PET/CT上淋巴结与原发肿瘤SUV的比值可准确预测非小细胞肺癌的淋巴结恶性程度。

Ratio of Lymph Node to Primary Tumor SUV on PET/CT Accurately Predicts Nodal Malignancy in Non-Small-Cell Lung Cancer.

作者信息

Mattes Malcolm D, Moshchinsky Ariella B, Ahsanuddin Salma, Rizk Nabil P, Foster Amanda, Wu Abraham J, Ashamalla Hani, Weber Wolfgang A, Rimner Andreas

机构信息

Department of Radiation Oncology, West Virginia University, Morgantown, WV.

Department of Radiation Oncology, New York Methodist Hospital, Brooklyn, NY.

出版信息

Clin Lung Cancer. 2015 Nov;16(6):e253-8. doi: 10.1016/j.cllc.2015.06.001. Epub 2015 Jun 15.

DOI:10.1016/j.cllc.2015.06.001

PMID:26163919

Abstract

UNLABELLED

Thoracic lymph nodes with marginally elevated maximum standardized uptake value (SUVmax) on PET/CT a diagnostic challenge in staging non-small-cell lung cancer. We evaluated the ratio of lymph node to primary tumor SUVmax (SUVN/T) in predicting nodal malignancy among 132 sampled nodes from 85 patients both a primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0. SUVN/T was more accurate than SUVmax for this subset of patients.

INTRODUCTION/BACKGROUND: Among non-small-cell lung cancers with appreciable functional activity, positron emission tomography/computed tomography (PET/CT) is the most accurate imaging modality for clinical staging. However, lymph nodes (LN) with marginally elevated standardized uptake value (SUV) present a diagnostic challenge. In this retrospective study, we hypothesized that normalizing the LN SUV by using the ratio of the LN to primary tumor SUVmax (SUVN/T) may be a better predictor of nodal malignancy than using SUVmax alone for nodes with low to intermediate SUV.

PATIENTS AND METHODS

We identified 172 patients with newly diagnosed non-small-cell lung cancer who underwent pathologic LN staging and PET/CT within 31 days before biopsy. Receiver operating characteristic curves with area under the curve (AUC) calculations were used to evaluate SUVmax and SUVN/T for their ability to predict nodal malignancy for both the entire cohort of 504 LNs and a subset of 132 LNs from 85 patients who had both primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0.

RESULTS

In patients with primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0, SUVN/T was significantly more accurate in predicting nodal malignancy (AUC, 0.846; 95% confidence interval, 0.775-0.917) than SUVmax (AUC, 0.653; 95% confidence interval, 0.548-0.759). The optimal cutoff value of SUVN/T to predict nodal malignancy was 0.28 (90% sensitivity, 68% specificity). Sensitivity was > 95% for SUVN/T < 0.21, whereas specificity was > 95% for SUVN/T > 0.50.

CONCLUSION

The ratio of LN SUV to primary tumor SUV on PET/CT is more accurate than SUVmax when assessing nodes of low to intermediate SUV.

摘要

未标注

PET/CT上最大标准化摄取值（SUVmax）轻度升高的胸部淋巴结是非小细胞肺癌分期诊断中的一项挑战。我们评估了85例患者132个采样淋巴结中淋巴结与原发肿瘤SUVmax之比（SUVN/T）在预测淋巴结恶性肿瘤方面的作用，这些患者的原发肿瘤SUVmax>2.5且淋巴结SUVmax为2.0至6.0。对于这部分患者，SUVN/T比SUVmax更准确。

引言/背景：在具有明显功能活性的非小细胞肺癌中，正电子发射断层扫描/计算机断层扫描（PET/CT）是临床分期最准确的成像方式。然而，标准化摄取值（SUV）轻度升高的淋巴结带来了诊断挑战。在这项回顾性研究中，我们假设通过使用淋巴结与原发肿瘤SUVmax之比（SUVN/T）对淋巴结SUV进行标准化，可能比单独使用SUVmax能更好地预测低至中等SUV的淋巴结的恶性肿瘤。

患者与方法

我们确定了172例新诊断的非小细胞肺癌患者，他们在活检前31天内接受了病理淋巴结分期和PET/CT检查。使用带有曲线下面积（AUC）计算的受试者工作特征曲线来评估SUVmax和SUVN/T预测504个淋巴结整个队列以及85例原发肿瘤SUVmax>2.5且淋巴结SUVmax为2.0至6.0患者的132个淋巴结亚组中淋巴结恶性肿瘤的能力。

结果

在原发肿瘤SUVmax>2.5且淋巴结SUVmax为2.0至6.0的患者中，SUVN/T在预测淋巴结恶性肿瘤方面（AUC为0.846；95%置信区间为0.775 - 0.917）比SUVmax（AUC为0.653；95%置信区间为0.548 - 0.759）显著更准确。预测淋巴结恶性肿瘤的SUVN/T最佳截断值为0.28（敏感性90%，特异性68%）。当SUVN/T<0.21时敏感性>95%，而当SUVN/T>0.50时特异性>95%。