^(18)F-FDG PET/CT对非小细胞肺癌区域淋巴结诊断的假阴性与假阳性研究  

The false negative and positive of ^(18)F-FDG PET/CT in regional lymph node of lung cancer

作　　者：杨文锋[1] 付政[2] 于金明[3] 王绍平[4] 房玉芳[1] 袁方[1] 穆殿斌[5] 

机构地区：[1]山东省肿瘤医院胸外科,济南250117 [2]山东省肿瘤医院PET/CT中心,济南250117 [3]山东省肿瘤医院放疗科,济南250117 [4]山东省肿瘤医院检验科,济南250117 [5]山东省肿瘤医院病理科,济南250117

出　　处：《中华核医学杂志》2007年第3期139-142,共4页Chinese Journal of Nuclear Medicine

基　　金：山东省医药卫生科研项目(2005HW137)

摘　　要：目的探讨^(18)F-FDG PET/CT 在检测非小细胞肺癌(NSCLC)区域淋巴结中出现假阴性和假阳性的因素。方法随机选择手术治疗的 NSCLC 患者48例,术前1周内行^(18)F-FDG PET/CT 检查,同期行 CT 增强扫描,术后根据病理检查结果分析 PET/CT 诊断 NSCLC 区域淋巴结转移的假阴性与假阳性因素。结果 48例患者共切除区域淋巴结313枚,转移淋巴结51枚,PET/CT 结果7枚假阴性,8枚假阳性,阳性预测值和阴性预测值分别为85%,97%,高于 CT(57%,94%;P=0.002,0.045)。3枚假阴性淋巴结内的癌灶较小;2枚淋巴结短径约为0.4 mm,小于 PET/CT 的空间分辨率;2枚紧邻原发灶的淋巴结,图像无法区分而视为原发灶。8枚假阳性淋巴结为患者在原发病灶基础上并发不同程度的肺部疾病和淋巴结炎症,使其糖代谢率增高。结论假阳性出于(1)淋巴结的短径小于 PET/CT 的空间分辨率;(2)淋巴结内的小癌灶糖代谢率较低;(3)紧邻原发灶的淋巴结与原发灶无法区分。原发肿瘤合并肺部疾病是导致 PET/CT 出现假阳性的重要原因。Objective 18^F-FDG PET/CT is now widely used in clinical staging of lung cancer. But false positive（FP） and negative（FN） results may occur. The aim of this study was to analyze the factors causing false 18^-FDG PET/CT results in the detection of lymph node in non-small cell lung cancer （NSCLC）. Methods Forty-eight patients underwent pulmonay lohectomy and dissection of lymph nodes after their 18^F-FDG PET/CT and contrast enhanced CT results were retrospectively reviewed. The pathological status of the resected lymph nodes was the major concern. Results The pathological examination confirmed metastasis in 51 out of 313 excised lymph nodes in 48 patients. There were 7 FN and 8 FP lymph nodes in PET/CT. The positive and negative predictive values of PET/CT were 85% and 97%, respectively, compared with 57% and 94% of CT（P = 0. 002, 0.045; respectively）. Among the seven FN lymph nodes, 3 were with smaller tumor loci, 2 were 0. 4 mm in short axis, and 2 proximate to the primaries were masked hy the higher uptake of the primary tumor. The 8 FP lymph nodes were all with pulmonary complications and lymphadenitis. Conclusion The smaller size, micro-metastases, and little separation from the primaries were the major reasons for FN, and the lymphadenitis with pulmonary complications for FP lymph node imaging in PET/CT.

关 键 词：癌 非小细胞肺 肿瘤转移 淋巴结 体层摄影术 发射型计算机 体层摄影术 X线计算机 脱氧葡萄糖 

分 类 号：R734.2[医药卫生—肿瘤]