主题：PET/CT在恶性肿瘤中的应用 -- 良金百辟

PET/CT用于部分高龄人群的肿瘤筛查，是毫无价值，还是可能有益这是我们这几天讨论的问题。进而，又外延到PET/CT在肿瘤中的地位如何。

认为毫无价值者，依据在于1.PET/CT检查肿瘤特异度低；2.用于高龄人群的阳性预测值低。

简单回答一下：

关于日本50-59岁男性中阳性预测值3.3%

假设某个检查项目，敏感度 特异度都是95% 人群患病率0.5%

PPV=患病率×灵敏度/[患病率×灵敏度+(1-患病率)×(1-特异性)]×100%

PPV计算值=8.7%

比3.3%高很多吗？并不见得

是不是敏感度 特异度都是95%的检查 准确度不足以做筛查？

参看昨天的回帖，新英格兰杂志一篇文章上列出乳腺钼靶在各年龄段人群筛查的敏感度和特异度，分别在87-92%，72-84%之间

http://www.ccthere.com/article/2909841

可见筛查要求的敏感度和特异度并没有高到离谱的程度。而且片面强调特异度，势必牺牲灵敏度，从根本上背离筛查的目的。

而且可以注意到乳腺钼靶的PPV在40岁到60岁之间，按5年分段，不过1.3%，2.2%.3.1%和4.5%，甚至低于PET/CT的3.3%。

而在NCCN的筛查指南里边乳腺钼靶的地位很确定。

可见 所谓的PET/CT低PPV故不适合筛检 并不成立。

再看看那一篇批判日本PET/CT筛检指南的文章，发在asian pacific journal of cancer prevention上边 影响因子没有查到？？ 据此认为日本医学界公认的治疗指南如何如何，似乎有点离谱。

为什么坚持这样建楼，而不在”脉络“清楚的帖子里回复，原因就在于此。没有循证医学意义上的高质量证据，没有看出来对文献质量的评价，这个”脉络“是混乱的和不可信的。无法进一步评点。

关于PET/CT在肿瘤中的地位和检查肿瘤的特异性，大概在前文提过多次，补充一下在PUBMED查到的指南，以资佐证：1: García Garzón JR, Rodríguez A, Cabrera A. [Positron emission

tomography/computed tomography with 18F-FDG. PET Working Group. Procedures

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Mar-Apr;28(2):85-9. Spanish. PubMed PMID: 19406058.

2: Stauss J, Franzius C, Pfluger T, Juergens KU, Biassoni L, Begent J, Kluge R,

Amthauer H, Voelker T, Hjgaard L, Barrington S, Hain S, Lynch T, Hahn K;

European Association of Nuclear Medicine. Guidelines for 18F-FDG PET and PET-CT

imaging in paediatric oncology. Eur J Nucl Med Mol Imaging. 2008

Aug;35(8):1581-8. Erratum in: Eur J Nucl Med Mol Imaging. 2008 Nov;35(11):2140.

PubMed PMID: 18536914.

3: [Guidelines for the management of differentiated thyroid cancers]. Ann

Endocrinol (Paris). 2007 Dec;68 Suppl 2:S57-72. French. PubMed PMID: 18342281.

4: Barrington SF, Begent J, Lynch T, Schleyer P, Biassoni L, Ramsden W, Kane T,

Stoneham S, Brooks M, Hain SF. Guidelines for the use of PET-CT in children. Nucl

Med Commun. 2008 May;29(5):418-24. PubMed PMID: 18391724.

5: Krause BJ, Beyer T, Bockisch A, Delbeke D, Kotzerke J, Minkov V, Reiser M,

Willich N. [FDG-PET/CT in oncology. German Guideline]. Nuklearmedizin.

2007;46(6):291-301. German. PubMed PMID: 18084685.

6: Manning K, Tepfer B, Goldklang G, Loyd R, Garimella P, Halkar R. Clinical

practice guidelines for the utilization of positron emission tomography/computed

tomography imaging in selected oncologic applications: suggestions from a

provider group. Mol Imaging Biol. 2007 Nov-Dec;9(6):324-32; discussion 323.

PubMed PMID: 17701257.

7: Bourguet P, Planchamp F, Montravers F, Vincendeau S; Association francaise

d'urologie; Federation nationale des centres de lutte contre le cancer. [2006

technology monitoring report: clinical practice guideline: use of FDG-PET in

kidney, prostate, testis and bladder cancers]. Prog Urol. 2007 Apr;17(2):172-5.

French. PubMed PMID: 17489312.

8: Bourguet P, Planchamp F, Monteil J, Metges JP, Mitry E, Tubiana-Mathieu N.

[Recommendations for clinical practice: use of TEP-FDG in cancer of the

esophagus, stomach, colon and rectum, anal canal, large intestine, pancreas and

bile ducts, liver and endocrine tumors (digestive system)]. Bull Cancer. 2007 Feb

1;94(2):212-8. Review. French. PubMed PMID: 17338096.

9: Bourguet P, Planchamp F, Montravers F, Vincendeau S, Courbon F, Edeline V,

Helal BO, Rossi D, Villers A; Standards, Options et Recommandations (SOR);

Institut National du Cancer; Fédération nationale des centres de lutte contre le

cancer (FNCLCC); Ligue Nationale contre le Cancer; SFMN; Fédération hospitalière

de France (FHF); Fédération nationale de cancérologie des CHRU (FNCHRU);

Fédération franaise de cancérologie des CHG (FFCCHG). [Recommendation for

clinical practice: use of PET-FDG in cancer of the kidney, prostate, testicles,

and the urinary bladder]. Bull Cancer. 2006 Dec 1;93(12):1228-32. French. PubMed

PMID: 17191352.

10: Shankar LK, Hoffman JM, Bacharach S, Graham MM, Karp J, Lammertsma AA, Larson

S, Mankoff DA, Siegel BA, Van den Abbeele A, Yap J, Sullivan D; National Cancer

Institute. Consensus recommendations for the use of 18F-FDG PET as an indicator

of therapeutic response in patients in National Cancer Institute Trials. J Nucl

Med. 2006 Jun;47(6):1059-66. PubMed PMID: 16741317.

11: Bourguet P, Hitzel A, Houvenaeghel G, Vinatier D, Bosquet L, Bonichon F,

Corone C, Giard-Lefèvre S, Morett JL, Touboul E; Standards Options et

Recommandations; Institut National du Cancer; Fédération Nationale des Centres de

Lutte contre le Cancer; Ligue Nationale contre le Cancer; SFMN; Fédération

Hospitalière de France; Fédération Nationale de Cancérologie des CHRU; Fédération

Franaise de Cancérologie. [Synthesis bulletin of 2005 surveillance. Clinical

practice recommendations: the use of PET-FDG in cancers of the breast, ovary and

uterus]. Bull Cancer. 2006 Apr 1;93(4):385-90. French. PubMed PMID: 16714228.

12: Japanese Society of Nuclear Medicine. [Practice guidelines for PDG-PET cancer

screening]. Kaku Igaku. 2004 Nov;41(4):1-21. Japanese. PubMed PMID: 15690769.

最后说一句 这几天查了很多相关文章，耽误无数时间.不过与laftodeath和chalet等同道以及其他河友的交流，也让我也得了很多教益。

不多写了。