대한핵의학회지 (The Korean Journal of Nuclear Medicine)

대한핵의학회 (The Korean Society of Nuclear Medicine)
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두경부암 환자에서 경부 림프절 전이에 대한 $^{18}F$ FDG-PET과 CT/MRI의 진단적 정확도 비교: 림프절군에 따른 연구

Comparison of $^{18}F$ FDG-PET and CT/MRI for the Diagnosis of Cervical Lymph Node Metastasis in Head and Neck Cancer: A Level-by-Level Based Study

  • 양유정 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 김재승 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 김상윤 (울산대학교 의과대학 서울아산병원 이비인후과) ;
  • 이호규 (울산대학교 의과대학 서울아산병원 방사선과) ;
  • 남순열 (울산대학교 의과대학 서울아산병원 이비인후과) ;
  • 최승호 (울산대학교 의과대학 서울아산병원 이비인후과) ;
  • 류진숙 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 여정석 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 문대혁 (울산대학교 의과대학 서울아산병원 핵의학과)
  • Yang, Yoo-Jung (Departments of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jae-Seung (Departments of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sang-Yun (Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Ho-Gyu (Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Nam, Soon-Yul (Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Seung-Ho (Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ryu, Jin-Sook (Departments of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yeo, Jeong-Seok (Departments of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Moon, Dae-Hyuk (Departments of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2004.02.28
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초록

목적: 두경부암의 중요한 예후인자인 경부림프절 전이의 수술전 진단은 최근 기능보존적 수술이 증가함에 따라 그 중요성이 증가되고 있다. 이 연구에서는 경부 림프절군의 전이에 대한 FDG-PET의 진단적 정확도를 평가하고 이를 CT/MRI와 비교하고자 하였다. 방법: 조직학적으로 두경부암(상부성문암 16, 설암 9, 기타 7)이 확인된 32명의 환자(남/녀=27/5, $56{\pm}10$세)를 대상으로 FDG-PET과 CT의 수술전 진단성적을 비교하였다. FDG-PET과 CT/MRI는 1개월 이내에 시행되었고 병리적 소견을 토대로 경부림프절군 단위로 예민도와 측이도를 구하였다. 결과 32명의 환자에서 153개의 림프절군이 절제되었고 이중 19명의 환자에서 32개의 림프절군이 조직학적으로 전이양성이었다. 전체적인 FDG-PET의 민감도와 예민도는 각각 88% (28/32)와 93% (113/121)이었고 CT/MRI의 민감도와 예민도는 각각 56% (18/32)와 92% (112/121)로 FDG-PET이 CT/MRI보다 예민도가 유의하게 높았다. (p=0.002) 개별 림프절군에서의 진단성적은 그 위치에 따라 서로 달랐으며 가장 낮은 민감도와 특이도를 보인 림프절군은 편측 제II 림프절군이었고 반대측 림프절군과 인두후부 림프절군 등에서 가장 높은 예민도와 특이도를 보였다. 결론: 두경부암에서 경부림프절전이를 발견하는데 FDG-PET이 CT/MRI보다 더 민감하였으며 FDG-PET은 경부절제술의 범위를 결정하는데 유용할 것으로 생각된다.

Purpose: Cervical lymph node metastasis is the most important factor of the prognosis and therapeutic planning in head and neck cancer. With increasing interest of minimally invasive neck surgery, more accurate preoperative assessment of cervical lymph node becomes more essential. We evaluated the diagnostic accuracy of $^{18}F$ FDG-PET in the assessment of lymph node metastasis in patients with primary head and neck cancer and compared the results with those of CT/MRI. Materials and Methods: Thirty-two patients (M/F=27/5, $56{\pm}10yr$) with biopsy proven head and neck cancer (16 supraglottic cancer, 9 tongue cancer, 7 others) underwent FDG-PET and CT/MRI (25/7) within 1 month before neck dissection. Based on lymph node level, the diagnostic sensitivity and specificity of FDG PET and CT/MRI for the metastasis of cervical lymph node were compared. Results: Of 153 lymph node levels dissected in 32 patients, 32 lymph node levels of 19 patients were positive for metastasis by histopatholologic examination. The overall sensitivity and specificity of FDG-PET were 88% (28/32) and 93% (113/121), whereas those of CT/MRI were 56% (18/32) (p=0.002) and 92% (112/121), respectively. The diagnostic sensitivity and specificity of FDG-PET were different according to location of lymph node levels, and those of ipsilateral level 11 were lower than those of other levels. Conclusion: FDG-PET is more sensitive in detecting metastatic cervical lymph node in head and neck cancer than CT/MRI. FDG-PET might be useful in guiding the extent of neck dissection.

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