PET在孤立性肺结节患者中应用价值的研究
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摘要
目的：研究正电子发射断层显像术(Positron Emission Tomography, PET)诊断孤立性肺结节(Solitary Pulmonary Nodules, SPN)的灵敏度(Sen)和特异度(Spe)以及在SPN患者中的应用价值。方法：回顾分析近两年新疆维吾尔自治区人民医院收治疑似SPN并获得病理证实的患者189例,绘制SPN诊断试验交叉表,并计算PET诊断SPN的灵敏度和特异度等指标。比较非PET组和PET组的无效开胸率以及两组在良恶性SPN患者中的花费。结果：PET组患者最终确诊恶性肿瘤75例(39.68%),良性结节17例(8.99%)。PET阳性患者76例(40.21%),PET阴性患者16例(8.47%)。诊断SPN的灵敏度为0.97,特异度为0.83,阳性11以然比为5.71,阴性似然比为0.04,阳性预测值为0.96,阴性预测值为0.88,诊断符合率为0.95。PET组和非PET组在无效开胸率的比较x2=9.803,P=0.002,差别具有统计学意义。PET组和非PET组在恶性结节经过开胸治疗的总花费上比较t=8.2195,P=0.0000,差别具有统计学意义；PET组和非PET组在良性结节经过开胸治疗的总花费上比较t=7.6406,P=0.0000,差别具有统计学意义。结论：PET在诊断SPN中有较高的准确性、使用价值较高,并且可以显著降低孤立性肺结节患者的无效开胸率。
Objective:Research for Positron emission tomography (Positron Emission Tomography, PET), Diagnose sensitivity (Sen) and specificity (Spe) of solitary pulmonary nodules (Solitary Pulmonary Nodules, SPN) and application value of SPN patients. Methods:Review and Analysis of the past two years, suspected of Xinjiang Uygur Autonomous Region People's Hospital, received 189 cases of patients with pathologically confirmed, draw SPN diagnostic experiment crosstab, and calculate the sensitivity that PET diagnoses SPN and especially beacons like difference, etc. A little bit not the void of PET set and PET set opens chest rate and 2 sets in the payout in the good malignant SPN sufferer. Results:The PET set sufferer finally confirms a malignant tumor 75(39.68%), the positive knot is 17(8.99%).The male sufferer of PET is 76(40.21%),16(8.47%) of PET feminine gender sufferer. Diagnose SPN sensitivity to 0.97, especially difference for 0.83, masculine gender however compare to 5.71, feminine gender however compare to 0.04, masculine gender anticipation be worth to 0.96, feminine gender predicts to be worth to 0.88, diagnosis match to lead to 0.95.PET group and non-PET group open the compare of chest rate in the void=9.803,P=0.002, the difference has statistical meaning. PET group and non-PET group at the malignant knot has been opened the total payout of chest treatment top compare t=8.2195, P=0.0000, the difference has a statistical meaning. PET group and the non-PET group of benign nodules after thoracotomy in the treatment of the total cost To compare t= 7.6406, P=0.0000, statistically significant differences. Conclusion:PET at diagnose there is higher accuracy, value in use in SPN and can be significantly reduced invalid thoracotomy rate in patients with solitary pulmonary nodules.
Objective:Research for Positron emission tomography (Positron Emission Tomography, PET), Diagnose sensitivity (Sen) and specificity (Spe) of solitary pulmonary nodules (Solitary Pulmonary Nodules, SPN) and application value of SPN patients. Methods:Review and Analysis of the past two years, suspected of Xinjiang Uygur Autonomous Region People's Hospital, received 189 cases of patients with pathologically confirmed, draw SPN diagnostic experiment crosstab, and calculate the sensitivity that PET diagnoses SPN and especially beacons like difference, etc. A little bit not the void of PET set and PET set opens chest rate and 2 sets in the payout in the good malignant SPN sufferer. Results:The PET set sufferer finally confirms a malignant tumor 75(39.68%), the positive knot is 17(8.99%).The male sufferer of PET is 76(40.21%),16(8.47%) of PET feminine gender sufferer. Diagnose SPN sensitivity to 0.97, especially difference for 0.83, masculine gender however compare to 5.71, feminine gender however compare to 0.04, masculine gender anticipation be worth to 0.96, feminine gender predicts to be worth to 0.88, diagnosis match to lead to 0.95.PET group and non-PET group open the compare of chest rate in the void=9.803,P=0.002, the difference has statistical meaning. PET group and non-PET group at the malignant knot has been opened the total payout of chest treatment top compare t=8.2195, P=0.0000, the difference has a statistical meaning. PET group and the non-PET group of benign nodules after thoracotomy in the treatment of the total cost To compare t= 7.6406, P=0.0000, statistically significant differences. Conclusion:PET at diagnose there is higher accuracy, value in use in SPN and can be significantly reduced invalid thoracotomy rate in patients with solitary pulmonary nodules.
