Fluorine 18-tagged fluorodeoxyglucose positron emission tomographic scanning to predict lymph node metastasis, invasiveness, or both, in clinical T1 NO MO lung adenocarcinoma
Fluorine 18-tagged fluorodeoxyglucose positron emission tomographic scanning to predict lymph node metastasis, invasiveness, or both, in clinical T1 NO MO lung adenocarcinoma
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DOI：
10.1016/j.jtcvs.2004.03.020
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发表时间：
2004-09-01
影响因子：
6
通讯作者：
Uno, K
中科院分区：
文献类型：
--
作者：
Nomori, H;Watanabe, K;Uno, K
目的：我们试图预测临床 T1 N0 M0 肺腺癌的淋巴结转移和肿瘤侵袭性，并通过正电子发射断层扫描测量氟脱氧葡萄糖的摄取。方法：对 44 例临床分期为 T1 N0 M0 的大小为 1 至 3 cm 的腺癌患者在进行淋巴结清扫术前进行氟脱氧葡萄糖正电子发射断层扫描。通过使用肿瘤和对侧健康肺组织之间的对比度来评估氟脱氧葡萄糖的摄取。检查肿瘤内淋巴管和血管侵犯、胸膜受累情况以及组织学分化程度。结果：36例患者肿瘤病理分期为T1 N0 M0，其中8例为晚期。尽管所有 22 例氟脱氧葡萄糖摄取对比度低于 0.5 的腺癌均为病理性 T1 N0 M0 肿瘤，但 22 例对比度为 0.5 或更高的腺癌中，有 8 例 (36%) 处于比 T1 N0 M0 更晚期的状态，差异显着 (P = .002)。与对比度为 0.5 或更大的腺癌相比，对比度小于 0.5 的腺癌表现出较少的淋巴和血管侵犯以及较少的胸膜受累（分别为 P = .006、P = .004 和 P = .02）。 22 例对比度小于 0.5 的腺癌中有 19 例 (86%) 组织学分化程度良好，高于 22 例对比度为 0.5 或更大的腺癌中的 4 例 (18%) (P < .001)。结论：对比度小于 0.5 的临床 T1 N0 M0 肺腺癌通常具有良好的组织学分化程度。与对比度为0.5或更大的患者相比，无淋巴结转移，血管或胸膜肿瘤受累较少，且分化良好。对于这种类型的腺癌，可能需要进行有限的肺切除，或者减少淋巴结清扫或纵隔镜检查，或两者兼而有之。
Objective: We sought to predict lymph node metastasis and tumor invasiveness in clinical T1 N0 M0 lung adenocarcinomas, and we measured fluorodeoxyglucose uptake on positron emission tomography.Methods: Fluorodeoxyglucose positron emission tomography was performed on 44 patients with adenocarcinomas of 1 to 3 cm in size clinically staged as T1 N0 M0 before major lung resection with lymph node dissection. Fluorodeoxyglucose uptake was evaluated by using the contrast ratio between the tumor and contralateral healthy lung tissue. Lymphatic and vascular invasion within tumors, pleural involvement, and grade of histologic differentiation were examined.Results: The pathologic tumor stage was T1 N0 M0 in 36 patients, and a more advanced stage was found in 8 patients. Although all 22 adenocarcinomas with a contrast ratio of less than 0.5 in fluorodeoxyglucose uptake were pathologic T1 N0 M0 tumors, 8 (36%) of 22 with a contrast ratio of 0.5 or greater were of a more advanced stage than T1 N0 M0, with the difference being significant (P = .002). Adenocarcinomas with a contrast ratio of less than 0.5 showed less lymphatic and vascular invasion and less pleural involvement than those with a contrast ratio of 0.5 or greater (P = .006, P = .004, and P = .02, respectively). The grade of histologic differentiation was well differentiated in 19 of 22 adenocarcinomas with a contrast ratio of less than 0.5 (86%), which was a greater frequency than the 4 (18%) of 22 adenocarcinomas with a contrast ratio of 0.5 or greater (P < .001).Conclusion: Clinical T1 N0 M0 lung adenocarcinomas with a contrast ratio of less than 0.5 usually did not have lymph node metastasis, had less tumor involvement of vessels or pleura, and were more frequently well differentiated than those with a contrast ratio of 0.5 or greater. Limited lung resection could be indicated, lymph node dissection or mediastinoscopy could be reduced, or both in this type of adenocarcinoma.