간세포암종 진단에서 18F-FDG 양전자 방출단층촬영(PET)의 정확성
Diagnostic Accuracy of 18F-FDG Positron Emission Tomography for Evaluation of Hepatocellular Carcinoma
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목적: 양전자방출단층촬영(positron emission tomography; 이하 PET)은 세포 대사를 반영하는 기능 영상 기법인데, 간세포암종의 경우에는 민감도와 특이도가 높지 않으며 비용-효과가 불분명하여 보편적으로 이용되고 있지 못한 실정이다. 이에 연구자들은 간세포암종의 병기 및 전이 평가 검사로서의 18F-FDG-PET의 정확성을 살펴보고자 본 연구를 시행하였다. 대상과 방법: 2001년 6월부터 2005년 2월까지 본원에서 임상 또는 조직검사로 진단되고 치료된 간세포암종 환자들 중 18F- FDG-PET를 촬영하고 3개월 내 임상경과 및 영상검사 또는 수술 등으로 경과가 추적될 수 있었던 32명의 환자들을 대상으로 후향조사하였다. PET 영상에서 standarzied uptake value (SUV) 2.5 이상을 양성으로 판정하였다. 결과: 18F-FDG-PET를 시행한 32예 중에서 21예가 PET 양성을 보였고, 그 중 19예가 추적 조사에서 실제 양성으로 판명되었고, 2예가 위양성으로 나타났다. PET 음성은 11예였으나 추적 기간 동안 10예가 실제 양성으로 판명되어, 대부분이 위음성이었다. 이 결과를 바탕으로 PET 민감도는 65.5%, 특이도 33.3%, 양성 예측도 90.5%, 정확도 62.5%로 나타났다. 결론: 위의 결과에서 18F-FDG-PET는 간세포암종의 진단 정확성이 높지 않으므로, 간세포암종의 선별 검사(screening)로 시행하기에는 그 가치가 제한적이라고 생각된다. PET의 임상적 유용성을 평가하기 위해서는 좀더 많은 대상에서의 전향연구가 필요하다.
Abstract
Positron emission tomography (PET) is an imaging technique reflecting cellular metabolism. However, the feasibility of PET in the diagnosis of hepatocellular carcinoma (HCC) is limited because of vague accuracy and high cost. The aim of this study was to evaluate the diagnostic accuracy of 18F-FDG-PET in detection of HCC. Methods: We retrospectively studied HCC patients who underwent 18F- FDG-PET between June 2001 and February 2005 in Korea National Cancer Center. Thirty-two patients were enrolled and HCC status of these patients were verified by surgical pathology or clinical course using imaging studies (CT, MRI or angiography) within 3 months after PET. PET studies were read by 2 specialists for nuclear medicine and determined as malignant when its standardized uptake value (SUV) was over 2.5. Results: HCC was suspected in 21 out of 32 cases on 18F-FDG-PET. On follow-up, 2 of 21 cases were determined false-positive. In cases of 11 patients without evidence of HCC on 18F-FDG-PET, 10 patients were found to have HCC on follow-up. Thus, the sensitivity and specificity of 18F-FDG-PET were 65.5% and 33.3% respectively. The positive predictive value was 90.5%. The diagnostic accuracy was 62.5%. Conclusion: 18F- FDG-PET showed a low accuracy in diagnosis of HCC. Therefore, 18F-FDG-PET has a limited role in a staging and detection of occult HCC.
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