Okada Morihito, Tauchi Shunsuke, Iwanaga Koichiro, Mimura Takeshi, Kitamura Yoshitaka, Watanabe Hirokazu, Adachi Shuji, Sakuma Toshiko, Ohbayashi Chiho
Department of Thoracic Surgery, Hyogo Medical Center for Adults, Akashi City, Hyogo, Japan.
J Thorac Cardiovasc Surg. 2007 Jun;133(6):1448-54. doi: 10.1016/j.jtcvs.2007.02.023.
The aggressiveness of small adenocarcinomas has not been fully evaluated using integrated positron emission tomography/computed tomography. We investigated malignant aggressiveness according to positron emission tomography/computed tomography, high-resolution computed tomographic findings, and the proportions of pathologically defined bronchioloalveolar carcinomas in cT1N0M0 lung adenocarcinoma.
Sixty consecutive patients with cT1N0M0 lung adenocarcinomas of 3 cm or less in diameter underwent fluorodeoxyglucose-positron emission tomograph/computed tomography, and high-resolution computed tomography, followed by complete tumor resection. Correlations between the proportion of bronchioloalveolar carcinoma and maximum standardized uptake value on positron emission tomographic scan/computed tomographic scan, ground-glass opacity, and tumor shadow disappearance rate were investigated and the findings were compared with clinicopathologic features.
Lymphatic and vascular invasion occurred in 18 (30%) and 13 (22%) patients, respectively, whereas hilar or mediastinal lymph nodes occurred in 8 patients (13%). Maximum standardized uptake value generally seemed the most valuable predictor of lymphatic invasion, vascular invasion, and nodal metastasis compared with ground-glass opacity, tumor shadow disappearance rate, and bronchioloalveolar carcinoma ratios. Although the association was significant between the bronchioloalveolar carcinoma ratio versus maximum standardized uptake value, ground-glass opacity ratio, and tumor shadow disappearance rate (all P < .0001), maximum standardized uptake value (R2 = 0.245) was less correlated with the bronchioloalveolar carcinoma ratio than was the ground-glass opacity ratio (R2 = 0.554) and tumor shadow disappearance rate (R2 = 0.671).
The malignant behavior of small adenocarcinomas with a lower maximum standardized uptake value and a greater proportion of ground-glass opacity, tumor shadow disappearance rate, and bronchioloalveolar carcinoma was less aggressive. Maximum standardized uptake value was a more powerful clinical predictor of biologic tumor performance, independent of pathologic bronchioloalveolar carcinoma proportion. Preoperative assessment of maximum standardized uptake value on positron emission tomographic/computed tomographic findings, in addition to the ground-glass opacity ratio and tumor shadow disappearance rate on high-resolution computed tomographic scans, might be useful to guide treatment strategies for small adenocarcinomas.
利用正电子发射断层扫描/计算机断层扫描（PET/CT）对小腺癌的侵袭性尚未进行全面评估。我们根据PET/CT、高分辨率计算机断层扫描（HRCT）结果以及cT1N0M0肺腺癌中病理定义的细支气管肺泡癌比例来研究其恶性侵袭性。
连续60例直径3 cm及以下的cT1N0M0肺腺癌患者接受了氟脱氧葡萄糖 - 正电子发射断层扫描/计算机断层扫描（FDG - PET/CT）和HRCT检查，随后进行了肿瘤完整切除。研究细支气管肺泡癌比例与PET/CT扫描的最大标准化摄取值、磨玻璃影及肿瘤阴影消失率之间的相关性，并将结果与临床病理特征进行比较。
分别有18例（30%）和13例（22%）患者发生了淋巴管和血管侵犯，8例（13%）患者出现肺门或纵隔淋巴结转移。与磨玻璃影、肿瘤阴影消失率及细支气管肺泡癌比例相比，最大标准化摄取值似乎总体上是淋巴管侵犯、血管侵犯和淋巴结转移最有价值的预测指标。尽管细支气管肺泡癌比例与最大标准化摄取值、磨玻璃影比例及肿瘤阴影消失率之间存在显著相关性（所有P <.0001），但最大标准化摄取值（R2 = 0.245）与细支气管肺泡癌比例的相关性低于磨玻璃影比例（R2 = 0.554）和肿瘤阴影消失率（R2 = 0.671）。
最大标准化摄取值较低、磨玻璃影比例较大、肿瘤阴影消失率较高且细支气管肺泡癌比例较高的小腺癌，其恶性行为侵袭性较低。最大标准化摄取值是肿瘤生物学行为更有力的临床预测指标，独立于病理细支气管肺泡癌比例。除了HRCT扫描的磨玻璃影比例和肿瘤阴影消失率外，术前评估PET/CT结果中的最大标准化摄取值可能有助于指导小腺癌的治疗策略。
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