切换至 "中华医学电子期刊资源库"
高级检索
中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2015, Vol. 02 ›› Issue (01) : 48 -54. doi: 10.3877/cma.j.issn.2095-8773.2015.01.009

所属专题： 文献；

论著

18F-脱氧葡萄糖PET-CT在鉴别周围性非小细胞肺癌阳性前哨淋巴结中的价值
郝少雨1, 韩丹2, 张百江1,†(), 宋平平1, 刘希斌1, 宋峥峥1, 付政3   
  1. 1. 250117　济南，山东省肿瘤医院外六科
    2. 250117　济南，山东省肿瘤医院放射肿瘤科
    3. 250117　济南，山东省肿瘤医院PET/CT中心
  • 收稿日期:2015-01-09 出版日期:2015-02-28
  • 通信作者: 张百江
  • 基金资助:
    山东省自然科学基金项目(ZR2013HL046)

Application of 18F-deoxyglucose PET-CT in diagnosing positive sentinel lymph nodes of peripheral non-small cell lung cancer

Shaoyu Hao1, Dan Han2, Baijian Zhang1,†(), Pingping Song1, Xibin Liu1, Zheng-zheng Song1, Zheng Fu3   

  1. 1. Department 6 of Thoracic Surgery, Shandong Province Cancer Hospital, Jinan 250117, China
    2. Department of Radiation Oncology, Shandong Province Cancer Hospital, Jinan 250117, China
    3. PET/CT Center, Shandong Province Cancer Hospital, Jinan 250117, China
  • Received:2015-01-09 Published:2015-02-28
  • Corresponding author: Baijian Zhang
  • About author:
    Corresponding author: Zhang Baijiang, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

郝少雨, 韩丹, 张百江, 宋平平, 刘希斌, 宋峥峥, 付政. 18F-脱氧葡萄糖PET-CT在鉴别周围性非小细胞肺癌阳性前哨淋巴结中的价值[J]. 中华胸部外科电子杂志, 2015, 02(01): 48-54.

Shaoyu Hao, Dan Han, Baijian Zhang, Pingping Song, Xibin Liu, Zheng-zheng Song, Zheng Fu. Application of 18F-deoxyglucose PET-CT in diagnosing positive sentinel lymph nodes of peripheral non-small cell lung cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(01): 48-54.

目的

分析18F-脱氧葡萄糖(18F-FDG)正电子发射型计算机断层显像(PET-CT)诊断的阳性淋巴结与应用染料法诊断的前哨淋巴结(SLN)在周围性非小细胞肺癌(NSCLC)淋巴结转移中的灵敏度、特异度和准确性以及两者间的关联性，探讨PET-CT在肺癌SLN中的应用价值及对纵隔淋巴结清扫的影响。

方法

选择2012年7月至2014年6月期间在山东省肿瘤医院可手术切除的周围性NSCLC患者60例，所有患者手术前行PET-CT检查判断淋巴结转移情况。术中肺癌SLN应用亲脂的异舒泛蓝染料法进行识别后单独送快速病理检验。常规行肺切除术，再将所探测的非前哨淋巴结分别切除，行常规苏木精-伊红(HE)病理检查及免疫组织化学检查，PET-CT和SLN最终以病理诊断为金标准。

结果

在60例接受手术切除的周围性NSCLC患者中，术中有37例应用异舒泛蓝染料法成功识别出蓝染SLN，SLN检出率达61.7%(37/60)。共清扫出蓝染SLN 85枚，有18例患者中共52枚SLN未查到转移癌细胞，其中有15例患者在术前经PET-CT诊断为N0，有4例患者(22.2%)发生非前哨淋巴结(non-SLN)转移；有19例患者中共33枚SLN查到转移癌细胞，其中有15例患者共25枚SLN在术前经PET-CT诊断为阳性，PET-CT诊断SLN的灵敏度为78.9%(15/19)，特异度为83.3%(15/18)，阳性预测值为83.3%(15/18)，阴性预测值为78.9%(15/19)，符合率为81.1%(30/37)。

结论

PET-CT能较准确的鉴别阳性SLN。PET-CT对NSCLC的临床分期和术后病理分期的符合率高。将PET-CT和SLN技术结合，可以促进对区域淋巴结转移的准确评估和淋巴结清扫术的正确选择，从而对患者预后和术后治疗方式产生重要影响。

关键词: 癌，非小细胞肺, 体层摄影术，发射型计算机, 淋巴结, 诊断
Objective

To analyze the sensitivity, specificity and accuracy as well as correlation of positive lymph nodes diagnosed by 18F-deoxyglucose positron emission computed tomography(PET-CT) and sentinel lymph nodes (SLN) detected using blue dyes in lymph node metastasis of peripheral non-small cell cancer (NSCLC), and investigate the value of PET-CT in SLN of lung cancer and its significance with mediastinal lymph nodes dissection.

