非小细胞肺癌不同区域淋巴结转移18F-FDG PET-CT显像诊断效能研究  

Clinical value of 18 F-FDG PET-CT on the imaging of lymph node metastasis in different regions in non-small cell lung cancer

作　　者：孟庆红[1] 邵国强[3] 彭鸣亚[2] 徐龙宝[2] 赵骏[2] 王坚[4] MENG Qing-hong;SHAO Guo-qiang;PENG Ming-ya;XU Long bao;ZHAO Jun;WANG Jian(Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Changzhou 213003,P.R.China;Department of Nuclear Medicine,Nanjing First Hospital,Nanjing Hospital Affiliated to Nanjing Medical Unituersity,Nanjing 210006,P.R.China)

机构地区：[1]南京医科大学附属常州市第二人民医院肿瘤中心,江苏常州213003 [2]南京医科大学附属常州市第二人民医院核医学科,江苏常州213003 [3]南京医科大学附属南京医院、南京市第一医院核医学科,江苏南京210006 [4]东南大学附属江阴市人民医院肿瘤中心,江苏无锡214400

出　　处：《中华肿瘤防治杂志》2020年第19期1561-1566,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：江苏省科技发展计划(BL2012037)。

摘　　要：目的 18F-FDG PET-CT显像是判断非小细胞肺癌(non-small cell lung cancer,NSCLC)术前分期的重要方法。本研究对NSCLC不同区域淋巴结的最佳最大标准摄取值(maximum standardized uptake value,SUVmax)、淋巴结/纵隔血池摄取比、淋巴结/肝脏血池摄取比进行研究,探讨PET-CT显像对不同区域淋巴结转移的诊断效能差异和临床价值。方法回顾性分析2016-01-01-2018-12-31南京医科大学附属南京医院、南京市第一医院行18F-FDG PET-CT显像后2周内接受肺癌根治术的77例患者病例资料,根据2017年第8版肺癌TNM分期,患者为N0~2期。以手术病理诊断为"金标准",采用χ2检验比较18F-FDG PET-CT显像对肺门(N1区)和同侧纵膈(N2区)淋巴结转移诊断效能差异,根据受试者工作特征(receiver operating characteristic,ROC)曲线探讨N1和N2区淋巴结SUVmax值、淋巴结/纵隔血池摄取比、淋巴结/肝脏血池摄取比差异,多因素Logistic回归分析评估PET-CT诊断淋巴结转移假阳性的影响因素。结果 77例患者共清除353组区域淋巴结,包括N1区淋巴结107组和N2区淋巴结246组。84组(23.8%)淋巴结存在转移,269组(76.2%)淋巴结未见转移。18F-FDG PET-CT N1区(83.3%)淋巴结转移诊断灵敏度高于N2区(62.0%),χ2=5.381,P=0.02。N2区(96.4%)淋巴结诊断特异性高于N1(83.6%),χ2=13.415,P=0.010。N1区淋巴结最佳SUVmax、淋巴结/纵隔血池摄取比和淋巴结/肝脏血池摄取比分别为4.05、1.90和1.17;N2区分别为2.95、1.26和0.93。多因素分析显示,阻塞性肺炎(OR=7.325,95%CI为2.342~22.905)和N1区淋巴结(OR=4.255,95%CI为1.600~11.319)是易发生PET-CT假阳性的因素,P<0.05。结论 18F-FDG PET-CT诊断NSCLC淋巴结转移效能与淋巴结位置有关,呈现N1区淋巴结灵敏度高、N2区淋巴结特异性高的特点。不同部位淋巴结采用不同参考指标有助于提高诊断准确性。OBJECTIVE 18F-FDG PET-CT was the important method for non-small cell lung cancer(NSCLC)staging.The SUVmax,node/aorta ratio and node/liver ratio in N1 and N2 stage lymph node metastasis in patients with NSCLC were studied in this paper.This study was to explore the differences of diagnosis efficiency and the clinical value of PET-CT in the diagnosis of lymph node metastasis in different regions.METHODS A total of 77 patients(55 males and22 females,aged 42-78 years)with TNM-stageing N0-2 NSCLC received radical cancer resection from January 2016 to December 2018 were included in this retrospective study.All the patients received 18F-FDG PET-CT imaging within2 weeks before surgery.The diagnosis was given based on the golden standard(surgical pathology analysis).The difference of diagnostic efficiency of PET-CT,SUVmax,node/aorta ratio and node/liver ratio in N1 and N2 stage lymph node metastasis were analyzed by ROC curve,together with the investigation on the factors affecting the false positivity of lymph node metastasis using PET-CT by the multi-variate analysis.RESULTS A total of 353 regional lymph nodes were dissected in 77 patients,including 107 N1 lymph nodes and 246 N2 lymph nodes.Among them,84(23.8%)had lymph node metastasis and 269(76.2%)had no lymph node metastasis.The diagnostic sensitivity of 18F-FDG PET-CT for the N1 and N2 stage lymph node metastasis were 85.3% and 62.0%,respectively,showing that the sensitivity in region N1 was significantly higher than that of N2(χ2=5.381,P=0.02).The specificity of PET-CT for the N1 and N2 stage lymph node metastasis were 83.6% and 96.4%,respectively,showing that the specificity in region N2 was significantly higher than that of N1(χ2=13.415,P=0.010).The SUVmax,node/aorta ratio,node/liver ratio at N1 stage were 4.05,1.90 and 1.17,and the SUVmax,node/aorta ratio,node/liver ratio at N2 stage were 2.95,1.26 and 0.93,respectively.The multi-variate analysis indicated that obstructive pneumonia(OR=7.325,95%CI=2.342-22.905)and N1 stage lymph node metastasis(OR=4.255,95%CI=

关 键 词：非小细胞肺癌 区域淋巴结 正电子发射断层显像 标准摄取值 脱氧葡萄糖 

分 类 号：R734.2[医药卫生—肿瘤]