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Pneumologie 2001; 55(8): 367-377
DOI: 10.1055/s-2001-16201
ORIGINALARBEIT
Georg Thieme Verlag Stuttgart · New York

Metaanalyse zum Stellenwert der Positronen-Emissions-Tomographie mit F-18-Fluorodesoxyglukose (FDG-PET) bei Lungentumoren[1]

Diskussionsbasis der deutschen Konsensus-Konferenz Onko-PET 2000Metaanalysis of the efficacy of positron emission tomography with F-18-fluorodeoxyglucose (FDG-PET) in lung tumors as a base for discussion of the German Consensus Conference on PET in oncologyD. Hellwig1 , D. Ukena2 , F. Paulsen3 , M. Bamberg3 , C.-M. Kirsch1
  • 1Abteilung Nuklearmedizin der Radiologischen Universitätsklinik Homburg/Saar (Direktor: Prof. Dr. Dr. C.-M. Kirsch)
  • 2Medizinische Universitätsklinik V, Homburg/Saar (Direktor: Prof. Dr. G. W. Sybrecht)
  • 3Klinik für Radioonkologie, Eberhard-Karls-Universität Tübingen (Direktor: Prof. Dr. M. Bamberg)
  • für die Arbeitsgruppe Lunge der 3. Konsensuskonferenz Onko-PET der Deutschen Gesellschaft für Nuklearmedizin
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Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung:

Hintergrund: Auswertung der FDG-PET-Literatur über die Dignitätsbeurteilung pulmonaler Herde, N-Staging, M-Staging sowie Rezidivdiagnostik des Bronchialkarzinoms als Diskussionsgrundlage für die 3. Konsensuskonferenz Onko-PET. Methode: Nuklearmediziner, Pneumologen, Strahlentherapeuten, Radiodiagnostiker und Thoraxchirurgen prüften die relevante MEDLINE-gelistete Literatur aus 1985 - 1999 auf Eignung zur weiteren Analyse. Aus den publizierten Vierfeldertafeln wurden kumulative Häufigkeiten und „Summary receiver operating characteristic curves” (sROC-Kurven) berechnet. Ergebnisse: Aus 15 Studien zur Herddignität mit 1144 Patienten (Pat) ergeben sich Sensitivität (Sens), Spezifität (Spez) und diagnostische Genauigkeit (Acc) zu 96 %, 80 % und 91 %. Das N-Staging mit FDG-PET (20 Studien, 1292 Pat, Sens 88 %, Spez 92 %, Acc 91 %) ist der CT überlegen (19 Studien, 1268 Pat, Sens 65 %, Spez 76 %, Acc 73 %). Durch das genaue M-Staging mit FDG-PET (4 Studien, 336 Pat, Sens 94 %, Spez 97 %, Acc 96 %) änderte sich das Procedere bei 18 % der Fälle (8 Arbeiten, 695 Pat), unerwartete extrathorakale Metastasen wurden in 12 % der Fälle gefunden (7 Arbeiten, 581 Pat). Bei Verdacht auf Nebennierenmetastasen ist FDG-PET die genaueste nicht-invasive Methode zur Dignitätsbeurteilung (3 Studien, 263 Pat, Sens 96 %, Spez 99 %, Acc 98 %). Die Rezidivdiagnostik ist sehr genau möglich (4 Studien, 224 Pat, Sens 99 %, Spez 89 %, Acc 95 %). Schlussfolgerungen: Studien mit kumulativ bis über 1000 Patienten belegen beim Bronchialkarzinom hohe Aussagekraft und Überlegenheit der FDG-PET gegenüber konventioneller Bildgebung. Darauf basierend sieht die 3. Konsensuskonferenz Onko-PET 1a-Indikationen für FDG-PET bei der Dignitätsbeurteilung pulmonaler Herde bei Patienten mit erhöhtem Operationsrisiko, N-Staging, M-Staging (außer Gehirn) sowie Rezidivdiagnostik des Bronchialkarzinoms.

Metaanalysis of the Efficacy of Positron Emission Tomography with F-18-fluorodeoxyglucose (FDG-PET) in Lung Tumors as a Base for Discussion of the German Consensus Conference on PET in Oncology:

Background: To analyse current literature on FDG-PET for evaluation of lung lesions, N-staging, M-staging, and recurrence of lung cancer for the third German Consensus Conference on PET in oncology. Methods: Specialists in nuclear medicine, pneumology, radiation oncology, diagnostic radiology, and thoracic surgery reviewed the relevant literature as listed in MEDLINE from 1985 to 1999 for further analysis. Out of the published data cumulative test parameters and summary receiver operating characteristic curves (sROC curves) were computed. Results: Sensitivity, specificity, and accuracy of FDG-PET are 96 %, 80 %, 91 % for evaluating lung lesions (15 studies with at least 35, in total 1144 patients). With corresponding values of 88 %, 92 %, 91 % (20 studies, 1292 patients) for N-staging FDG-PET is superior to CT with 65 %, 76 %, 73 % (19 studies, 1268 patients). With 94 %, 97 %, 96 % (4 studies, 336 patients) M-staging with FDG-PET is very accurate and changed therapeutic management in 18 % of the cases (8 studies, 695 patients), unexpected extrathoracic metastases were found in 12 % (7 studies, 581 patients). FDG-PET is the most accurate non-invasive method to evaluate suspected adrenal metastases (3 studies, 263 patients, sensitivity 96 %, specificity 99 %, accuracy 98 %). Recurrence is detected accurately (4 studies, 224 patients, sensitivity 99 %, specificity 89 %, accuracy 95 %). Conclusions: Studies with in total more than 1000 patients show the high diagnostic efficacy of FDG-PET and its superiority to conventional imaging in lung cancer. Based on this analysis the third German Consensus Conference on PET in oncology evaluated FDG-PET on lung cancer. 1a-indications are evaluation of lung nodules in patients at risk for complications during surgery, N-staging, M-staging (except brain), and detection of recurrence.

1 Die Ergebnisse der Arbeit wurden teilweise am 19.9.2000 bei der 3. Konsensuskonferenz Onko-PET in Ulm sowie am 26.4.2001 auf der Jahrestagung 2001 der Deutschen Gesellschaft für Nuklearmedizin in Hamburg präsentiert.

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1 Die Ergebnisse der Arbeit wurden teilweise am 19.9.2000 bei der 3. Konsensuskonferenz Onko-PET in Ulm sowie am 26.4.2001 auf der Jahrestagung 2001 der Deutschen Gesellschaft für Nuklearmedizin in Hamburg präsentiert.

Dr. med. Dipl.-Phys. D. Hellwig

Abteilung für Nuklearmedizin der Radiologischen Universitätskliniken

66421 Homburg/Saar

Email: E-mail: Dirk.Hellwig@med-rz.uni-saarland.de