FDG PET-CT 对部分实性肺腺癌淋巴结分期的系统综述和 Meta 分析
Systematic review and meta-analysis of FDG PET-CT for nodal staging of part-solid lung adenocarcinomas.
作者
作者单位
- Department of Nuclear Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK. Electronic address: p.choy@nhs.net.
- St Andrews Medical Practice, 50 Oakleigh Road, London, N20 9EX, UK. Electronic address: arnold.wong2@nhs.net.
- Department of Thoracic Surgery, Royal Brompton Hospital, Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK. Electronic address: eric.lim@nhs.net.
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK. Electronic address: samhare@nhs.net.
- Department of Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK. Electronic address: anant.patel3@nhs.net.
- Department of Nuclear Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK. Electronic address: d.pencharz@nhs.net.
- Department of Nuclear Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK; Centre for Medical Imaging, UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK. Electronic address: thomas.wagner@nhs.net.
摘要
中文
肺腺癌是肺癌最常见的亚型。当表现为磨玻璃或部分实性结节时，肺腺癌通常生长缓慢，很少转移，且 FDG 亲和力低。回顾性证据表明 FDG PET-CT 分期在 T1 部分实性肺癌中的价值有限。NICE 推荐 FDG PET-CT 以确认适合根治性治疗患者的局限性疾病。进行系统综述以确定 FDG PET-CT 对 T1 部分实性肺癌淋巴结分期的诊断准确性。使用 PICO 框架进行系统检索。应用预定义的纳入和排除标准。提取相关数据，并使用 QUADAS-2 工具评估偏倚风险。汇总了 FDG PET-CT 对 T1 部分实性肺癌淋巴结分期的敏感性和特异性，以森林图和 HSROC 曲线呈现，并与胸部 CT 的诊断性能进行比较。探讨了总结节大小与淋巴结分期之间的关联。淋巴结转移罕见，六项研究报告 0% 淋巴结受累。四项研究报告了 FDG PET-CT 的诊断性能指标，显示低敏感性（28%）、高特异性（90%）和较差的准确性（0.599）。在两项比较 CT 和 FDG PET-CT 的研究中，敏感性无显著差异（敏感性：CT 12%，FDG PET-CT 29%，p=0.320），而 CT 显示更高的特异性（特异性：CT 97%，FDG PET-CT 83%，p < 0.001）。此外，两项研究报告总大小 ≤10 mm 的结节无淋巴结转移。FDG PET-CT 对部分实性肺癌的淋巴结分期诊断价值有限，特别是对于小结节（总大小 ≤10 mm，T1a），其中未观察到淋巴结转移。虽然敏感性在 CT 和 FDG PET-CT 之间没有差异，但 CT 提供了更高的特异性。
English
Lung adenocarcinoma is the most prevalent subtype of lung cancer. When presenting as ground-glass or part-solid nodules, lung adenocarcinomas typically show slow growth, rarely metastasise and have low FDG-avidity. Retrospective evidence demonstrated limited value of FDG PET-CT staging in T1 part-solid lung cancers. NICE recommends FDG PET-CT to confirm localised disease in patients eligible for radical treatment. To carry out a systematic review to establish the diagnostic accuracy of FDG PET-CT for nodal staging in T1 part-solid lung cancers. A systematic search was conducted using the PICO framework. Predefined inclusion and exclusion criteria were applied. Relevant data were extracted, and risk of bias was assessed using the QUADAS-2 tool. Sensitivity and specificity of FDG PET-CT for nodal staging in T1 part-solid lung cancers were pooled, presented in forest plots and HSROC curve, and compared to, diagnostic performance of CT Thorax. The association between total nodule size and nodal staging was explored. Nodal metastases were rare, with six studies reporting 0% nodal involvement. Diagnostic performance metrics for FDG PET-CT were available in four studies, which showed low sensitivity (28%), high specificity (90%), and poor accuracy (0.599). In two studies comparing CT and FDG PET-CT, no significant difference in sensitivity was observed (sensitivity: CT 12%, FDG PET-CT 29%, p=0.320), whereas CT demonstrated higher specificity (specificity: CT 97%, FDG PET-CT 83%, p < 0.001). In addition, no nodal metastases were reported in nodules with a total size ≤10 mm in two studies. FDG PET-CT has limited diagnostic value for nodal staging in part-solid lung cancers, particularly for small nodules (total size ≤10 mm, T1a), where nodal metastasis was not observed. While sensitivity did not differ between CT and FDG PET-CT, CT provided higher specificity.
分类与指标
- 研究类型
- 综述Meta
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 9.8
- 新锐分区
- 1区