在非小细胞肺癌患者淋巴结分期的联合方法中，氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）的使用是否正确？

Is FDG-PET/CT used correctly in the combined approach for nodal staging in NSCLC patients?

作者信息

Simsek F S, Comak A, Asik M, Kuslu D, Balci T A, Ulutas H, Koroglu R, Kekilli E, Akatli A, Elmali F, Yalcin N C, Akyol H

机构信息

Department of Nuclear Medicine, Pamukkale University, Faculty of Medicine, Denizli, Turkey.

Department of Nuclear Medicine, Inonu University, Faculty of Medicine, Malatya, Turkey.

出版信息

Niger J Clin Pract. 2020 Jun;23(6):842-847. doi: 10.4103/njcp.njcp_2_19.

DOI:10.4103/njcp.njcp_2_19

PMID:32525121

Abstract

BACKGROUND

The most widely accepted approach nowadays in nodal staging of non-small cell lung cancer (NSCLC) is the combined use of 18-Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). However, this approach may not be sufficient, especially for early stages.

AIMS

Our aim was to assess whether more satisfactory results can be obtained with standardized uptake value maximum lymph node/standardized uptake value mean mediastinal blood pool (SUVmax LN/SUVmean MBP), SUVmax LN/Primary tumor, or a novel cut-off value to SUVmax in this special group.

SUBJECTS AND METHODS

Patients with diagnosed NSCLC and underwent FDG-PET/CT were reviewed retrospectively. 168 LNs of 52 early stage NSCLC patients were evaluated. The LNs identified in surgery/pathology reports were found in the FDG-PET/CT images. Anatomic and metabolic parameters were measured. Statistical analysis was performed by using of MedCalc Statistical Software.

RESULTS

Regardless of LNs size; sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SUVmax >2.5 were 91.5%, 65.9%, 58.2%, and 95.1%, respectively. Optimum cut-off value of SUVmax was >4.0. Sensitivity, specificity, PPV, and NPV were found as 81.0%, 90.0%, 81.0%, and 90.0% respectively. Optimum cut-off value of SUVmax LN/SUVmean MBP was >1.71. Sensitivity, specificity, PPV, and NPV were found as 94.7%, 80.0%, 71.1%, and 96.7%, respectively. Optimum cut-off value of SUVmax LN/Primary tumor was >0.28. Sensitivity, specificity, PPV, and NPV were found as 81.1%, 85.1%, 72.9% and 90.1%, respectively.

CONCLUSION

SUVmax LN/SUVmean MBP >1.71 has higher PPV than currently used, with similar NPV and sensitivity. This can provide increase in the accuracy of combined approach. In this way, faster nodal staging/treatment decisions, cost savings for healthcare system and time saving of medical professionals can be obtained.

摘要

背景

目前非小细胞肺癌（NSCLC）淋巴结分期中最广泛接受的方法是联合使用18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）和支气管内超声引导下经支气管针吸活检（EBUS-TBNA）。然而，这种方法可能并不充分，尤其是对于早期阶段。

目的

我们的目的是评估在这个特殊群体中，标准化摄取值最大淋巴结/标准化摄取值平均纵隔血池（SUVmax LN/SUVmean MBP）、SUVmax LN/原发肿瘤，或SUVmax的新临界值是否能获得更满意的结果。

对象与方法

回顾性分析已确诊NSCLC并接受FDG-PET/CT检查的患者。对52例早期NSCLC患者的168个淋巴结进行评估。在手术/病理报告中确定的淋巴结在FDG-PET/CT图像中找到。测量解剖和代谢参数。使用MedCalc统计软件进行统计分析。

结果

无论淋巴结大小如何；SUVmax>2.5时的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为91.5%、65.9%、58.2%和95.1%。SUVmax的最佳临界值>4.0。敏感性、特异性、PPV和NPV分别为81.0%、90.0%、81.0%和90.0%。SUVmax LN/SUVmean MBP的最佳临界值>1.71。敏感性、特异性、PPV和NPV分别为94.7%、80.0%、71.1%和96.7%。SUVmax LN/原发肿瘤的最佳临界值>0.28。敏感性、特异性、PPV和NPV分别为81.1%、85.1%、72.9%和90.1%。