Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma.
Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma.
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发表时间：
2000-09
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通讯作者：
Flavio Crippa;Monica Leutner;Filiberto Belli;F. Gallino;Marco Greco;Silvana Pilotti;Natale Cascinelli;Emilio Bombardieri
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作者：
Flavio Crippa;Monica Leutner;Filiberto Belli;F. Gallino;Marco Greco;Silvana Pilotti;Natale Cascinelli;Emilio Bombardieri
本研究的目的是建立FDG PET对淋巴结转移的诊断准确性，并确定最小可检测体积的疾病。方法采用FDG PET对38例经临床或仪器诊断为黑色素瘤淋巴结转移的患者的56个淋巴结盆进行术前研究。所有淋巴结盆均行淋巴结清扫术。将FDG PET结果与术后组织病理学结果进行比较。在注射平均活性为496 MBq（范围，366-699 MBq）的FDG后，使用GE 4096 WB扫描仪获得PET图像。结果FDGPET对淋巴结转移灶的诊断有较好的价值。敏感性为95%（35/37），特异性为84%（16/19），准确性为91%（51/56），阳性预测值为92%（35/38），阴性预测值为89%（16/18）。在647个手术切除的淋巴结中，114个在组织学上显示转移。FDG PET 100%检出≥ 10 mm的转移灶，83%检出6-10 mm的转移灶，23%检出≥ 93%的转移灶（仅限于淋巴结受累超过50%或有包膜浸润的转移灶）。结论FDGPET对黑色素瘤淋巴结转移的诊断具有较高的敏感性和特异性。然而，即使能够检测小体积的亚临床肉眼可见的疾病，FDG PET也不能以可接受的灵敏度检测亚临床显微镜下的疾病。FDG PET的特异性较好，但可能出现假阳性结果。
UNLABELLED The purposes of this study were to establish the diagnostic accuracy of FDG PET for lymph node metastases and to determine the smallest detectable volume of disease. METHODS Using FDG PET, we preoperatively studied 56 lymph node basins in 38 patients with a clinical or instrumental diagnosis of lymph node metastases from melanoma. All lymph node basins underwent node dissection. The FDG PET results were compared with the postoperative histopathology results. PET images were obtained using a GE 4096 WB scanner, after injection of a mean activity of 496 MBq (range, 366-699 MBq) of FDG. RESULTS The efficacy of FDG PET in the diagnosis of involved lymph node basins was good. Sensitivity was 95% (35/37); specificity, 84% (16/19); accuracy, 91% (51/56); positive predictive value, 92% (35/38); and negative predicative value, 89% (16/18). Metastases were shown histologically in 114 of 647 surgically removed lymph nodes. FDG PET detected 100% of metastases > or = 10 mm, 83% of metastases 6-10 mm, and 23% of metastases or = 93%) only for metastases with more than 50% lymph node involvement or with capsular infiltration. CONCLUSION Our study shows that FDG PET has a reasonable sensitivity and specificity for detecting the presence or absence of lymph node metastases in patients with melanoma. However, even if able to detect small volumes of subclinical macroscopic disease, FDG PET cannot detect subclinical microscopic disease with acceptable sensitivity. The specificity of FDG PET is good, but some false-positive results may occur.