폐암 병기 결정에서 PET-CT의 역할에 대한 연구
The role of the PET-CT in staging of lung cancer
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목적 : PET-CT는 PET 스캐너에 CT 스캐너를 부착시켜 대사영상인 PET 영상과 해부학적 형태영상인 CT의 융합영상을 얻을 수 있어서, 두 영상법의 장점을 살려 종격동 림프절에 있어서 진단 정확도를 향상 시킬 수 있는 것으로 알려져 있다. 그러나 국내에서는 아직까지 PET-CT의 성적에 대한 연구가 없었다. 이에 본 저자들은 N병기 결정에 있어서 CT와 비교하여 PET-CT의 성적을 알아보고자 하였으며, PET-CT의 시행이 종격동내시경에 의한 조직생검과 같은 침습적 방법을 피할 수 있게 해 주는지와 병기 결정에 있어서 PET-CT가 추가됨으로써 얻는 다른 이익이 있는지를 알아보고자 하였다. 방법 : 조직학적으로 확진된 비소세포폐암 환자에서 수술 전 병기 결정을 위하여 PET-CT와 CT를 둘 다 시행한 38명의 환자를 대상으로 후향적으로 조사하여, 그 중 수술적 절제가 가능한 병기 Ⅰ∼Ⅲa인 22명이 연구 대상이 되었다.결과 : 림프절 병기에서 CT는 민감도, 특이도, 정확도, 양성 예측치, 음성 예측치에서 각각 44%, 77%, 64%, 57%, 67%이었고, PET-CT는 각각 78%, 95.2%, 86%, 88%, 86%이었다. PET-CT에서 1명의 위양성 환자와 2명의 위음성 환자가 있었으며 3명의 환자에서 전신골스캔에서 발견하지 못한 뼈 전이를 PET-CT에서 먼저 발견하였다.
Abstract
Background : PET-CT can provide both a physiological and anatomical image with the benefits of both PET and CT scanners. This may improve the accuracy of a diagnosis of a mediastinal lymph node metastasis. The aims of this study were to compare PET-CT versus CT on the nodal staging of lung cancer and to determine if it could be used to avoid an invasive diagnostic examination. The benefit of the additional PET-CT as preoperative evaluation of the lung cancer was also assessed. Methods : The results of CT and PET-CT scanning in 22 patients with a proven non-small cell lung cancer (NSCLC) were correlated with the pathological findings of lymph node sampling using mediastinoscopy or surgery. Results : The sensitivity, specificity, accuracy, positive and negative predictive values of CT for detecting metastatic lymphadenopathy were 44%, 77%, 64%, 57%, and 67%, respectively. For PET-CT, these were 78%, 92%, 86%, 88%, and 86%, respectively. The earlier detection of a bone metastasis was obtained by PET-CT in 3 cases, which was not detected in bone scan. Conclusions : Better results for nodal staging and higher negative-predictive values by PET-CT (than CT) can avoid the need for invasive mediastinal staging of the lung cancer with negative mediastinal lymph node metastasis. An additional histological evaluation by mediastinoscopy needs to be done when positive findings are detected by PET-CT. PET-CT is also helpful in detecting a distant metastasis and avoiding unnecessary surgery. More accurate diagnostic staging can be expected using the simultaneous execution of PET-CT with a conventional preoperative evaluation of lung cancer.(Korean J Med 71:627-634, 2006)
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