Stellenwert der Positronen-Emissions-Tomographie mit 18-Fluor-Desoxyglukose (FDG-PET) in der Rezidivdiagnostik des Bronchialkarzinoms

Zusammenfassung:

Das Ziel der vorliegenden Untersuchung bestand darin, die diagnostische Aussagekraft der Positronen-Emissions-Tomographie (PET) mit F-18-Desoxyglukose (FDG) im Rahmen der Rezidivdiagnostik von Patienten mit Bronchialkarzinomen zu bestimmen. Nach Injektion von 220 ± 50 MBq F-18-Desoxyglukose wurde die Ganzkörper-PET (ECAT ART Scanner, Siemens CTI) durchgeführt. Die PET-Befundung durch visuelle Interpretation transversaler, koronaler und sagittaler Schnitte erfolgte im Konsens zweier erfahrener Nuklearmediziner ohne Kenntnis klinischer Daten oder anderer bildgebender Verfahren. 40 Patienten (= 41 Fälle) mit primär kurativ therapierten Bronchialkarzinomen wurden untersucht. In 29 der 35 Fälle mit Tumorrezidiv erfolgte eine pathologische Diagnosesicherung. Die FDG-PET-Untersuchung ergab einen richtig positiven Befund in 34/35 Fällen mit Tumorrezidiv. In 5/6 Fällen ohne Nachweis eines Tumorrezidivs ergab die PET-Untersuchung einen richtig negativen Befund. Die diagnostische Genauigkeit der FDG-PET lag insgesamt bei 39/41 = 95 % (95 %-Vertrauensintervall 83 - 99 %). Die FDG-PET weist eine hohe diagnostische Aussagekraft bei Rezidivverdacht von kurativ vorbehandelten Bronchialkarzinomen, kann jedoch die pathologische Diagnosesicherung nicht substituieren.

The aim of the present investigation was to evaluate the diagnostic accuracy of positron emission tomography with 18-fluoro-2-deoxyglucose (FDG-PET) in the detection of recurrent lung cancer. PET was performed using an ECAT ART scanner (Siemens CTI) after i. v. injection of 220 ± 50 MBq ¹⁸FDG. PET data were analysed by visual interpretation of coronal, sagittal and transversal slices. PET scans were interpreted independently by two experienced nuclear medicine physicians without prior knowledge of the results of other imaging studies or clinical data. 40 patients (= 41 cases) who had undergone primarily curative tumour treatment, were evaluated. In 29 of 35 cases with recurrent tumour, diagnosis was verified by pathologic means. FDG-PET correctly identified tumour recurrence in 34/35 cases. In 5/6 cases without provent tumour recurrence PET gave true negative results. The overall accuracy of FDG-PET was 39/41 = 95 % (95 %-confidence interval 83 - 99 %). FDG-PET shows high diagnostic accuracy in detecting recurrent lung cancer in patients with prior curative tumour treatment, but cannot substitute the need for pathological diagnosis.

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