then compared the findings with the results of CT by region based on the histological diagnosis. For FDG-PET, the sensitivity, specificity and accuracy were 93%, 76%, and 98%, respectively, whereas, for CT, this was 65%, 87%, and 82%, which showed significant differences. FDG-PET is significantly more accurate than CT in lymph node staging of lung cancer, and also can improve the diagnostic accuracy in distant metastases.     

Comparative efficacy of positron emission tomography with FDG and computed tomographic scanning in preoperative staging of non-small cell lung cancer

OBJECTIVE: To determine the sensitivity, specificity, and accuracy of positron emission tomography with 2-fluorine-18-fluorodeoxyglucose (PET-FDG) in the preoperative staging (N and M staging) of patients with lung cancer. The authors wanted to compare the efficacy of PET scanning with currently used computed tomography (CT) scanning. MATERIALS AND METHODS: Results of whole-body PET-FDG imaging and CT scans were compared with histologic findings for the presence or absence of lymph node disease or metastatic sites. Sampling of mediastinal lymph nodes was performed using mediastinoscopy or thoracotomy. RESULTS: PET-FDG imaging was significantly more sensitive, specific, and accurate for detecting N disease than CT. PET changed N staging in 35% and M staging in 11% of patients. CT scans helped in accurate anatomic localization of 6/57 PET lymph node abnormalities. CONCLUSION: PET-FDG is a reliable method for preoperative staging of patients with lung cancer and would help to optimize management of these patients. Accurate lymph node staging of lung cancer may be ideally performed by simultaneous review of PET and CT scans.     

Integrated FDG-PET/CT does not make invasive staging of the intrathoracic lymph nodes in non-small cell lung cancer redundant: a prospective study

BACKGROUND: Staging of non-small cell lung cancer (NSCLC) is important for determining choice of treatment and prognosis. The accuracy of FDG-PET scans for staging of lymph nodes is too low to replace invasive nodal staging. It is unknown whether the accuracy of integrated FDG-PET/CT scanning makes invasive staging redundant. METHODS: In a prospective study, the mediastinal and/or hilar lymph nodes in patients with proven NSCLC were investigated with integrated FDG-PET/CT scanning. Pathological confirmation of all suspect lymph nodes was obtained to calculate the accuracy of the fusion images. In addition, the use of the standardised uptake value (SUV) in the staging of intrathoracic lymph nodes was analysed. RESULTS: 105 intrathoracic lymph node stations from 52 patients with NSCLC were characterised. The prevalence of malignancy in the lymph nodes was 36%. The sensitivity of the integrated FDG-PET/CT scan to detect malignant lymph nodes was 84% and its specificity was 85% (positive likelihood ratio 5.64, negative likelihood ratio 0.19). SUV(max), SUV(mean) and the SUV(max)/SUV(liver) ratio were all significantly higher in malignant than in benign lymph nodes. The area under the receiver operating curve did not differ between these three quantitative variables, but the highest accuracy was found with the SUV(max)/SUV(liver) ratio. At a cut-off value of 1.5 for the SUV(max)/SUV(liver )ratio, the sensitivity and specificity to detect malignant lymph node invasion were 82% and 93%, respectively. CONCLUSION: The accuracy of integrated FDG-PET/CT scanning is too low to replace invasive intrathoracic lymph node staging in patients with NSCLC. The visual interpretation of the fusion images of the integrated FDG-PET/CT scan can be replaced by the quantitative variable SUV(max)/SUV(liver) without loss of accuracy for intrathoracic lymph node staging.     

