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題名 | Efficacy Comparison of Conventional Computed Tomography and Whole-Body 18F-Fluorodeoxyglucose Positron Emission Tomography for Staging in Non-Small Cell Lung Cancer Patients=傳統電腦斷層和正子掃瞄在非小細胞癌診斷分期上的準確度分析比較 |
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作者 | 徐稟智; 陳志弘; 何恭之; 吳怡成; 高國晉; 劉劍英; 張文震; 蔡熒煌; 楊政達; Hsu, Ping-chih; Chen, Chih-hung; Ho, Kung-chu; Wu, Yi-chen; Kao, Kuo-chin; Liu, Chien-ying; Chang, Wen-cheng; Tsai, Ying-huang; Yang, Cheng-ta; |
期刊 | 胸腔醫學 |
出版日期 | 20130200 |
卷期 | 28:1 2013.02[民102.02] |
頁次 | 頁8-17 |
分類號 | 415.468 |
語文 | eng |
關鍵詞 | 非小細胞肺癌; 正子掃瞄; 分期; 縱膈腔淋巴結; Non-small cell lung cancer; 18F-fluorodeoxyglucose positron emission tomography; FDG-PET; Staging; Mediastinal lymph node; |
中文摘要 | 背景:非小細胞肺癌(non-small cell lung cancer, NSCLC)的分期和預後有重要的關連,正子掃瞄(18F-fluorodeoxyglucose positron emission tomography, FDG PET)和傳統電腦斷層掃瞄已經普遍使用在非小細胞肺癌的診斷和分期上。然而這兩項檢查的準確度可能影響在臨床上的治療計畫,尤其是在縱膈腔淋巴結(N2)診斷方面。所以本研究目的在於分析這兩項檢查在非小細胞肺癌的分期準確度比較。方法:本研究瀏覽了自2006年11月到2010年7月,596名新診斷的非小細胞肺癌的病患,並且在初診斷時同接受正子掃瞄和傳統電腦斷層掃瞄者,分析其分期治療計畫的改變。在接受手術的病患中,以最後病理確定的診斷分期去比較這兩者檢查在分期上的準確度。結果:相較於傳統電腦斷層,加上全身正子掃瞄之後,有百分之三十的病人分期上的改變是上升的,另外百分之四點九的病人分期下降,因此,百分之二十六點三的病人會改變原本的治療計畫。其中有一百七十三名病人在沒有接受任何前置輔助治療(Neoadjuvant therapy)下直接接受手術治療,以這些手術後的病理組織作為最後分期診斷的根據比較,電腦斷層的準確率為百分之五十七點八,全身正子掃瞄為百分之六十點七。對於縱膈腔淋巴結(N2)分期的診斷靈敏度(Sensitivity)、特異度(Specificity)、陽性預測值(Positive predictive value)、陰性預測值(Negative predictive value)和準確率(Accuracy),在電腦斷層分別為42.9%, 95.0%, 52.9%, 92.3%及88.4%,而在正子掃瞄方面為62.0%, 96.0%, 68.4%, 94.8%及91.9%。結論:該研究顯示出正子掃瞄(FDG PET)對於非小細胞肺癌的臨床分期上是稍優於電腦斷層。但是在在縱膈腔淋巴結(N2)或遠處轉移分期診斷方面仍有三成左右的偽陽性率,這也可能使得有些病人失去痊癒治療的機會。因此,當這兩項檢查有懷疑癌細胞縱膈腔淋巴結侵犯時,或許進一步侵襲性的如經內視鏡超音波穿刺或縱膈腔鏡去直接取得組織證實是建議必要的。 |
英文摘要 | Objectives: The prognosis of non-small cell lung cancer (NSCLC) is strongly correlated with the disease stage. Both 18F-fluorodeoxyglucose positron emission tomography (FDGPET) and conventional contrast-enhanced computed tomography (CT) are commonly used for staging, and their accuracies may thus influence the clinical outcome of NSCLC treatment. In this study, we investigated the efficacy of both methods for staging, particularly mediastinal nodal staging, in NSCLC patients.Methods: From November 2006 to July 2010, 596 newly diagnosed NSCLC patients who had received chest CT and subsequent FDG-PET for initial staging were enrolled for assessment. Of these, 173 patients who received surgical resection without neoadjuvant therapy were further analyzed based on the final pathological stage.Results: Compared to CT, FDG-PET led to upstaging in 180 (30.2%) patients and downstaging in 29 (4.9%). The pathological results of the 173 (31.0%) patients who received surgical intervention without neoadjuvant therapy revealed that the accuracy rate in staging was 57.8% by CT and 60.7% by PET. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for mediastinal nodal staging (N2) were 42.9%, 95.0%, 52.9%, 92.3% and 88.4% by CT, and 62.0%, 96.0%, 68.4%, 94.8% and 91.9% by PET, respectively.Conclusions: This study suggests that FDG-PET is superior to conventional CT on the clinical staging of NSCLC, but there was still a false positive rate up to 31.6% in mediastinal staging or metastasis by FDG-PET. The false positive may cause that some patients receive inadequate treatment. Therefore, if nodal involvement is suspected by either image study which may alter the decision for surgical treatment, another invasive procedure may be required for tissue proof. |
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