Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
Clin Nucl Med. 2013 Jul;38(7):501-5. doi: 10.1097/RLU.0b013e318279f0f5.
This study aimed to assess the imaging findings in patients with pathologically proven carcinoid tumors and determine if SUV can help to differentiate typical from atypical (more aggressive) pulmonary carcinoid tumors.
A retrospective review of patients with a biopsy-proven diagnosis of a pulmonary carcinoid tumor at our institution from 2002 to 2010 that had a preoperative PET scan was performed after institutional review board approval was obtained. PET results, including SUV uptake and location, were recorded as well as all data from pathology reports. Carcinoids were considered to be more aggressive if they showed pathological diagnosis consistent with atypical carcinoid, lymph node invasion, poor histological grade (poorly differentiated), or evidence of systemic metastases. Atypical carcinoid pathology consisted of focal necrosis or a higher mitotic index (2-10 per square millimeter) with features of nests, trabeculae, pleomorphic cells, or dense hyperchromasia. SUV uptake was then evaluated and compared between the typical and atypical carcinoid groups using nonparametric statistical methods.
We identified 29 patients from 2002 to 2010 at our institution with a pathological diagnosis of pulmonary carcinoid. Twenty-three were histopathologically typical, and the other 6 showed atypia. Mean (SD) nodule size was 2.4 (1.3) cm in the typical group versus 5.0 (3.2) cm in the atypical group (P = 0.065). Mean (SD) SUV uptake in the typical carcinoid group was 2.7 (1.6) and in the atypical group the SUV was 8.1 (4.1) (P < 0.01). A cutoff SUV of 6 or greater is predictive of malignancy (odds ratio, 23.6; P < 0.01), as well as a nodule size of 3.5 cm or greater (odds ratio, 5.1; P = 0.024).
Preoperative PET imaging result is frequently positive in carcinoid tumors, and the biological behavior correlates well with SUV; however, size is not as strong of a predictor of malignancy. Size of 3.5 cm or greater and SUV of 6 or greater have a predictive value of greater than 95% for malignant histology.
本研究旨在评估经病理证实的类癌肿瘤患者的影像学表现，并确定 SUV 是否有助于区分典型与非典型（侵袭性更高）肺类癌肿瘤。
在获得机构审查委员会批准后，对 2002 年至 2010 年在我院经活检证实为肺类癌肿瘤且术前进行了 PET 扫描的患者进行了回顾性研究。记录了 PET 结果，包括 SUV 摄取和位置，以及病理报告的所有数据。如果类癌肿瘤的病理诊断符合非典型类癌、淋巴结侵犯、组织学分级差（低分化）或有全身转移的证据，则认为其侵袭性更高。非典型类癌的病理特征包括局灶性坏死或更高的有丝分裂指数（每平方毫米 2-10 个），伴有巢状、小梁状、多形性细胞或密集的嗜色性。然后使用非参数统计方法评估并比较典型和非典型类癌组之间的 SUV 摄取值。
在我院 2002 年至 2010 年期间，我们共发现 29 例经病理诊断为肺类癌的患者。其中 23 例为组织病理学典型，6 例为非典型。典型组的结节平均大小为 2.4（1.3）cm，而非典型组为 5.0（3.2）cm（P=0.065）。典型类癌组的平均 SUV 摄取值为 2.7（1.6），而非典型组为 8.1（4.1）（P<0.01）。SUV 摄取值≥6 或结节大小≥3.5cm 可预测恶性肿瘤（比值比，23.6；P<0.01）。
术前 PET 成像结果在类癌肿瘤中经常为阳性，其生物学行为与 SUV 密切相关；然而，大小并不是恶性肿瘤的强预测指标。结节大小≥3.5cm 或 SUV 摄取值≥6 对恶性组织学具有超过 95%的预测价值。