Advantages of positron emission tomography over computed tomography in mediastinal staging of non-small cell lung cancer

BACKGROUND: New treatment algorithms in early stage non-small cell lung cancer (NSCLC) involving preoperative chemotherapy require accurate clinical staging of the mediastinum. This study compares the accuracy of 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) scanning with that of computed tomography (CT) scanning in the clinical staging of non-small cell lung cancer. MATERIALS AND METHODS: A retrospective review was performed on 52 patients with NSCLC who were evaluated with both CT and PET scans. All patients had their mediastinal lymph nodes sampled by mediastinoscopy or at the time of thoracotomy for pulmonary resection. Each imaging study was evaluated separately and correlated with histopathologic results. RESULTS: For detecting mediastinal metastases the sensitivities of PET and CT scans were 67 and 50%, respectively; specificities were 91 and 65%, respectively; accuracies were 88 and 63%, respectively; positive predictive values were 50 and 16%, respectively; negative predictive values were 95 and 88%, respectively. PET scans were significantly better than CT scans at detecting mediastinal metastases (PET, 4/8; CT, 3/19) (P = 0.01). CONCLUSIONS: PET scanning is superior to CT scanning for clinical staging of the mediastinum in NSCLC. A more confident decision regarding stratification of patients into current treatment algorithms can be made when the decision is based on PET scanning rather than the current "gold standard" of CT scanning.     

Positron emission tomography for preoperative lymph node diagnosis in esophageal carcinoma]

BACKGROUND: Exact preoperative staging is a prerequisite for the indication and the choice of appropriate operative technique for patients with esophageal carcinoma. The objective of this prospective study was to assess whether positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) increases the accuracy of preoperative lymph node staging with standard computed tomography (CT) and thus leads to a different surgical approach. PATIENTS AND METHODS: Fifty-eight patients with carcinoma of the esophagus (46 men and 12 women) with a median age of 61 years underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen. Sensitivity, specificity, and accuracy were calculated for both imaging techniques to evaluate the detection of histologically verified lymph node metastases. RESULTS: The FDG-PET showed higher specificity, whereas CT proved to be more accurate for detecting lymph node metastases not only of the abdomen (73% vs 59%) but also of the thorax (73% vs 63%). Resections were transhiatal in 23 patients and transthoracal in 16. As a supplement to conventional CT diagnostic procedure, FDG-PET was not decisive for the surgical approach. CONCLUSIONS: Altogether, pretherapeutical PET imaging did not increase the accuracy of lymph node staging for our patients with esophageal carcinoma, which had already been defined through CT. Therefore, no new consequences resulted for the surgical procedure. Due to the high costs involved with PET investigation, lymph node staging with it is momentarily indicated mainly for clinical studies and when CT does not offer unequivocal results. Increased sensitivity of the already advantageous whole-body FDG-PET imaging by means of tumor-affinitive radiopharmaceuticals and optimized apparatus resolution could lead to new indications for this staging procedure.     

支气管内超声引导针吸活检术在非小细胞肺癌术前分期中的临床应用

目的探讨支气管内超声引导针吸活检术(EBUS-TBNA)在非小细胞肺癌纵隔淋巴结分期中的应用价值。 方法2010年9月至2012年9月,北京大学人民医院利用EBUS-TBNA对术前确诊或CT扫描高度怀疑非小细胞肺癌且伴有纵隔淋巴结肿大(N₂站淋巴结短径≥1.0cm,或N₁站淋巴结短径≥1.0cm且N₂多站短径≥0.5cm者),有手术切除可能,术前无放、化疗史的126例患者进行纵隔淋巴结分期。最终入组82例非小细胞肺癌患者。 结果该组82例患者,经EBUS-TBNA检查证实纵隔淋巴结转移(阳性)者54例,未见纵隔淋巴结转移(阴性)者28例。EBUS-TBNA在该组肺癌术前纵隔淋巴结分期中的敏感度、特异度和准确性分别为94.7%(54/57)、100.0%(25/25)和96.3%(79/82),阳性预测值及阴性预测值分别为100.0%(54/54)和89.3%(25/28)。而CT对于本组患者纵隔淋巴结分期中的敏感度、特异度和准确性分别为98.2%(55/56)、38.5%(10/26)和79.3%(65/82),阳性预测值及阴性预测值分别为77.5%(55/71)和90.9%(10/11)。CT在术前纵隔淋巴结分期中的假阳性率为22.5%(16/71)。全组中,16例(19.5%)肺癌患者因EBUS-TBNA病理结果改变了治疗策略。 结论EBUS-TBNA用于非小细胞肺癌纵隔淋巴结分期的敏感性、特异性和准确性较高。EBUS-TBNA可以作为非小细胞肺癌术前分期、指导治疗策略的检查手段。     