引文
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[7]Nomori H, Watanabe K, Ohtsuka T, et al. Visual-and semiquantitative analyses for F-18 fluorodeoxyglucose PET scanning in pulmonary nodules 1cm to 3cm in size[J]. Ann Thorac Surg,2005,79:984-988.
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[10]蒋磊,吴建彬,左翔,等.胸部直接数字化摄影在肺癌筛查中的价值[J].实用医剂杂志,2008,15(19)：2577-2578.
[11]Nishiyama Y, Yamamoto Y, Kimura N, et al. Dual-time-point FDG-PET for evaluation of lymph node metastasis in patients with non-small-cell lung cancer[J]. Ann Nucl Med,2008,22:245-250.
[12]OST D, FEIN AM. Management strategies for the solitary pul-monary nodule[J]. Curr Opin PulmMed,2004,10(4):272-278.
[13]Gu P, Zhao YZ, Jiang LY, et al. Endobronchial ultrasound-guidedtransbronchial needle aspiration for staging of lung cancer:a sys-tematic review and meta-analysis[J]. Eur J Cancer,2009,45:1389-1396.
[14]Ampel NM. The solitary pulmonary nodule N Engl J Med,2003,349(16): 1575.
[15]Groome PA, Bolejack V, Crowley JJ, et al. The IASLC lung cancer staging project:validation of the proposals for revision of the T N, and M descriptors and consequentstage groupings in the forthcoming (seventh) edition of the TNM classification ofmalig-nant tumours[J]. J Thorac Onco,2007,2(8):694-705.
[16]Cafarella, JellknerS, Brinkl, et al. Validationo FDG positronemission tomography for differentiation of unknown pulmonary[J]. lesions Cardiothorae Surg,2006,20(2):324-9.
[17]Mankoff A, Eary J, Link J, et al. Tumor-specific positron emission tomography imaging in patients:F fluorodeoxyglucose and beyond [J]. Clin Cancer Res, 2007, (13):460-3469.
[18]操乐杰,程广源.肺癌早期诊断.临床肺科杂志,2002,7(3)：48-49.
[19]Kaneko M, Eguehi K, Obmasu H, et al. Peripheral lung cancer:screening and detection with low dose spiral CT versus radiography[J]. Radiology,1996: 201:798.
[20]周清华.肺癌筛查早诊研究进展.中国肿瘤,2009,18(9)：705-712.
[21]Lammertsma A A, Hoekstra C J, Giaccone G, et al. How should we analyse PET studies for monitoring tumour response? [J]. Eur J Nucl Med Mol Imaging, 2006,33:S16-S21.
[22]Matthies A, Hickeson M, Cuchiara A, et al. Dual time point PET for the evaluation of pulmonary nodules [J]. J Nucl Med,2002,43(7):871-875.
[23]Aquino SL, Halpern EF, Kuester LB, et al. FDG-PET and CT features of non-small cell lung cancer based on tumor type [J]. Int J Mol Med,2007,19(3): 495-499.
[24]Gould. PET evaluation of lung cancer [J]. J Nucl Med,2006,47:451-469.
[25]vansteenkiste JF, Stroobants SD, Advancesin pulmonary imaging. The role of solid or partly solid solitary pulmonary nodules[J]. Lung Caneer,2008,3(2): 14.
[26]Al-Sarraf N, Gately K, Lucey J, et al. Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes:analysis of 1,145 lymph nodes [J]. Lung Cancer,2008, 60(1):62-68.
[27]Vansteenkiste A, Yao WJ, et al. Dual-phase 18F-FDG PET in the diagnosis of pul monary nodules with an initial standard uptake value less than 2.5[J]. AJR,2008, 191 (2):475-479.
[28]Alkhawaldeh K, Bural G, Kumar R, et al. Impact of dual-time-point 18F-FDG PET imaging and partial volume correctionin the assessment of solitary pulmonary nodules[J]. Eur JNucl Med Mol Imaging,2008,35 (2):246-252.
[29]Gambhir JW, Kymes SM, Gould M, et al. A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules[J]. J NuclMed,2008,49 (2):179-185.
[30]Zhuang HM, Alavi A. 18F-FDG imaging in the detection and monitoring of infection and in flammation[J]. Semin NuclMed,2002,32(1):47-59. Parkin D M, Bray F B, Pisani P. Global cancer statistics[J]. Ca Cancer J Clin,2005,55(2): 74-108.
[31]王中秋,吴江,朱虹,等PET/CT对肺部肿块的诊断[J].中华核医学杂志,2009,29(1)：19-22.
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