Tuberculosis and Respiratory Diseases
- 제47권5호
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- Pages.642-649
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- 1999
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- 1738-3536(pISSN)
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- 2005-6184(eISSN)
비소세포폐암의 림프절 병기 결정에서 Coincidence PET의 역할
The Role of Camera-Based Coincidence Positron Emission Tomography in Nodal Staging of Non-Small Cell Lung Cancer
- 이선민 (아주대학교 의과대학 호흡기내과학교실) ;
- 최영화 (아주대학교 의과대학 호흡기내과학교실) ;
- 정성철 (아주대학교 의과대학 호흡기내과학교실) ;
- 오윤정 (아주대학교 의과대학 호흡기내과학교실) ;
- 박광주 (아주대학교 의과대학 호흡기내과학교실) ;
- 황성철 (아주대학교 의과대학 호흡기내과학교실) ;
- 이이형 (아주대학교 의과대학 호흡기내과학교실) ;
- 박찬희 (아주대학교 의과대학 핵의학교실) ;
- 한명호 (아주대학교 의과대학 호흡기내과학교실)
- Lee, Sun-Min (Department of Pulmonology and Critical Care Medicine, Ajou University, School of Medicine) ;
- Choi, Young-Hwa (Department of Pulmonology and Critical Care Medicine, Ajou University, School of Medicine) ;
- Oh, Yoon-Jung (Department of Pulmonology and Critical Care Medicine, Ajou University, School of Medicine) ;
- Cheong, Seong-Cheoll (Department of Pulmonology and Critical Care Medicine, Ajou University, School of Medicine) ;
- Park, Kwang-Joo (Department of Pulmonology and Critical Care Medicine, Ajou University, School of Medicine) ;
- Hwang, Sung-Chul (Department of Pulmonology and Critical Care Medicine, Ajou University, School of Medicine) ;
- Lee, Yi-Hyeong (Department of Pulmonology and Critical Care Medicine, Ajou University, School of Medicine) ;
- Park, Chan-H (Department of Nuclear Medicine, Ajou University, School of Medicine) ;
- Hahn, Myung-Ho (Department of Pulmonology and Critical Care Medicine, Ajou University, School of Medicine)
- 발행 : 1999.11.30
초록
연구배경: 비소세포폐암의 림프절의 병기 결정은 치료 및 예후 결정에 매우 중요하나 정확한 병기 결정에는 많은 어려움이 있다. 야에 저자들은 최근에 개발된 CoDe PET의 림프절 병기 결정에 대한 유용성을 알아보고자 하였다. 방 법: 1998년 2월부터 1999년 6월까지 아주대학교병원에 내원하여 원발성 비소세포폐암으로 진단되어 치료를 시행하였던 환자 21예를 대상으로 하였다. 수술적 술전 폐암의 병기 결정을 위하여 흉부 전산화단층촬영, 복부 초음파검사, 전신 골주사 촬영, CoDe PET를 시행하였다. 대상 환자들의 수술후 병리학적 병기를 기준으로 하여서 CoDe PET로 결정된 림프절 병기의 민감도, 특이도, 양성 예측도, 음성 예측도, 정확도를 분석하였다. 결 과: 21예의 비소세포폐암중 20예에서 원발 종괴에
Background: It is very important to determine an accurate staging of the non-small cell lung cancer(NSCLC) for an assessment of operability and it's prognosis. However, it is difficult to evaluate tumor involvement of mediastinal lymph nodes accurately utilizing noninvasive imaging modalities. PET is one of the sensitive and specific imaging modality. Unfortunately PET is limited use because of prohibitive cost involved with it's operation. Recently hybrid SPECT/PET(single photon emission computed tomography/positron emission tomography) camera based PET imaging was introduced with relatively low cost. We evaluated the usefulness of coincidence detection(CoDe) PET in the detection of metastasis to the mediastinal lymph nodes in patients with NSCLC. Methods: Twenty one patients with NSCLC were evaluated by CT or MRI and they were considered operable. CoDe PET was performed in all 21 patients prior to surgery. Tomographic slices of axial, coronal and sagittal planes were visually analysed. At surgery, mediastinal lymph nodes were removed and histological diagnosis was performed. CoDe PET findings were correlated with histological findings. Results: Twenty of 21 primary tumor masses were detected by the CoDe PET. Thirteen of 21 patients was correctly diagnosed mediastinal lymph node metastasis by the CoDe PET. Pathological N0 was 14 cases and the specificity of N0 of CoDe PET was 64.3%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of N1 node was 83.3%, 73.3%, 55.6%, 91.7%, and 76.2% respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of N2 node was 60.0%, 87.5%, 60.0%,87.5%, and 90.0% respectively. There were 3 false negative cases but the size of the 3 nodes were less than 1cm. The size of true positive nodes were 1.1cm, 1.0cm, 0.5cm respectively. There were 1 false positive among the 12 lymph nodes which were larger than 1cm. False positive cases consisted of 1 tuberculosis case, 1 pneumoconiosis case and 1 anthracosis case. Conclusion: CoDe PET has relatively high negative predictive value in the enlarged lymph node in staging of mediastinal nodes in patients with NSCLC. Therefore CoDe PET is useful in ruling out metastasis of enlarged N3 nodes. However, further study is needed including more number of patients in the future.