纵隔镜检查术在PET/CT纵隔淋巴结阳性的非小细胞肺癌中的应用  

Role of Mediastinoscopy in PET/CT Positive Mediastinal Involvement in Non-small Cell Lung Cancer

作　　者：廖日强[1,2] 杨学宁[1,2] 钟文昭[1,2] 聂强[1,2] 董嵩[1,2] 王思云[3] 吴一龙[1,2] 

机构地区：[1]广东省人民医院肿瘤中心肺二科 [2]广东省医学科学院 广东省肺癌研究所,广州510080 [3]广东省人民医院肿瘤中心核医学科 PET中心

出　　处：《肿瘤防治研究》2013年第12期1170-1173,共4页Cancer Research on Prevention and Treatment

摘　　要：目的探讨纵隔镜检查术在纵隔或肺门淋巴结PET/CT(positron emission tomography-computed tomography)代谢阳性的非小细胞肺癌中(non-small cell lung cancer,NSCLC)的应用价值。方法回顾性分析纵隔镜检查术前PET/CT纵隔或肺门淋巴结异常的NSCLC病例,以病理结果为标准,计算纵隔镜检查术诊断纵隔淋巴结转移的敏感度、特异性、阳性预测值、阴性预测值和准确率以及PET/CT的假阳性率。结果 2007年4月—2011年12月期间,73例患者符合条件。纵隔镜检查术诊断纵隔淋巴结转移的敏感度、特异性、阳性预测值、阴性预测值和准确率分别为91.3%、100%、100%、87.1%和94.5%。PET/CT诊断纵隔淋巴结转移的假阳性率高达30.8%。如果将非巨块型纵隔淋巴结代谢升高且双侧肺门淋巴结代谢升高定义为纵隔淋巴结阴性,其阳性预测值升高至81.1%。结论在PET/CT纵隔或者肺门淋巴结代谢升高的NSCLC,纵隔镜检查术诊断纵隔淋巴结转移的敏感度和特异性高。对PET/CT代谢阳性的纵隔淋巴结需要病理确认,特别是合并双侧肺门对侧性代谢增高的纵隔淋巴结。Objective To evaluate the value of mediastinoscopy in cases of positive mediastinal/hilar lymph node involvement in positron emission tomography and computed tomography （ PET/CT ） scanning in non- small cell lung cancer. Methods NSCLC cases with mediastinal or hilar involvement in PET/CT treated by mediastinoscopy were retrospectively analyzed. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） and accuracy rate of PET/CT and the false positivity of mediastinoscopy in mediastinal staging were calculated. Results Between Apr 2007 and Dec 2011, 73 NSCLC cases were enrolled. The sensitivity, specificity, PPV, NPV and accuracy rate of mediastinoscopy in mediastinal staging were 91.3%,100%,100%,87.1% and 94.5%,respectively. The the false positivity of PET/CT was 30.8%. If non-bulky mediatinal lymph nodes with bilateral hilar distribution were considered benign, PPV of PET/CT was increased to 81.1%. Conclusion Mediastinoscopy has high sensitivity, specificity in mediastinal staging in NSCLC cases with mediastinal or hilar involvement in PET/CT. Positive mediastinal involvement in PET/ CT, especially bilateral hilar distribution needs to stage by invasive methods.

关 键 词：肺癌 PET CT 纵隔镜检查术 纵隔分期 

分 类 号：R734.2[医药卫生—肿瘤]