The Application Of PET/CT And Sentinel Lymph Nodes In Clinical Early Non–small Cell Lung Cancer

BACKGROUND AND OBJECTIVE: Resection of the primary lung cancer arecompletely and normative system mediastinal lymph node removal is the basic principlesof surgical treatment of non-small cell lung cancer (non-small cell lung cancer, NSCLC).Mediastinal lymph node disection is mainly divided into the mediastinal lymph nodesampling and complete mediastinal lymph node dissection. Due to the wide scope ofcomplete mediastinal lymph node dissection removal surgery, trauma, postoperativecomplications and mortality is relatively increased, to the extent and the way of lymphnode disection, there are still many problems and controversy of clinical practice.Therefore, exploring new technology of accurating diagnosis of metastasis of lymph nodesbecome the focus of research. This study compared the sensitivity, specificity and accuracyof different tracer detection of sentinel lymph node (sentinel lymph node, SLN) metastasisof clinical early NSCLC, the application value of SLN predicting the regional lymph nodesmetastasis of early NSCLC was studied.METHODS: A total of88patients with clinical stage I NSCLC in my hospital wererandomized selected in this prospective study from June2010to December2012, anddivided into four groups,32patients were given methylene blue solution inject beforeopertion (group A),27patients were given activated carbon nanoparticles (group B),17patients were given99Technetium sulfur colloid solution (group C) and12patients weregiven methylene blue and99technetium sulfur colloid combinated (group D). Lobe resection was performed， SLN and mediastinal lymph nodes detected were resected,respectively. The pathological diagnosis was standard finally.RESULTS:1. The detection rate was59.4%(19/32),63.0%(17/27),76.5%(13/17) and91.7%(11/12) in group A, B, C and D, respectively. The detection rate of group D issignificantly higher than the previous three group(P=0.042).2．Accuracy, sensitivity, negative predictive value and false negative rate ofSLN predicting regional lymph node metastasis were89.5%,66.7%,86.7%and10.5%ingroup A; were94.1%,75.0%,92.8%and5.9%in group B; were92.3%,80.0%,88.8%andwere7.7%in group C and91.7%,100.0%,100.0%and0%in group D, respectively.3．Radioactivity count of SLN is significantly higher than Non-SLN node ingroup C(6208±3206vs.1324±476, P=0.045), group D wa(s6315±3423vs.1438±537,P=0.047).CONCLUSION：Dye and Radioisotope are suitable for SLN detection; it has betterfeasibility SLN detection for combination method; SLN can reflect the states of regionallymph node metastasis in a certain degree for clinical early NSCLC, it is helpful toimprove prediction accuracy of regional lymph node metastasis. OBJECTIVE：To analyze the application of18F-FDG PET/CT and sentinel lymphnode (SLN) diagnosing regional lymph node metastasis in clinical earlynon-small cell lung cancer (NSCLC), the application value of PET/CT and SLNpredicting lymph node metastasis and intraoperative mediastinal lymph nodecleaning way were discussed for early NSCLC.METHOD: A total of52patients with clinical early NSCLC in my hospitalwere randomized selected in this prospective study from July2010to December2012, all of the patients were examinated with PET/CT predicting lymph nodemetastasis, SLN were detected with radioactive nuclide in the operation foridentifing NSCLC. Lung cancer resection was performed, all the detecting SLNand mediastinal lymph nodes were excised, pathologic examinations wereperformed and the pathological diagnosis was standard finally.RESULT: Of52cases of early NSCLC patients, there were43cases SLNdetected with nuclide method, There was34adenocarcinoma,6squamous cellcarcinoma,1large cell carcinoma, and2adenosquamous cell carcinoma for thefinal histological classification. The detection rate was82.7%(43/52), theaccuracy of SLN predicting mediastinal lymph node metastasis was95.3%(41/43),the sensitivity was85.7%(6/7), the false negative rate was14.3%(1/7). Theaccuracy of PET/CT predicting SLN was88.4%(38/43),the specificity was91.7% (33/36), the sensitivity was71.4%(5/7), the positive predictive value was62.5%(5/8), the negative predictive value was94.3%(33/35). The accuracyof PET/CT and SLN predicting regional lymph node metastasis was95.3%(41/43),the specificity was97.1%(34/35), the sensitivity was87.5%(7/8),thepositive predictive value was87.5%(7/8), the negative predictive value was97.1%(34/35).CONCLUSION: SLN has good effect of predicting regional lymph nodemetastases; There was high accuracy to predicting SLN with PET/CT for earlyNSCLC; It improved the prediction value of the regional lymph nodesmetastasis with PET/CT and SLN combined, which can guide a right way of thelymph node dissection for clinical early NSCLC.