手术前PET-CT对非小细胞肺癌纵隔淋巴结转移的诊断价值

目的探讨术前PET-CT显像对非小细胞肺癌(NSCLC)纵隔淋巴结转移的诊断价值。方法选取2011年10月至2012年8月间进行手术根治或纵隔淋巴结活检的25例NSCLC患者。所有患者术前均行PET-CT检查,并根据手术或纵隔镜结果进行诊断及分期,计算PET-CT对诊断纵隔淋巴结的准确性、灵敏度、特异度、阳性预测值和阴性预测值。结果 25例患者中,纵隔淋巴结阳性率为28.0%。PET-CT对诊断纵隔淋巴结转移的准确性、灵敏度、特异度、阳性和阴性预测值分别为76.0%、57.1%、83.3%、57.1%和83.3%。3例假阴性患者的纵隔最大淋巴结短径分别为1.0、0.9和0.7cm。3例假阳性患者均为炎性增生。结论 PET-CT对NSCLC手术患者纵隔淋巴结转移的诊断灵敏度较低,特异度和阴性预测值较高。因此,PET-CT显示为阳性的纵隔淋巴结,有必要行纵隔镜检查;而阴性者则可不需行纵隔镜检查。

The value of preoperative positron emission tomography- computerised tomography in the diagnosis of mediastinal lymph node metastasis in patients with non-small cell lung cancer

Objective Mediastinal lymph node staging determines the treatment strategy for non- small cell lung cancer （NSCLC）. This study aims to retrospectively evaluate the value of preoperative posi- tron emission tomography-computerised tomography （PET-CT） in the diagnosis of mediastinal lymph node metastasis. Methods Twenty-five patients with NSCLC undergoing surgical resection and/or mediastinos- copy were enrolled in this study from December 2011 to August 2012. All patients received preoperative ex- aminations with PET-CT and underwent mediastinal lymph node dissection or sampling. The results of PET- CT were compared to the mediastinal lymph node histology results. Results The incidence of N2 pathologi- cal disease was 28.0 %. The accuracy, sensitivity and specificity of PET-CT in the diagnosis of the medias- tinal lymph nodes was 76. 0 % , 57. 1% and 83.3 % , respectively. The positive and negative predictive values were 57. 1% and 83.3%, respectively. The short diameters of lymph nodes of false-negative results （three patients） were 1.0cm,0. 9cm and 0. 7cm, respectively. False-positive results （three patients） were due to inflammatory lymph nodes. Conclusions The sensitivity of PET-CT for mediastinal lymph node staging in patients selected for surgery is low and its specificity and negative predictive value is high. When mediastinal lymph nodes are detected as positive by PET-CT, mediastinoscopy must be performed; on the other hand, and tmediastinoscopy might not be necessary in the negative patients.