Department of Nuclear Medicine of Pusan National University Hospital, Busan, Republic of Korea.
Biomedical Research Institute of Pusan National University Hospital, Busan, Republic of Korea.
PLoS One. 2018 Feb 27;13(2):e0193403. doi: 10.1371/journal.pone.0193403. eCollection 2018.
We aimed to develop a decision tree model to improve diagnostic performance of positron emission tomography/computed tomography (PET/CT) to detect metastatic lymph nodes (LN) in non-small cell lung cancer (NSCLC). 115 patients with NSCLC were included in this study. The training dataset included 66 patients. A decision tree model was developed with 9 variables, and validated with 49 patients: short and long diameters of LNs, ratio of short and long diameters, maximum standardized uptake value (SUVmax) of LN, mean hounsfield unit, ratio of LN SUVmax and ascending aorta SUVmax (LN/AA), and ratio of LN SUVmax and superior vena cava SUVmax. A total of 301 LNs of 115 patients were evaluated in this study. Nodular calcification was applied as the initial imaging parameter, and LN SUVmax (≥3.95) was assessed as the second. LN/AA (≥2.92) was required to high LN SUVmax. Sensitivity was 50% for training dataset, and 40% for validation dataset. However, specificity was 99.28% for training dataset, and 96.23% for validation dataset. In conclusion, we have developed a new decision tree model for interpreting mediastinal LNs. All LNs with nodular calcification were benign, and LNs with high LN SUVmax and high LN/AA were metastatic Further studies are needed to incorporate subjective parameters and pathologic evaluations into a decision tree model to improve the test performance of PET/CT.
我们旨在开发一种决策树模型，以提高正电子发射断层扫描/计算机断层扫描（PET/CT）检测非小细胞肺癌（NSCLC）转移性淋巴结（LN）的诊断性能。本研究纳入了 115 例 NSCLC 患者。训练数据集包括 66 例患者。该决策树模型由 9 个变量开发，并通过 49 例患者进行验证：LN 的短长径、短长径比、LN 的最大标准化摄取值（SUVmax）、平均亨氏单位、LN SUVmax 与升主动脉 SUVmax 的比值（LN/AA）以及 LN SUVmax 与上腔静脉 SUVmax 的比值。本研究共评估了 115 例患者的 301 个 LN。结节状钙化被用作初始成像参数，LN SUVmax（≥3.95）被评估为第二个参数。需要 LN/AA（≥2.92）来判断 LN SUVmax 是否升高。训练数据集的敏感性为 50%，验证数据集的敏感性为 40%。然而，训练数据集的特异性为 99.28%，验证数据集的特异性为 96.23%。总之，我们已经开发了一种新的决策树模型来解释纵隔 LN。所有有结节状钙化的 LN 均为良性，而具有高 LN SUVmax 和高 LN/AA 的 LN 则为转移性的。需要进一步的研究将主观参数和病理评估纳入决策树模型，以提高 PET/CT 的检测性能。
