SUVmax/THKmax 作为鉴别进展期胃癌和原发性胃淋巴瘤的生物标志物。
SUVmax/THKmax as a biomarker for distinguishing advanced gastric carcinoma from primary gastric lymphoma.
机构信息
Department of Nuclear Medicine, General Hospital of the Chinese People's Liberation Army and Military Medical Postgraduate College, Beijing, China.
出版信息
PLoS One. 2012;7(12):e50914. doi: 10.1371/journal.pone.0050914. Epub 2012 Dec 4.
BACKGROUND
Gastric carcinoma and primary gastric lymphoma (PGL) are the two most common malignancies in stomach. The purpose of this study was to screen and validate a biomarker of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) for distinguishing advanced gastric carcinoma (AGC) from PGL for clinical applications.
METHODOLOGY/PRINCIPAL FINDINGS: We reviewed PET/CT scans collected from January 2008 to April 2012 of 69 AGC and 38 PGL (14 low-grade mucosa-associated lymphoid tissue [MALT], 24 non-MALT aggressive non-Hodgkin lymphoma [ANHL]) with a focus on FDG intensity (maximum standardized uptake value [SUVmax]) of primary lesions and its CT-detected abnormalities, including maximal gastrointestinal wall thickness (THKmax) and mucosal ulcerations. Gastric FDG uptake was found in 69 (100%) patients with AGC and 36 (95%, 12 MALT vs. 24 ANHL)with PGL. The presence of CT-detected abnormalities of AGC and PGL were 97% (67/69) and 89% (12 MALT vs. 22 ANHL), respectively. After controlling for THKmax, SUVmax was higher with ANHL than AGC (17.10 ± 8.08 vs. 9.65 ± 5.24, p<0.05) and MALT (6.20 ± 3.60, p<0.05). THKmax did not differ among MALT, ANHL and AGC. Mucosal ulceration was more common with AGC (n = 9) than PGL (n = 2),but the difference was not statistically significant (p>0.05). Cross-validation analysis showed that for distinguishing ANHL from AGC, the classifier with SUVmax as a feature achieved a correct classification rate of 81% with thresholds 13.40 ± 1.12 and the classifier with SUVmax/THKmax as a feature achieved a correct classification rate of 83% with thresholds 7.51 ± 0.63.
CONCLUSIONS/SIGNIFICANCE: SUVmax/THKmax may be as a promising biomarker of FDG-PET/CT for distinguishing ANHL from AGC. Structural CT abnormalities alone may not be reliable but can help with PET assessment of gastric malignancies. (18)F-FDG PET/CT have potential for distinguishing AGC from PGL at the individual level.
背景
胃癌和原发性胃淋巴瘤（PGL）是胃内最常见的两种恶性肿瘤。本研究旨在筛选和验证一种（18）F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（（18）F-FDG PET/CT）的生物标志物，用于临床应用中区分进展期胃癌（AGC）和 PGL。
方法/主要发现：我们回顾了 2008 年 1 月至 2012 年 4 月期间 69 例 AGC 和 38 例 PGL（14 例低度黏膜相关淋巴组织[MALT]，24 例非 MALT 侵袭性非霍奇金淋巴瘤[ANHL]）的 PET/CT 扫描，重点是原发肿瘤的 FDG 摄取强度（最大标准化摄取值[SUVmax]）及其 CT 检测到的异常，包括最大胃壁厚度（THKmax）和黏膜溃疡。在 69 例 AGC 患者（100%）和 36 例 PGL 患者（95%，12 例 MALT 与 24 例 ANHL）中发现了胃 FDG 摄取。AGC 和 PGL 的 CT 检测到的异常存在率分别为 97%（67/69）和 89%（12 例 MALT 与 22 例 ANHL）。在控制 THKmax 后，ANHL 的 SUVmax 高于 AGC（17.10 ± 8.08 与 9.65 ± 5.24，p<0.05）和 MALT（6.20 ± 3.60，p<0.05）。MALT、ANHL 和 AGC 之间的 THKmax 没有差异。与 PGL（n=2）相比，AGC（n=9）的黏膜溃疡更为常见，但差异无统计学意义（p>0.05）。交叉验证分析表明，对于区分 ANHL 和 AGC，以 SUVmax 为特征的分类器在阈值为 13.40 ± 1.12 时的正确分类率为 81%，以 SUVmax/THKmax 为特征的分类器在阈值为 7.51 ± 0.63 时的正确分类率为 83%。
结论/意义：SUVmax/THKmax 可能是 FDG-PET/CT 区分 ANHL 和 AGC 的一种很有前途的生物标志物。单独的结构 CT 异常可能不可靠，但有助于对胃恶性肿瘤进行 PET 评估。（18）F-FDG PET/CT 有可能在个体水平上区分 AGC 和 PGL。
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