Methods

Sixty patients with resectable peripheral NSCLC were randomly selected from Shandong Province Cancer Hospital between July 2012 and June 2014 in this study. All patients underwent integrated PET-CT before operation for lymph node staging. The first lymph nodes to stain blue with oleophilic isosulfan blue dye defined as SLN were sent separately for fast pathological examination at thoracotomy, then all the non-SLN detected intraoperatively were also sent for hematoxylin-eosin(H-E) staining and immunohistochemical examination after pneumectomy. Pathological diagnosis was served as golden standard for comparing PET-CT with SLN.

Results

At thoracotomy, SLNs were successful identified in 37 of 60 peripheral NSCLC patients injected with isosulfan blue dye, and the rate of SLN detection was 61.7%. Eighty-five blue-stained SLNs were resected. Of them, 52 SLNs in 18 patients were proved negative, while 15 of these 18 patients were diagnosed N0 by PET-CT before operation, and 4 patients(22.2%) had only non-SLN metastasis. Thirty-three SLNs in 19 patients were proved positive, while 15 patients including 25 SLNs were diagnosed positive by PET-CT before operation, with the sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of PET-CT for SLN diagnosis of 78.9%(15/19), 83.3% (15/18) , 83.3% (15/18), 78.9% (15/19) and 81.1%(30/37), respectively.

Conclusions

Integrated PET-CT diagnoses SLN quite precisely. PET-CT shows high coincidence rate for clinical staging and postoperative pathological staging in NSCLC. Combined PET-CT and SLN procedure facilitates the precise estimation of localized lymph node involved as well as the determination of relevant pattern of lymphadenectomy, which may accordingly have important impact on the prognosis and postoperative treament in NSCLC patients.

