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目的比较正电子发射计算机断层摄影显像(PET)和CT显像在判定可切除非小细胞肺癌(NSCLC)患者纵隔淋巴结有无转移上的临床价值。方法68例可切除非小细胞肺癌患者于手术前常规进行PET和CT胸部显像,判定纵隔淋巴结有无转移。1个月以内行开胸手术纵隔淋巴结清扫或标准电视纵隔镜淋巴结活检以获取纵隔淋巴结病理标本,对切除的纵隔淋巴结进行常规石蜡切片HE染色和PCNA/Ki67免疫组织化学染色,病理学检查结果与手术前的影像学CT检查进行比较。结果有纵隔淋巴结转移者52例,无纵隔淋巴结转移者16例。CT显像诊断纵隔淋巴结的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为76.9%(40/52)、50%(8/16)、70.6%(48/68)、83.3%(40/48)、40%(8/20)。PET显像诊断纵隔淋巴结的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为92.3%(48/52)、87.5%(14/16)、91.2%(62/68)、96%(48/50)、77.7%(14/18)。CT+PET的敏感性为98%(51/52)。结论在诊断非小细胞肺癌纵隔淋巴结转移上,PET明显优于CT,CT+PET能提高检查非小细胞肺癌纵隔淋巴结的敏感性。
Objective To compare the clinical value of positron emission tomography (PET) and CT imaging in determining the metastasis of mediastinal lymph nodes in patients with resectable non-small cell lung cancer (NSCLC). Methods Sixty-eight patients with resectable non-small cell lung cancer underwent conventional PET and CT chest imaging before operation to determine whether there was metastasis to mediastinal lymph nodes. One month later, thoracotomy was performed for mediastinal lymphadenectomy or standard mediastinoscopy lymph node biopsy to obtain mediastinal lymph node biopsy. The resected mediastinal lymph nodes were stained with HE and PCNA / Ki67 immunohistochemistry. The results of pathological examination and Preoperative imaging CT examination for comparison. Results of mediastinal lymph node metastasis in 52 cases, no mediastinal lymph node metastasis in 16 cases. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CT imaging in diagnosing mediastinal lymph nodes were 76.9% (40/52), 50% (8/16), 70.6% (48/68), 83.3 % (40/48), 40% (8/20). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET imaging in diagnosing mediastinal lymph nodes were 92.3% (48/52), 87.5% (14/16), 91.2% (62/68), 96 % (48/50), 77.7% (14/18). The sensitivity of CT + PET was 98% (51/52). Conclusion PET is superior to CT in diagnosis of mediastinal lymph node metastasis of non-small cell lung cancer. CT + PET can improve the sensitivity of detecting mediastinal lymph nodes in non-small cell lung cancer.