| Objective To analyze the difference between the data of lymph node metastasis detected by positron emission computed tomography(PET/CT)and the data of lymph node metastasis reported by postoperative pathology,to study the role of PET/CT in the diagnosis of lymph node metastasis before operation,and to further explore the significance of PET/CT in lymph node dissection of non-small cell lung cancer.Methods From January 2016 to January 2019,the clinical data of patients with non-small cell lung cancer(NSCLC)who underwent lung tumor resection and were confirmed by postoperative pathology were analyzed retrospectively.The sensitivity,specificity,positive predictive value and negative predictive value,false positive rate and false negative rate of PET/CT in detection of lymph node metastasis were calculated.Then,according to the age and tumor size,the basic clinical data were matched by the propensity score matching(PSM),and the characteristics of PET/CT group(experimental group)and non-PET/CT(control group)related surgical indicators were analyzed,and the application value of PET/CT in different populations was discussed.Results In this study,667 patients were enrolled,191 in the experimental group(28.6%)and 476 in the control group(71.4%).The number of women in the two groups was higher than that of men(50.8%vs 59.9%,P<0.05).The average age of the experimental group(59.41±10.87)was higher than that of the control group(56.80±11.38),and the patients with age less than 70 years were more than those with age≥70 years(81.2%vs 86.6%,P>0.05).The number of patients with basic diseases in the two groups was lower than that without basic diseases(35.6%vs 39.3%,P<0.05).Among the two groups,lobectomy was the most common operation(69.1%vs 61.1%,P<0.05),followed by segmental resection(27.2%vs 29.0%,P<0.05).The proportion of tumor≤2cm in the experimental group was less than that in the control group(44.5%vs 74.2%,P<0.001).The most common tumor sites in the two groups were right upper lung(35.1%vs 34.5%,P>0.05),left upper lung(22.5%vs 23.7%,P>0.05)and right lower lung(19.9%vs 17.6%,P>0.05).There were more adenocarcinoma than squamous cell carcinoma in the two groups(88.5%vs 93.9%,P<0.05).There were more adenocarcinoma than squamous cell carcinoma in the two groups(88.5%vs 93.9%,P<0.05).In the PET/CT group,a total of 925 lymph nodes(2703)were removed,of which 24 cases were reported to have lymph node metastasis,a total of 49 groups(104)by postoperative pathology;in the PET/CT group,31 cases were found,of which 61 groups considered the possibility of lymph node metastasis,among which 8 cases were confirmed as metastatic lymph nodes by postoperative pathology,11 groups were found.The sensitivity,specificity,positive predictive value and negative predictive value of PET/CT in the diagnosis of lymph node metastasis were 22.4%,94.3%,18.0%and 95.6%respectively;the false positive rate and false negative rate were 5.7%and 77.6%respectively.All patients were matched successfully with PSM,and the bleeding,extubation time and hospitalization time were similar between the two groups(P>0.05);the operation time of the experimental group was lower than that of the control group(100min vs 105min,u=11412.500,P<0.001);the number of lymph node cleaning group was lower than that of the control group(5 vs 6,u=10444.500,P<0.001);the postoperative complication rate of the experimental group was lower than that of the control group(χ2=7.117,P=0.008);there was a positive correlation between the number of lymphadenectomy groups and the operation time(Kendall’s tau-b=0.405,P<0.01).There was no significant difference in the median or proportion of the operation related indexes(P>0.05).Twenty five patients with age≥70 years were matched successfully.The operation time(130.80±53.92)min in the experimental group was lower than that in the control group(165.60±46.53)min(t=-2.443,P=0.018);the number of lymph nodes in the experimental group(4.68±1.49)was less than that in the control group(5.68±1.41)(t=0.414,P=0.018);the hospital stay in the experimental group was shorter than that in the control group(7 days vs 9 days,u=205.000,P=0.035);the postoperative complication rate of the experimental group was lower than that of the control group(χ2=4.667,P=0.031);there was no significant difference in the amount of intraoperative bleeding and the time of extubation(P>0.05).85 patients with tumors less than or equal to 2 cm were successfully matched with PSM,and the operation time of the experimental group was shorter than that of the control group(90 min vs 120 min,u=2607.000,P=0.002);the median of the number of lymph node cleaning groups in both groups was 5 groups(U=2922.500,P=0.028);the hospital stay in both groups was 7 days(U=2993.500,P=0.047);the postoperative complication rate in the experimental group was lower than that in the control group(χ2=3.977,P=0.046).The bleeding time was similar between the two groups(P>0.05).There were 82 patients in the tumor>2cm group who were matched with PSM successfully,and the median of each operation related index was similar(P>0.05).Conclusions 1.PET/CT,as one of the important preoperative examinations of lung cancer,can better reflect the characteristics and rules of lymph node metastasis,which is helpful for clinicians to choose the appropriate way of lymph node dissection.2.Preoperative PET/CT examination has a good application value in the elderly(≥70 years old)or non-small cell lung cancer patients with basic diseases,which can guide the strategy of lymph node sampling or cleaning during operation,so that the elderly patients can benefit from it;3 Preoperative PET/CT examination has a good application value in patients with small tumor(<2cm).It can guide the strategy of lymph node sampling or cleaning during operation,so that patients with small tumor can benefit from it. |
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