【摘要】 目的:分析18F-PET/CT在诊断非小细胞肺癌(NSCLC)前哨淋巴结(SLN)和非前哨淋巴结(Non-SLN)转移情况的应用价值及其临床意义。方法:采用前瞻性研究分析,随机选择可手术切除的周围性NSCLC患者60例,患者手术前全部行18F-PET/CT检查判断淋巴结转移情况。18F-PET/CT判断淋巴结转移标准为SUV≥2.5,术中肺癌SLN应用亲脂的异舒泛蓝染料法进行识别,将所探测的淋巴结分别切除后行术中快速病理检查,PET/CT和SLN最终以病理诊断为标准。结果:60例NSCLC患者中有37例成功识别出蓝染SLN,SLN检出率61.7%(37/60)。成功识别SLN的37例患者中,术前经18F-PET/CT诊断为N0患者共18例,清除SLN 31枚,转移8枚;清除Non-SLN 195枚,转移17枚,SLN的转移度明显高于Non-SLN(20.5%vs 8.0%,P<0.05),转移率差异无统计学意义(16.7%vs 7.2%,P>0.05)。结论:18F-PET/CT能较准确的诊断SLN转移,但存在一定的漏诊率,将PET/CT和肺癌前哨淋巴结结合,有助于区域淋巴结转移的准确诊断。更多还原

【Abstract】 OBJECTIVE: To analyze the applicablity value and clinical significance of PET/CT in diagnosing the lymph node metastatic status of sentinel lymph nodes(SLN) and Non-sentinel lymph node(Non-SLN) in non-small cell lung cancer(NSCLC).METHODS: Sixty patients with resectable suspected NSCLC were randomly selected in this prospective study.All patients underwent integrated PET/CT before surgery for lymph node staging.Lymph nodes were considered malignant on PET/CT if the maximum standardize uptake value(SUV) were greater than 2.5.The SLNs were identified with oleophilic isosulfan blue dye.All the lymph nodes detected at thoracotomy were sent separately for fast pathology examination and if necessary,immunohistochemically examination was used.Pathologic diagnosis were the golden standard for comparing PET/CT with SLN.RESULTS: At thoracotomy,37 of 60 peripheral NSCLC patients had SLNs successfully identified with isosulfan blue dye.The rate of SLN detection was 61.7%(37/60).Eighteen cases were preoperatively diagnosed N0 according to PET/CT imaging,31 SLNs were dissected with 8 contained metastases,and 195 Non-SLNs were dissected with 17 metastases.The metastatic degree presenting in SLNs was significantly higher than that in Non-SLNs(20.5% vs 8.0%,P<0.05) but there was no significant difference in metastatic rate(16.7% vs 7.2%,P>0.05).CONCLUSIONS: Integrated PET/CT in diagnosing SLN metastases is quite precise except for existing misdiagnose rate to some extent.Combined PET/CT and SLN procedure can facilitate the precise estimation of lymph node metastatic status.更多还原