Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Improved Specificity of $^{18}F-FDG$ PET/CT for Lymph Node Staging of Non-Small Cell Lung Cancer Considering Calcified Lymph Node as Benign

비소세포 폐암에서 석회화 림프절을 양성으로 보았을 때 $^{18}F-FDG$ PET/CT의 특이도 향상

  • Kwon, Seong-Young (Departments of Nuclear Medicine, Chonnam National University Hospital) ;
  • Seo, Young-Soon (Departments of Nuclear Medicine, Chonnam National University Hospital) ;
  • Min, Jung-Joon (Departments of Nuclear Medicine, Chonnam National University Hospital) ;
  • Song, Ho-Chun (Departments of Nuclear Medicine, Chonnam National University Hospital) ;
  • Na, Kook-Joo (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital) ;
  • Choi, Chan (Department of Pathology, Chonnam National University Hospital) ;
  • Kim, Young-Chul (Department of Medicine, Chonnam National University Hospital) ;
  • Kim, Yun-Hyun (Department of Radiology, Chonnam National University Hospital) ;
  • Bom, Hee-Seung (Departments of Nuclear Medicine, Chonnam National University Hospital)
  • 권성영 (전남대학교 의과대학 핵의학교실) ;
  • 서영순 (전남대학교 의과대학 핵의학교실) ;
  • 민정준 (전남대학교 의과대학 핵의학교실) ;
  • 송호천 (전남대학교 의과대학 핵의학교실) ;
  • 나국주 (전남대학교 의과대학 흉부외과학교실) ;
  • 최찬 (전남대학교 의과대학 병리학교실) ;
  • 김영철 (전남대학교 의과대학 내과학교실) ;
  • 김윤현 (전남대학교 의과대학 영상의학교실) ;
  • 범희승 (전남대학교 의과대학 핵의학교실)
  • Published : 2007.02.28
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Abstract

Purpose: We evaluated the diagnostic value of $^{18}F-FDG$ PET/CT (PET/CT) in lymph node staging of non-small cell lung cancer (NSCLC) considering calcification and histologic types as well as FDG uptake. Materials and Methods: Fifty-three patients (38 men, 15 women; mean age, 62 years) with NSCLC underwent surgical resection (tumor resection and lymph node dissection) after PET/CT. After surgery, we compared PET/CT results with the biopsy results, and analyzed lymph node metastases, based on histologic types. PET diagnosis of lymph node metastasis was determined by maximum SUV (maxSUV) > 3.0, and PET/CT diagnosis was determined by maxSUV > 3.0 without lymph node calcification. Results: By PET diagnosis, the sensitivity, specificity, and accuracy of overall lymph node staging were 45% (13 of 29), 91% (228 of 252), and 86% (241 of 281). Specificity was 91% in both squamous cell carcinoma and adenocarcinoma, while sensitivity was 71% in squamous cell carcinoma and 36% in adenocarcinoma. When we excluded calcified lymph node with maxSUV > 3.0 from metastasis by PET/CT diagnosis, specificity improved to 98% in squamous cell carcinoma and 97% in adenocarcinoma. The degree of improvement was not dependent on histologic types. Conclusion: PET/CT improved specificity of lymph node staging by reducing false positive lymph node regardless of histologic types of NSCLC.

목적: 우리나라와 같이 만성 염증성 폐질환이 호발하는 지역에서는 폐문 및 종격동 림프절에 석회화가 동반될 수 있고 이 부위에 FDG 섭취가 될 수 있기 때문에 FDG 섭취만 고려할 경우 위양성률이 높다. 이 연구에서는 비소세포 폐암환자에서 림프절의 PET/CT 판독 시 FDG 섭취 정도뿐만 아니라 CT 영상에서의 림프절 석회화 혹은 감쇠 정도를 고려하여 진단율을 평가하였고 조직학적 종류에 따라 향상 정도의 차이가 있는지 또한 알아 보았다. 대상 및 방법: 2004년 9월부터 2005년 12월사이 화순전남대학교병원에서 비소세포 폐암으로 처음 진단 받고 PET/CT와 림프절 절제술을 시행 받은 53명(평균나이; 62세, 남:여=38:15)을 대상으로 수술 후 림프절 전이에 대한 PET/CT 결과를 병리결과와 비교하였다. 림프절의 maxSUV값이 3.0 이상인 경우를 악성으로 분류하여 PET의 진단율을 조사하였다. PET/CT의 경우에는 maxSUV값이 3.0 이상이라도 CT 영상에서 석회화가 있거나 높은 감쇠를 보이는 림프절은 양성으로 분류하였으며, 조직학적 분류에 따라 진단율의 차이를 보이는지 조사 하였다. 결과: 각 림프절 군에서 maxSUV 값에 따른 PET 진단의 전체적인 민감도, 특이도, 정확도는 각각 45%, 91%, 86%였고, 편평세포암종 71%, 91%, 90%, 샘암종에서는 36%, 91%, 84%이였다. PET/CT의 민감도, 특이도, 정확도는 각각 45%, 97%, 92%였고 편평세포암종인 경우에서는 71%, 98%, 95%. 샘암종에서는 36%, 97%, 89%이였다. 결론: PET 진단에 비해 PET/CT 진단의 특이도가 유의하게 향상되었고, 이는 편평세포암종 및 샘암종 모두에서 유의하게 향상되었으며, 향상되는 정도는 조직학적 분류와 관계가 없었다.

Keywords

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