Clinical relevance of imaging proliferative activity in lung nodules
Clinical relevance of imaging proliferative activity in lung nodules
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DOI：
10.1007/s00259-004-1706-7
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发表时间：
2005-04-01
影响因子：
9.1
通讯作者：
Reske, SN
中科院分区：
文献类型：
--
作者：
Buck, AK;Hetzel, M;Reske, SN
目的：最近，胸苷类似物 3'-脱氧- 3'[F-18] 氟胸苷 (FLT) 已被引入用于通过正电子发射断层扫描 (PET) 进行增殖成像。在这项前瞻性研究中，我们检查了 FLT 区分良恶性肺部病变和肿瘤分期的准确性。方法：除了常规分期程序外，共有 47 例胸部 CT 新诊断出疑似恶性肿瘤的肺结节患者接受了 FLT-PET 检查。共有 43 名患者还接受了 2-[F-18] 氟-2-脱氧-D-葡萄糖 (FDG) PET 成像。 2周内，患者接受肺部病灶切除手术或核心活检。结果：组织病理学显示32例患者为恶性肺部肿瘤（20例非小细胞肺癌，1例小细胞肺癌，1例肺类癌，1例非霍奇金淋巴瘤，9例肺外肿瘤转移），15例良性病变。 FLT 摄取增加仅与恶性肿瘤相关。两名非小细胞肺癌患者、一名肺类癌患者和三名肺转移患者的 FLT-PET 呈假阴性。 FLT-PET检测肺癌的敏感性为90%，特异性为100%，准确性为94%。 21名肺癌患者中有15名出现纵隔淋巴结转移。 FLT-PET 在 7/15 名患者中呈真阳性，N 分期的敏感性为 53%（特异性 100%，准确性 67%）。 67% (20/30) 患者的临床 TNM 分期被正确识别，而 FDG-PET 为 85% (23/27)。结论：FLT-PET 对于检测肺部恶性肿瘤具有较高的特异性。与 FDG 相比，FLT-PET 对肺癌患者 N 分期和肺转移检测的准确性较低。因此，不推荐 FLT-PET 用于肺癌分期。
Purpose: Recently, the thymidine analogue 3'-deoxy- 3'[F-18] fluorothymidine (FLT) has been introduced for imaging proliferation with positron emission tomography ( PET). In this prospective study, we examined the accuracy of FLT for differentiation of benign from malignant lung lesions and for tumour staging.Methods: A total of 47 patients with newly diagnosed pulmonary nodules on chest CT suspicious for malignancy were examined with FLT-PET in addition to routine staging procedures. A total of 43 patients also underwent 2-[F-18] fluoro-2-deoxy-D-glucose (FDG) PET imaging. Within 2 weeks, patients underwent resective surgery or core biopsy of the pulmonary lesion.Results: Histopathology revealed malignant lung tumours in 32 patients ( 20 non-small cell lung cancer, 1 small cell lung cancer, 1 pulmonary carcinoid, 1 non-Hodgkin's lymphoma, nine metastases from extrapulmonary tumours) and benign lesions in 15 patients. Increased FLT uptake was exclusively related to malignant tumours. FLT-PET was false negative in two patients with non-small cell lung cancer, in the patient with a pulmonary carcinoid and in three patients with lung metastases. The sensitivity of FLT-PET for detection of lung cancer was 90%, the specificity 100% and the accuracy 94%. Fifteen out of 21 patients with lung cancer had mediastinal lymph node metastases. FLT-PET was true positive in 7/15 patients, resulting in a sensitivity of 53% for N-staging ( specificity 100%, accuracy 67%). Clinical TNM stage was correctly identified in 67% (20/30) patients, compared to 85% (23/27) with FDG-PET.Conclusion: FLT-PET has a high specificity for the detection of malignant lung tumours. Compared with FDG, FLT-PET is less accurate for N-staging in patients with lung cancer and for detection of lung metastases. FLT-PET therefore cannot be recommended for staging of lung cancer.