Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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The Usefulness of $^{18}F-FDG $ PET as a Cancer Screening Test

$^{18}F-FDG $ PET의 암 선별검사로서의 유용성

  • Ko, Doo-Heun (Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Joon-Young (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Song, Yun-Mi (Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Su-Jin (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Young-Hwan (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyung-Han (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Byung-Tae (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Moon-Kyu (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 고두흔 (성균관의대 삼성서울병원 가정의학과) ;
  • 최준영 (성균관의대 삼성서울병원 핵의학과) ;
  • 송윤미 (성균관의대 삼성서울병원 가정의학과) ;
  • 이수진 (성균관의대 삼성서울병원 핵의학과) ;
  • 김영환 (성균관의대 삼성서울병원 핵의학과) ;
  • 이경한 (성균관의대 삼성서울병원 핵의학과) ;
  • 김병태 (성균관의대 삼성서울병원 핵의학과) ;
  • 이문규 (성균관의대 삼성서울병원 내과)
  • Published : 2008.12.31
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Abstract

Purpose: The aim of this study was to evaluate the usefulness of whole body positron emission tomography (PET) using $^{18}F-fluorodeoxyglucose$ ($^{18}F-FDG$) for cancer screening in asymptomatic subjects. Materials and Methods: The subjects were 1,762 men and 259 women who voluntarily underwent $^{18}F-FDG$ PET for cancer screening as a part of a routine health examination. Final diagnosis was decided by other diagnostic studies, pathological results or clinical follow-up for 1 year. Results: Of 2,021 subjects, 40 (2.0%) were finally proved to have cancer. Abnormal focal $^{18}F-FDG$ uptake suggesting malignancy was found in 102 subjects (5.0%). Among them, 21 subjects (1.0%) were proved to have cancer. Other tests in the routine health examination could not find 9 of 21 cancers (42.9%) detected by PET. The sensitivity, specificity, positive predictive value, and negative predictive value of PET for cancer screening were 52.5%, 95.9%, 20.6%, and 99.0%, respectively. Pathologies of cancers missed on PET were adenocarcinoma (n = 9; 3 colon cancers, 3 prostate cancers, 2 stomach cancers, and 1 rectal cancer), differentiated thyroid carcinoma (n = 6), bronchioalveolar cell carcinoma (n = 2), urinary bladder cancer (n = 1), and melanoma (n = 1). More than half of cancers which were not detected by PET were smaller than 1 cm in diameter. Conclusion: $^{18}F-FDG$ PET might be useful for cancer screening in asymptomatic subjects due to its high specificity and negative predictive value and playa supplementary role to the conventional health check-up, but it could not replace due to limited sensitivity for urological cancers, small-sized tumors and some hypometaboic cancers.

목적 : 이 연구에서는 암병력이 없는 무증상 건강인을 대상으로 $^{18}F-FDG$ PET의 암 선별검사로서의 유용성에 대하여 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2005년 12월까지 삼성서울병원 건강의학센터에서 건강 검진 프로그램중의 하나로 시행된 $^{18}F-FDG$ PET 검사 2,021건을 연구 대상으로 하였다. 종양 유무에 최종 진단은 건강 검진 프로그램에 포함된 다른 검사, 추가적인 진단 검사, 병리진단 결과 또는 1년 이상의 임상적 추적관찰을 통하여 정해졌다. 결과: 대상군에서 40건(2.0%)의 악성 종양이 최종적으로 진단되었다. $^{18}F-FDG$ PET에서는 악성 종양중 21건(전체 대상의 1.0%)이 발견되었다. PET으로 진단된 암의 42.9%(9/21)는 다른 건강 건진 프로그램에서 발견하지 못한 암이었다. 악성 종양을 진단하는 $^{18}F-FDG$ PET검사의 민감도는 52.5%(21/40), 특이도 95.9%(1900/1981), 양성 예측도 20.6%(21/102), 음성 예측도 99.0%(1900/1919)로 측정되었다. $^{18}F-FDG$ PET 위음성(n=19)을 보인 암은 갑상선 암이 6건으로 가장 많은 부분을 차지하고 있었고, 결장함과 전립선암이 각각 3건, 폐암과 위암이 각각2건, 방광암과 악성 흑색종(malignant melanoma), 직장암이 각각 1건이었다. 결론 : $^{18}F-FDG$ PET은 아주 높은 특이도와 음성 예측도로 인하여 악성 종양을 발견하는 암 선별검사로서 유용한 것으로 보인다. 그렇지만, $^{18}F-FDG$ PET은 비뇨 부인과계 종양, 당대사가 낮은 종양과 표재성 종양 발견에 민감도가 떨어지므로 단독보다는 다른 암 선별검사와 함께 시행하는 것이 유용하다.

Keywords

References

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