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首页> 外文期刊>South African medical journal = >The diagnostic accuracy of integrated positron emission tomography/computed tomography in the evaluation of pulmonary mass lesions in a tuberculosis-endemic area
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The diagnostic accuracy of integrated positron emission tomography/computed tomography in the evaluation of pulmonary mass lesions in a tuberculosis-endemic area

机译：综合正电子发射断层扫描/计算机断层扫描在评估结核病流行地区肺部肿块病变中的诊断准确性

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BACKGROUND: Integrated positron emission tomography/computed tomography (PET-CT) is a well-validated modality for assessing pulmonary mass lesions and specifically for estimating risk of malignancy. Tuberculosis (TB) is known to cause false-positive PET-CT findings. OBJECTIVE: To investigate the utility of PET-CT in the evaluation of pulmonary mass lesions and nodules in a high TB prevalence setting. METHODS: All patients referred for the evaluation of a solitary pulmonary nodule or mass and who underwent PET-CT scanning over a 3-year period were included. The PET-CT findings, including maximum standardised uptake value (SUVmax), were compared with the gold standard (tissue or microbiological diagnosis). The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy for malignant disease were calculated according to the SUVmax cut-off of 2.5 and a proposed cut-off obtained from a receiver operating characteristic (ROC) curve. RESULTS: Forty-nine patients (mean (standard deviation) age 60.1 (10.2) years; 29 males) were included, of whom 30 had malignancy. Using an SUVmax cut-off of 2.5, PET-CT had a sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for malignancy of 93.3%, 36.8%, 70.0%, 77.8% and 71.4%, respectively. After a ROC curve analysis, a suggested SUVmax cut-off of 5.0 improved the specificity to 78.9% and the diagnostic accuracy to 86.7%, with a small reduction in sensitivity to 90.0%. CONCLUSIONS: The diagnostic accuracy of PET-CT in the evaluation of pulmonary mass lesions using the conventional SUVmax cut-off of 2.5 was reduced in a TB-endemic area. An SUVmax cut-off of 5.0 has a higher specificity and diagnostic accuracy for malignancy, with a comparable sensitivity.
机译：背景：集成正电子发射断层扫描/计算机断层扫描（PET-CT）是一种经过充分验证的方法，可用于评估肺部肿块病变，尤其是用于估计恶性肿瘤的风险。已知结核病（TB）会导致PET-CT假阳性结果。目的：探讨PET-CT在高TB患病率环境下评估肺部肿块和结节的实用性。方法：所有转诊为孤立性肺结节或肿块并在3年内接受PET-CT扫描的患者均包括在内。 PET-CT的发现，包括最大标准摄取值（SUVmax），与金标准（组织或微生物学诊断）进行了比较。根据SUVmax临界值2.5和从受试者工作特征（ROC）曲线获得的建议临界值，计算出恶性疾病的敏感性，特异性，阳性和阴性预测值和诊断准确性。结果：四十九例患者（平均（标准差）年龄为60.1（10.2）岁;男29例），其中30例患有恶性肿瘤。使用SUVmax截止值2.5，PET-CT对恶性肿瘤的敏感性，特异性，阳性和阴性预测值和诊断准确性分别为93.3％，36.8％，70.0％，77.8％和71.4％。经过ROC曲线分析后，建议的SUVmax临界值为5.0，将特异性提高到78.9％，将诊断准确性提高到86.7％，而灵敏度则略有降低，降至90.0％。结论：在TB流行区域，使用常规SUVmax截止值为2.5时，PET-CT在评估肺部肿块病变中的诊断准确性降低。 SUVmax临界值5.0具有更高的特异性和对恶性肿瘤的诊断准确性，并具有可比的灵敏度。

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