대한핵의학회지 (1967년~2009년)
대한핵의학회지 2005;39(4)231~238
비소세포폐암에서 CT-보정 양전자단층촬영술을 이용한 악성 림프절 평가 및 N 병기 결정 성적 향상
(Improving Diagnostic Accuracy for Malignant Nodes and N Staging in Non-Small Cell Lung Cancer Using CT-Corrected FDG-PET)
Author 이은정·최준영·이경수1·정현우·이수진·조영석·최용·최연성·이경한·권오정2·심영목3·김병태,
Eun Jeong Lee, M.D., Joon Young Choi, M.D., Kyung Soo Lee, M.D.1, Hyun Woo Chung, M.D., Su Jin Lee, M.D., Young Seok Cho, M.D., Yong Choi, Ph. D.,Yearn Seong Choe, Ph. D.,Kyung Han Lee, M.D., O Jung Kwon, M.D.2, Young Mog Shim, M.D.3, Byung Tae Kim, M.D.
Affiliation 성균관대학교 의과대학 삼성서울병원 핵의학과, 영상의학과1, 내과2, 흉부외과3
Department of Nuclear Medicine, Radiology1, Internal Medicine2, and Thoracic Surgery3, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Abstract

Purpose: We investigated prospectively whether the interpretation considering the patterns of FDG uptake and the findings of unenhanced CT for attenuation correction can improve the diagnostic accuracy for assessing malignant lymph node (LN) and N stage in non-small cell lung cancer (NSCLC) using CT-corrected FDG-PET (PET/CT). Materials & Methods: Subjects were 91 NSCLC patients (M/F: 62/29, age: 60¡¾9 yr) who underwent PET/CT before LN dissection. We evaluated the maximum SUV (maxSUV), patterns of FDG uptake, short axis diameter, and calcification of LN showing abnormally increased FDG uptake. Then we investigated criteria improving the diagnostic accuracy and correlated results with postoperative pathology. In step 1, LN was classified as benign or malignant based on maxSUV only. In step 2, LN was regarded as benign if it had lower maxSUV than the cut-off value of step 1 or it had calcification irrespective of its maxSUV. In step 3, LN regarded as malignant in step 2 was classified as benign if they had indiscrete margin of FDG uptake. Results: Among 432 LN groups surgically resected (28 malignant, 404 benign), 71 showed abnormally increased FDG uptake. We determined the cut-off as maxSUV = 3.5 using ROC curve analysis. The sensitivity, specificity, and accuracy for assessing malignant LN were 64.3%, 86.9%, 85.4% in step 1, 64.3%, 95.0%, 93.1% in step 2, and 57.1%, 98.0%, 95.4% in step3, respectively. The accuracy for assessing N stage was 64.8% in step 1, 80.2% in step 2, and 85.7% in step 3. Conclusion: Interpreting PET/CT, consideration of calcification and shape of the FDG uptake margin along with maxSUV can improve the diagnostic accuracy for assessing malignant involvement and N stage of hilar and mediastinal LNs in NSCLC.(Korean J Nucl Med 39(4):231-238, 2005)

Keyword FDG, PET/CT, Lung, Carcinoma
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