Fluorodeoxyglucose positron emission tomography improves preoperative staging of resectable lung metastasis

OBJECTIVE: F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is now a procedure of proven clinical value in the staging of primary lung cancer. This study evaluated the role of PET in the preoperative assessment of resectable lung metastases. METHODS: Eighty-six patients with previously treated malignancy and proven or suspected lung metastases, deemed resectable at computed tomography scan, were investigated with 89 preoperative PET procedures. Primary tumor sites were: gastrointestinal in 32 cases, sarcoma in 13, urologic in 14, breast in 8, head and neck in 7, gynecologic in 5, thymus in 5, other in 5. Seventy lung resections were performed in 68 patients of whom only 54 proved to be lung metastasis, 7 were primary lung tumors, and 9 were benign lesions. RESULTS: In 19 cases (21%) lung surgery was excluded on the basis of PET scan results due to extrapulmonary metastases (11 cases), primary site recurrence (2), mediastinal adenopathy (2), or benign disease (4). All mediastinal node metastases (7 cases) were detected by PET with a sensitivity, accuracy, and negative predictive value for mediastinal staging of 100%, 96%, and 100%, respectively, versus 71%, 92%, and 95% of the computed tomography scan. In the group of patients who underwent lung resection, PET sensitivity for detection of lung metastasis was 87%. CONCLUSIONS: PET scan proved to be a valuable staging procedure in patients with clinically resectable lung metastasis and changed the therapeutic management in a high proportion of cases.     

FDG-PET/CT for the Preoperative Lymph Node Staging of Invasive Bladder Cancer

Background

Locoregional lymph node metastasis is an important prognostic factor in patients with bladder cancer. Multimodal treatment, depending on preoperative stage, may improve survival. The standard imaging modalities for staging (computed tomography [CT] or magnetic resonance imaging [MRI]) have an accuracy range of 70–90% for lymph node staging. A more accurate preoperative diagnostic test could improve survival rates even more.

Objective

To determine whether the use of 2-deoxy-2 [F] fluoro-D-glucose (FDG) positron emission tomography (PET) in combination with CT (FDG-PET/CT) can increase the reliability of preoperative lymph node staging in patients with nonmetastatic invasive bladder cancer (T2 or higher, M0) or recurrent high-risk superficial disease (T1G3 with or without Tis, M0).

Design, setting, and participants

Fifty-one patients underwent a preoperative FDG-PET/CT between April 2004 and December 2007. Independent of the result for lymph node status, all patients underwent a radical cystectomy and an extended lymphadenectomy. The FDG-PET/CT and CT results were compared with the definitive pathologic results.

Measurements

Among the 51 patients, 13 patients had metastatically involved locoregional lymph nodes, diagnosed on histopathology. In six patients, these nodes demonstrated increased FDG uptake on PET. In seven patients, PET/CT did not diagnose the positive lymph nodes. PET/CT was false positive in one patient.

Results and limitations

For the diagnosis of node-positive disease, the accuracy, the sensitivity, and the specificity of FDG-PET/CT were 84%, 46%, and 97%, respectively. When analysing the results of CT alone, there was accuracy of 80%, sensitivity of 46%, and specificity of 92%. The use of FDG-PET/CT is hampered by technical limitations.

Conclusions

We found no advantage for combined FDG-PET/CT over CT alone for lymph node staging of invasive bladder cancer or recurrent high-risk superficial disease.