Key words: Carcinoma, non-small cell lung, Tomography, emission-computed, Lymph node, Diagnosis
表1 非小细胞肺患者一般资料
项目 例数
性别 ?
? 男性 34
? 女性 26
年龄 ?
? <60岁 18
? ≥60岁 42
病理类型 ?
? 腺癌 36
? 鳞癌 14
? 其他 10
肿瘤分化程度 ?
? 高分化 23
? 中分化 17
? 低分化 20
肿瘤分布 ?
? 左肺上叶 14
? 左肺下叶 11
? 右肺上叶 16
? 右肺中叶 7
? 右肺下叶 12
肿瘤长径 ?
? ≤3cm 39
? 3～7cm 17
? >7cm 4
手术方式 ?
? 肺叶切除 56
? 全肺切除 4
表2 非小细胞肺癌患者前哨淋巴结SLN的分布情况(例)
肿瘤位置 病例数 肺门及叶间淋巴站(N1) 纵隔淋巴站(N2) N1＋N2
右肺上叶 6 0 6 0
右肺下叶 10 9 1 0
右肺中叶 6 4 2 0
左肺上叶 12 8 4 0
左肺下叶 3 3 0 0
合计 37 24 13 0
图2 患者右肺上叶鳞癌，术后病理示前哨淋巴结及非前哨淋巴结均无转移。2A为术前行PET-CT检查示腔静脉前淋巴结无FDG摄取；2B为术中瘤周注射染料后5min，腔静脉前淋巴结发生蓝染(白色箭头)，奇静脉弓前方可见通向SLN的蓝染浅表条索状淋巴管(黑色箭头)
表3 经病理诊断SLN阴性病例中PET-CT与non-SLN的符合情况(例)
非SLN PET-CT(＋) PET-CT(－) 合计
阳性 0 4 4
阴性 3 11 14
表4 经病理诊断SLN阳性病例中PET-CT与非SLN的符合情况(例)
非SLN PET-CT(＋) PET-CT(－) 合计
阳性 13 2 15
阴性 2 2 4
[1]
Zhong W, Yang X, Bai J, et al. Complete mediastinal lymphadenectomy: the core component of multidisciplinary therapy in resectable non-small cell lung cancer[J]. Eur J Cardiothorac Surg，2008，34(1)：187-195.
[2]
Detterbeck FC, Boffa DJ, Tanoue LT.The new lung cancer staging system[J]．Chest，2009，136(1) : 260-271.
[3]
Melfi MA, Chella A, Mencon GF, et al. Intraoperative radioguided sentinel lymph node biopsy in non-sm all cell lung cancer[J]．Eur J Cardio-thoracic Surg，2003, 23(2): 214-220.
[4]
Soltesz EG, Kim S, Laurence RG, et al. Intraoperative sentinel lymph node mapping of the lung using near-infrared fluorescent quantum dots[J] . Ann Thorac Surg, 2005，79(1)：269-277.
[5]
Pulte D, Li E, Crawford BK, et al. Sentinel lymph node mapping and molecular staging in non-small cell lung carcinoma[J]. Cancer，2005，104(7)：1453-1461.
[6]
Atinkaya C, Ozlem Küçük N, Koparal H, et al. Mediastinal intraoperative radioisotope sentinel lymph node mapping in non-small-cell lung cancer[J]. Nucl Med Commun, 2005，26(8)：717-720.
[7]
Tsang GM, Watson DC. The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer[J]．Thorax，1992, 47(1)：3-5.
[8]
Nomori H, Iwatani K, Kobayashi H，et al. Omission of mediastinal lymph node dissection in lung cancer: its techniques and diagnostic procedures [J]. Ann Thorac Cardiovasc Surg，2006，12(2)：83-88.
[9]
Morton DL, Wen DK, Wong JH，et al.Technical details of Tntraoperatine lymphatic mapping for early stage melanoma[J]. Arch surg, 1992, 127(4): 392-399.
[10]
Albertiai JJ, Cruse CW, Raparort D, et al. Imtraoperative radiolymphoscintigraphy improves sartinel lymph made identification for patients with melanoma[J]. Avn Surg, 1996, 223(2): 217-224.
[11]
Webb WR, Gastonis C, Zerhouni EA, et al. CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the radiologic diagnostic oncology group[J]. Radiology，1991，178(3)：705-713.
[12]
Al-Sarraf N, Aziz R, Gately K, et al. Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography[J]. Eur J Cardiothorac Surg, 2008，33(1)：104-109.
[13]
Kotoulas CS, Foroulis CN, Kostikas K, et al. Involvement of lymphatic metastatic spread in non-small cell lung cancer according to the primary cancer location[J]. Lung Cancer，2004, 44(2)：183-91.
[14]
Cerfolio RJ, Ojha B, Bryant AS, et al. The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with non-small cell lung cancer[J]. Ann Thorac Surg，2004，78(3)：1017-1023.
[15]
Halter G, Buck AK, Schirrmeister H, et al. Lymph node staging in lung cancer using FDG-PET[J]. Thorac Cardio Surg，2004，52(2)：96-101.
[16]
Cuaron J, Dunphy M, Rimner A．Role of FDG-PET scans in staging，response assessment and follow up care for non-small cell lung cancer[J]．Front Oncol，2012，2 ：208.
[17]
杨文锋，于金明，付政，等.18F-脱氧葡萄糖PET-CT与强化CT对非小细胞肺癌区域淋巴诊断价值的评价[J]．中华肿瘤杂志，2009，31(12)：925-928.
[18]
吴仪仪，张建，左长京，等．PET/CT与增强CT对肺癌淋巴结诊断及分期的比较[J]．临床肺科杂志，2014，19(10)：1846-1848.
[19]
Kitagawa Y, Ohgami M, Fujii H, et al. Laparoscopic detection of sentinel lymph nodes in gastrointestinal cancer : a novel and minimally invasive approach[J]. Ann Surg Oncol, 2001 ，8(9 Suppl)：86S-89S.
[20]
Sakurai H, Asamura H, Watanabe S, et al. Clinicopathologic features of peripheral squamous cell carcinoma of the lung [J]. Ann Thorac Surg, 2004，78(1)：222-227.
[21]
Asamura H, Nakayama H, Kondo H, et al. Lymph node involvement, recurrence，and prognosis in resected small peripheral non-small-cell lung carcinoma: are these caicinomas candidates for video-assisted lobectomy? [J] Thorac Cardiovasc Surg，1996，111(6)：1125-1134.
[22]
Kim AW.Lymph node drainage patterns and micrometastasis in lung cancer[J]. Semin Thorac Cardiovasc Surg, 2009, 21(4): 298-308.
[23]
王论青，张哲，尹志伊，等．原发性肺癌淋巴结转移清除临床价值的探讨[J]．中华肿瘤防治杂，2008，15(18)：1408-1410.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1061-1067.
[2] 邵华, 那子悦, 荆慧, 李博, 王秋程, 程文. 术前经皮超声造影对乳腺癌腋窝前哨淋巴结转移及负荷的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 849-853.
[3] 孙帼, 谢迎东, 徐超丽, 杨斌. 超声联合临床特征的列线图模型预测甲状腺乳头状癌淋巴结转移的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 734-742.
[4] 谭巧, 苏小涵, 侯令密, 黎君彦, 邓世山. 乳腺髓样癌的诊治进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 366-368.
[5] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[6] 燕速, 霍博文, 徐惠宁. 4K荧光腹腔镜扩大右半结肠CME+D3根治术及No.206、No.204组淋巴结清扫术[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 14-14.
[7] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[8] 姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗：10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[9] 关旭, 王锡山. 基于外科与免疫视角思考结直肠癌区域淋巴结处理的功与过[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 448-452.
[10] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[11] 卢艳军, 马健, 白鹏宇, 郭凌宏, 刘海义, 江波, 白文启, 张毅勋. 纳米碳在腹腔镜直肠癌根治术中253组淋巴结清扫的临床效果[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 473-477.
[12] 赵立力, 王魁向, 张小冲, 李志远. 血沉与C-反应蛋白比值在假体周围感染中的诊断价值分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 351-355.
[13] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[14] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[15] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号