18F-FDG PET/CT鉴别诊断非小细胞肺癌患者不同密度肺门纵隔淋巴结良恶性的价值  

Value of FDG PET/CT in the differential diagnosis of benign and malignant hilar mediastinal lymph nodes in patients with non-small cell lung cancer

作　　者：张毓艺 姚稚明[2] 薛倩倩 陈聪霞[2] 李旭[2] 刘秀芹[2] Zhang Yuyi;Yao Zhiming;Xue Qianqian;Chen Congxia;Li Xu;Liu Xiuqin(Department of Nuclear Medicine,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of Nuclear Medicine,the First Affiliated Hospital of Fujian Medicine University,Fuzhou 350005,China)

机构地区：[1]北京积水潭医院核医学科,100035 [2]北京医院核医学科、国家老年医学中心,100730 [3]福建医科大学附属第一医院核医学科,福州350005

出　　处：《中华核医学与分子影像杂志》2020年第9期513-517,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：首都临床特色应用研究与成果推广项目(Z151100004015140)。

摘　　要：目的探讨18F-脱氧葡萄糖(FDG)PET/CT对非小细胞肺癌(NSCLC)不同密度淋巴结N1、N2期转移的诊断价值。方法纳入2007年10月至2017年12月间北京医院118例[男68例、女50例,年龄27~87(65.4±10.8)岁]N0~N2期NSCLC初诊患者。患者均行术前18F-FDG PET/CT检查,检查后1个月内行肺癌切除并局部淋巴结清扫手术。将显像结果和清除术切除的肺门纵隔淋巴结病理结果进行对比,计算并比较不同密度(钙化、部分钙化、高密度、低+等密度)组淋巴结的转移构成比。以受试者工作特征(ROC)曲线分别获得诊断不同密度淋巴结N1、N2期转移的淋巴结短径和最大标准摄取值(SUVmax)界值,并计算诊断效能。采用两独立样本t检验、Mann-Whitney U检验及χ2检验(χ2分割)行统计学比较。结果获得病理结果的433枚肺门纵隔淋巴结中,N0期365枚,N1、N2期淋巴结68枚。钙化组(n=8)N1、N2期转移构成比为0,部分钙化组、低+等密度组的转移淋巴结构成比分别为28.6%(8/28)、20.3%(44/217),均高于高密度淋巴结组[8.9%(16/180),χ2值:7.369、9.945,均P<0.017(χ2分割阈值)];部分钙化组与低+等密度组之间差异无统计学意义(χ2=1.021,P>0.017)。N1、N2期淋巴结的SUVmax高于N0期淋巴结[6.94(4.51,11.36)与2.45(1.93,3.42);z=-10.388,P<0.01]。ROC曲线分析示,肺门纵隔淋巴结N1、N2期转移的SUVmax诊断界值为3.66,灵敏度、特异性、准确性分别为85.3%、78.9%、80.0%;低+等密度组、高密度组的SUVmax诊断界值分别为3.66、2.79,对应的灵敏度、特异性、准确性、阳性预测值分别为93.2%、86.7%、88.0%、64.1%和93.8%、57.9%、61.1%、17.9%,除灵敏度外,其余3个指标差异有统计学意义(χ2值:10.724、7.326、32.971,均P<0.01)。将淋巴结短径(短径界值1.0 cm)与SUVmax联合后,低+等密度组的特异性(94.2%)高于单纯应用短径(80.9%)或SUVmax的特异性(86.7%;χ2值:14.048、5.661,均P<0.05);高密度组特异性及准确性均高于单纯应用SUVmax�Objective To investigate the diagnostic value of 18F-fluorodeoxyglucose(FDG)PET/CT in detecting N1 or N2 metastasis of lymph node(LN)with different densities in patients with non-small cell lung cancer(NSCLC).Methods A total of 118 patients(68 males,50 females,age range:27-87(65.4±10.8)years)with N0-N2 M0 NSCLC in Beijing Hospital between October 2007 and December 2017 were included in this study.All patients underwent 18F-FDG PET/CT,followed by surgery within 1 month.The pathological findings of the resected hilar mediastinal LN were taken as the gold standard,and ratios of LN metastasis were calculated for different density groups(calcification,partial calcification,hyper density,hypodensity/isodensity).The cut-off values of LN size(short diameter)and the maximum standardized uptake value(SUVmax)in the detection of N1 and N2 metastases was determined by the receiver operating characteristic(ROC)curve,and the diagnostic efficiencies were calculated.Independent-sample t test,Mann-Whitney U test andχ2 test(partition ofχ2)were used for data analysis.Results A total of 433 LN has the histopathologic results:365 LN was in stage N0,68 LN was in stage N1-N2.There were no metastases in calcification group(0/8).The metastatic LN proportions in partial calcification group(28.6%,8/28),hypodensity/isodensity group(20.3%,44/217)were significantly higher than that in the hyper density group(8.9%,16/180;χ2 values:7.369,9.945,both P<0.017(threshold for partition ofχ2)).There was no significant difference between the partial group and hypodensity/isodensity group(χ2=1.021,P>0.017).The SUVmax of N1+N2 group was significantly higher than that in N0 group(6.94(4.51,11.36)vs 2.45(1.93,3.42);z=-10.388,P<0.01).According to the ROC curve,the cut-off value of SUVmax in detecting hilar and mediastinal LN was 3.66.The diagnostic sensitivity,specificity and accuracy for N1+N2 metastasis was 85.3%,78.9%,80.0%respectively.The cut-off values of SUVmax for hypodensity/isodensity group and hyper density group were 3.66 and 2.79 respective

关 键 词：癌 非小细胞肺 淋巴结 正电子发射断层显像术 体层摄影术 X线计算机 诊断 鉴别 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]