基于术前恶性肿瘤可能性的氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描在孤立性肺结节中的表现：来自意大利回顾性多中心试验的结果。

Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial.

机构信息

SSD Medicina Nucleare e Imaging Molecolare, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy.

Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli, Italy.

出版信息

Eur J Nucl Med Mol Imaging. 2018 Oct;45(11):1898-1907. doi: 10.1007/s00259-018-4016-1. Epub 2018 May 7.

DOI:10.1007/s00259-018-4016-1

PMID:29736699

Abstract

PURPOSE

The aim of this study was to determine the performance of F-FDG-PET/CT in patients with solitary pulmonary nodule (SPN), stratifying the risk according to the likelihood of pulmonary malignancy.

METHODS

FDG-PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. FDG uptake in SPN was assessed by a 4-point scoring system and semiquantitative analysis using the ratio between SUVmax in SPN and SUVmean in mediastinal blood pool (BP) and between SUVmax in SPN and SUVmean in liver (L). Histopathology and/or follow-up data were used as standard of reference.

RESULTS

SPN was malignant in 180 (36%) patients, benign in 175 (35%), and indeterminate in 147 (29%). The 355 patients with a definitive SPN nature (malignant or benign) were considered for the analysis. Considering FDG uptake ≥ 2, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were 85.6%, 85.7%, 86%, 85.2%, and 85.6% respectively. Sensitivity and PPV were higher (P < 0.05) in intermediate and high-risk patients, while specificity and NPV were higher (P < 0.05) in low-risk patients. On receiver operating characteristic curve analysis, the cut-offs for better discrimination between benign and malignant SPN were 1.56 (sensitivity 81% and specificity 87%) and 1.12 (sensitivity 81% and specificity 86%) for SUVmax/SUVmeanBP and SUVmax/SUVmeanL respectively. In intermediate and high-risk patients, including the SUVmax/SUVmeanBP, the specificity shifted from 85% and 50% to 100%.

CONCLUSION

Visual FDG-PET/CT has an acceptable performance in patients with SPN, but accuracy improves when SUVratios are considered, particularly in patients with intermediate and high risk of malignancy.

摘要

目的

本研究旨在确定 F-FDG-PET/CT 在孤立性肺结节（SPN）患者中的性能，根据肺癌恶性的可能性对风险进行分层。

方法

回顾性分析了 502 例按术前癌症风险分层的 FDG-PET/CT 患者。采用 4 分评分系统和半定量分析评估 SPN 中的 FDG 摄取，使用 SPN 中 SUVmax 与纵隔血池（BP）中 SUVmean 的比值以及 SPN 中 SUVmax 与肝（L）中 SUVmean 的比值来评估 SPN 的 SUVmax。使用组织病理学和/或随访数据作为标准参考。

结果

180 例（36%）患者的 SPN 为恶性，175 例（35%）为良性，147 例（29%）为不确定。考虑到 SPN 的明确性质（恶性或良性），对 355 例患者进行了分析。考虑到 FDG 摄取≥2，敏感性、特异性、阳性（PPV）和阴性（NPV）预测值和准确性分别为 85.6%、85.7%、86%、85.2%和 85.6%。在中高危患者中，敏感性和 PPV 更高（P<0.05），而在低危患者中，特异性和 NPV 更高（P<0.05）。在接受者操作特征曲线分析中，区分良性和恶性 SPN 的最佳 SUVmax/SUVmeanBP 和 SUVmax/SUVmeanL 截断值分别为 1.56（敏感性 81%，特异性 87%）和 1.12（敏感性 81%，特异性 86%）。在中高危患者中，包括 SUVmax/SUVmeanBP，特异性从 85%和 50%提高到 100%。