Clinical Impact of 18F-Fluorodeoxyglucose Positron Emission Tomography in Patients with Lung Cancer: Experience of Linko Chang-Gung Memorial Hospital

氟－18-去氧葡萄糖正子掃描在肺癌之臨床應用：林口長庚醫院之經驗

詹勝傑(Sheng-Chieh Chan) ； 閻紫宸(Tzu-Chen Yen) ； 蔡熒煌(Ying-Huang Tsai) ； 張潤忠(Cheung-Yun Chung)

《核子醫學雜誌》 18卷2期 (2005/06) Pp. 67-75

https://doi.org/10.6332/ANMS.1802.001

摘要

背景：此一回朔性研究旨在探討氟18去氧葡萄糖正子掃描在有治癒機會之懷疑或已證實的肺癌上的應用。
方法：本研究收集2001年一月到2004年五月來本院做氟18去氧葡萄糖正子掃描之懷疑或已證實但臨床上仍有治癒機會的肺癌病人。入案的條件為下列三點之一：(l)胸部X光片或電腦斷層發現病因不明之結節病變；(2)期數小於Ⅲb的肺癌病人；(3)懷疑或証實有復發腫瘤。共有53人入案，符合條件一的有10人，條件二的有27人，條件三的有16人（平均年齡為58歲，37名男性，16名女性）。
結果：若以個案為基凖，正子掃描和傳統影像在靈敏度、特異度、正確性、陽性預測值及陰性預測值的比率分別為93.3% vs. 37.9%, 66.7% vs. 94.7%, 83.3% vs. 60.4%, 82.4% vs. 91.7%及85.7% vs. 50%。因第一個條件入案的病患，有七位被正子掃描排除惡性的可能性，但有三例偽陽性的發現。因第二個條件入案的病患，正子掃描確認了其中17個人傳統影像的發現並在另外10個人中有出乎意料的發現；有16個病人的期數及14個的治療因此改變。因第三個條件入案的病患，有四位復發的可能性被排除，另外正子掃描於九個病人中證實殘存或復發的腫瘤，而在另三個人中有意外的發現；這組中有12個病人的的治療因此改變。整體來講，正子掃描在20%的病人中排除惡性的可能，證實了50%病人傳統影像的發現，並在25%的病人中有令人意外的發現。共有20個病人的期數及26個病人的治療改變。
結論：和傳統影像比較的話，氟18去氧葡萄糖正子掃描對於肺癌的評估有較高的敏感度及陰性預測率並特別適合用於偵測遠端轉移及殘存或復發之腫瘤。

關鍵字

肺癌 ； 氟－18-去氧葡萄糖 ； 正子掃描

並列摘要

Purpose: This retrospective study was to evaluate the clinical usefulness of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in patients who had suspicious or proven lung cancers with curative intent.
Methods: Between January 2001 and May 2004, consecutive patients who had suspicious or proven lung cancers with curative intent and had a FDG-PET scan in our hospital were enrolled. The including criteria were at least one of the follows: (1) had an indeterminated solitary pulmonary nodule (SPN) in chest X-ray (CXR) or chest computed tomography (CT); (2) had histologically proven lung cancer with clinically stage ≤ Ⅲb; (3) had suspicious or proven recurrent/residual lung cancer. Patients who did not meet the following criteria were excluded: (a) was not followed up for more than 6 months after PET scan (b) had the history of second cancers and the possibility of pulmonary metastases could not be ruled out (c) had incomplete chart or image records. The diagnostic criterion was tissue proven or clinical follow up. Finally, 53 patients were included in this study (mean age 58 years, 37 male and 16 female). Ten were criteria 1, 27 were 2, and 16 were 3.
Results: In all (patient-based), the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FDG-PET vs. conventional images were 93.3% vs. 37.9%, 66.7% vs. 94.7%, 83.3% vs. 60.4%, 82.4% vs. 91.7%, and 85.7% vs. 50.0%, respectively. For criteria 1, FDG-PET correctly ruled out the possibility of malignancy in 7 patients. However, 3 (30%) false- positives were found. Two (66.7%) were due to tuberculosis. As for criteria 2, FDG-PET confirmed the findings in conventional images in 17 (62%) patients and disclosed unexpected lesions in 10 (38%) patients. 16 (59%) patients changed their stage and 14 changed (50%) treatment planning. For criteria 3, four (25%) were proven to be disease-free, 9 (56%) were confirmed to have recurrent/residual disease, and 3 (20%) were found to have unexpected lesions after PET. Twelve patients (75%) changed their treatment planning. Overall, PET ruled out possible lesions in 20% (11/53) of patients and confirmed the findings of conventional images in 50% (26/53) of patients. It also discovered unexpected lesions in 25% (13/53) of patients. Twenty (40%) patients' stage and 26 (50%) patients' treatment were altered due to FDG-PET.
Conclusion: FDG-PET had a higher sensitivity and negative predictive value for lung cancer patient with curative intent than conventional images. It is especially useful in detecting unexpected distant metastases or residual/recurrent disease.

並列關鍵字

lung cancer ； FDG ； PET