Sedat ZİYADE, Şükrü DİLEGE, Göksel KALAYCI, Serhan TANJU, Osman EROĞLU, Alper TOKER

Küçük hücreli dışı akciğer kanserinde mediastinal lenf nodu evrelemesinde pozitron emisyon

Amaç: Akciğer kanserinde sağkalımı etkileyen en önemli faktörlerden biri lenfatik tutulumdur. Bu çalışmada, küçük hücreli dışı akciğer kanserinde mediastinal lenf nodu tutulumunun değerlendirilmesinde fluorodeoksiglukoz (FDG) kullanılarak yapılan pozitron emisyon tomografisinin (FDG-PET) yeri araştırıldı. Çalışma planı: Akciğer kanseri nedeniyle ameliyata aday olan ve FDG-PET görüntülemesinde uzak metastaz saptanmayan küçük hücreli dışı akciğer karsinomlu 53 hasta (45 erkek, 8 kadın; ort. yaş 64; dağılım 49-75) çalışmaya alındı. Lenf nodlarının, PET tutulum düzeyleri ve bilgisayarlı tomografideki (BT) boyutu, tümörün histolojik tipi, yapılan ameliyatlar ve çıkarılan mediastinal lenf nodları ve patoloji sonuçları değerlendirildi.Bulgular: Mediastinal lenf nodlarının değerlendirilmesinde PET görüntülemenin duyarlılığı %66.7, özgüllüğü %83.2, pozitif öngördürücü değeri %51.3, negatif öngördürücü değeri %90.4 bulunurken, aynı değerler BT’de sırasıyla %36.7, %85, %39.3 ve %83.5 idi. Pozitron emisyon tomografisi ile BT arasında duyarlılık açısından fark istatistiksel olarak anlamlı idi (p=0.004).Sonuç: Pozitron emisyon tomografisinde maksimum standardize tutulum değerinin 2.5’in üzerinde olduğu durumlarda lenf nodu tutulumunun mediastinoskopiyle değerlendirilmesi gerektiği, 2.5’in altında olduğu durumlarda ise torakotomi yapılmasının yanlış bir yaklaşım olmayacağı sonucuna varıldı.

The role of positron emission tomography in mediastinal lymph node staging of non-small-cell lung cancer

Background: Mediastinal lymph node involvement is one of the most important prognostic factors of survival in lung cancer. We analyzed the value of flourodeoxyglucose- positron-emission tomography (FDG-PET) in mediastinal lymph node staging of non-small-cell lung cancer. Methods: The study included 53 patients (45 men, 8 women; mean age 64 years; range 49 to 75 years) who were candidates for surgery for non-small cell lung cancer and had no distant metastasis on an FDG-PET scan. Mediastinal lymph nodes were assessed with PET and computed tomography (CT) and the results were compared in relation with histopathologic type of tumor, operations performed, lymph node dissections during thoracotomy, and histopathologic results.Results: Compared to the CT scan, PET had a higher sensitivity (66.7% vs 36.7%), positive predictive value (51.3% vs 39.3%), and negative predictive value (90.4% vs 83.5%), but a lower specificity (83.2% vs 85%) in the evaluation of mediastinal lymph nodes. The sensitivity rates for PET and CT were found to be significantly different (p=0.004).Conclusion: Our data suggest that lymph node involvement should be evaluated with mediastinoscopy if the standardized maximum uptake value of the PET scan is greater than 2.5, and that a direct thoracotomy would not be less appropriate if an uptake value of less than 2.5 is obtained

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