比較全身氟-18去氧葡萄糖正子放射斷層攝影與鎝-99m亞甲基雙磷酸骨骼掃描偵測非小細胞肺癌病人骨骼轉移之結果

背景：儘管形態學造影不斷的發展進步，一些非小細胞肺癌(non-small cell lung cancer， NSCLC)病人在手術時還是會被發現具有無法切除的病灶，或是在手術後一年內由於復發而死亡。目前轉移性骨骼侵犯通常是利用傳統高敏感度低特異度的鎝-99m亞甲基雙磷酸(Technetium-99m methylene diophosphonate， 99mTc MDP)全身骨骼掃描來作評估。在此篇研究中，我們試圖以全身氟-18去氧葡萄糖正子放射斷層攝影(18f-2-deoxyglucose positron emission tomography， FDG-PET)去評估非小細胞肺癌之惡性骨骼轉移的情形，並將其結果與骨骼掃描之發現作一比較。方法：三十位經過病理檢查証實是非小細胞肺癌且懷疑為第四期的病患，接受全身骨骼掃描與氟-18去氧葡萄糖正子放射斷層攝影檢查，以評估是否有骨骼轉移的情形。是否有骨骼轉移的最終診斷，則是經由手術的組織病理學發現，或藉由其它放射線攝影檢查追蹤一年以上或以骨骼掃描與氟-18去氧葡萄糖正子放射斷層攝影追蹤骨骼病灶是否有漸進、廣泛性擴大延伸之現象而得到確認。結果：經過氟-18去氧葡萄糖正子放射斷層攝影檢查和骨骼掃描之後，共有112個骨骼病灶被發現並加以評估。在86個轉移性和26個良性骨骼病灶，氟-18去氧葡萄精正子放射斷層攝影檢查能正確地診斷出81個轉移性和25個良性骨骼病灶，當中一位病患的五個轉移性及另一位病患的1個良性骨骼病灶分別呈現出偽陰性及偽陽性的結果：而骨骼掃描能正確地診斷出80個轉移性及1個良性骨骼病灶，當中兩位病患的6個轉移性及五位病患的25個良性骨骼病灶分別呈現出偽陰性及偽陽性的結果。因此本研究中氟-18去氧葡萄糖正子放射斷層攝影檢查和骨骼掃描的敏感度分別為94.2%及93.0% ，正確性則為94.6 %及72.3%。結論：總結來說，本研究的數據顯示氟-18去氧葡萄糖正子放射斷層攝影檢查在偵測非小細胞肺癌且懷疑為第四期病患、是否有轉移性骨骼病灶這方面，其敏感度與骨骼掃描接近，然而正確性卻比它優越許多。

關鍵字

骨骼轉移,氟-18去氧葡萄糖正子放射斷層攝影,非小細胞肺癌,鎝-99m亞甲基雙磷酸骨骼掃描

並列摘要

Background: Despite advances in morphological imaging, some patients with non-small cell lung cancer (NSCLC) are found to have non-resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using conventional technetium-99m methylene diophosphonate (99mTc MDP) whole body bone scan (bone scan), which has a high sensitivity but a poor specificity We have attempted to evaluate the usefulness of whole body positron emission tomography with 18F-2-deoxyglucose (FDG-PET) for the detection of malignant bone findings. Methods: Thirty patients with biopsy-proven NSCLC suspected of having stage IV diseases underwent whole body bone scan and FDG-PET to detect bone metastases. The final diagnoses of bone metastases were established during surgery by histopathological findings, clinical follow-up longer than 1 year by additional radiographs, or following FOG-PET /99mTc MDP bone scan findings showing progressively and extensively widespread bone lesions. Results: A total of 112 bone lesions found on either FDG-PET or 99mTc MDP bone scan were evaluated. Among the 86 metastatic and 26 benign bone lesions, FDG-PET and 99mTc MDP bone scan accurately diagnosed 81 and 80, as well as 25and 1 metastatic and benign bone lesions, respectively. Diagnostic sensitivity and accuracy of FDG-PET and 99mTc MDP bone scan were 94.2% and 93.0%, as well as 94.6% and 72.3%, respectively. Conclusions: Our data suggest that FDG-PET is as sensitive as and more accurate than 99mTc MDP bone scan for detecting metastatic bone lesions in patients with biopsy proven NSCLC suspected of having stage IV diseases.