Department of Surgery, Tokyo Medical University, Tokyo, Japan.
Department of Surgery, Tokyo Medical University, Tokyo, Japan.
Lung Cancer. 2018 Nov;125:14-21. doi: 10.1016/j.lungcan.2018.08.027. Epub 2018 Sep 3.
The aim of this study was to analyze the accuracy of computed tomography (CT) and F-18 fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) to distinguish lepidic growth adenocarcinoma (LGA), including adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and lepidic-predominant adenocarcinoma, all of which have favorable survival outcomes, from the more aggressive and invasive non-LGA subtypes.
We identified 225 patients with c-0/I adenocarcinoma of the lung who underwent PET/CT and 3DCT followed by complete resection. Maximum standardized uptake values (SUVmax) of FDG and several histogram parameters were analyzed. Histological grades were classified according to the predominant subtype (G1: lepidic; G3: micropapillary or solid; and G2: subtypes other than G1/G3).
The proportion of pathological invasive factors (lymphatic vessel involvement/blood vessel invasion/pleural invasion/lymph node metastasis) of patients with preinvasive adenocarcinoma, G1, G2, and G3 tumors were 0%, 3.6%, 48.0%, and 100%, respectively; p < 0.001). Multivariate analysis with CT-related parameters demonstrated that 75 percentile CT attenuation value (75%, p < 0.001) and maximum CT attenuation value (maxCT, p = 0.009) were associated with incidence of non-LGA, whereas the value of SUVmax demonstrated a significant correlation (p < 0.001). When all patients were dichotomized according to ground-glass opacities (GGO)/solid-dominancy for CT maximum diameter, a significant correlation with non-LGA was shown in patients with solid-dominant tumor on SUVmax (p < 0.001) and with GGO-dominant tumor on 75% (p = 0.006) and maxCT (p = 0.007). The combination of one of the two significant histogram parameters and SUVmax revealed higher predictive performance for pathological high malignant features (positive pathological invasive factors, non-LGA, and the highly malignant subtype covering G2 with moderately or poorly-differentiated carcinoma and G3) than the individual use of either factor.
The 75%, maxCT, and SUVmax were highly useful in distinguishing LGA from non-LGA in c-0/I adenocarcinoma.
本研究旨在分析计算机断层扫描（CT）和 F-18 氟脱氧葡萄糖正电子发射断层扫描/CT（FDG-PET/CT）在区分具有良好生存结局的贴壁型生长腺癌（LGA），包括原位腺癌（AIS）、微浸润腺癌（MIA）和以贴壁生长为主的腺癌，与侵袭性更强的非 LGA 亚型方面的准确性。
我们纳入了 225 例接受 PET/CT 和 3DCT 检查并随后行完全切除术的 c-0/I 期肺癌患者。分析 FDG 的最大标准化摄取值（SUVmax）和几个直方图参数。根据主要亚型（G1：贴壁；G3：微乳头或实体；G2：G1/G3 以外的亚型）对组织学分级进行分类。
术前浸润性因素（淋巴管浸润/血管浸润/胸膜侵犯/淋巴结转移）在具有术前腺癌、G1、G2 和 G3 肿瘤的患者中的比例分别为 0%、3.6%、48.0%和 100%；p<0.001）。与 CT 相关参数的多变量分析表明，75%CT 衰减值（75%，p<0.001）和最大 CT 衰减值（maxCT，p=0.009）与非 LGA 发生率相关，而 SUVmax 有显著相关性（p<0.001）。当根据 CT 最大直径的磨玻璃密度（GGO）/实体优势将所有患者分为两组时，在 SUVmax 上具有实性优势的患者中，与非 LGA 显著相关（p<0.001），而在 GGO 优势的患者中，与 75%（p=0.006）和 maxCT（p=0.007）显著相关。两种有意义的直方图参数之一与 SUVmax 的结合，对预测病理高恶性特征（阳性病理浸润性因素、非 LGA 和包括中度或低分化癌的 G2 和 G3 在内的高度恶性亚型）的性能优于单独使用任何一种因素。
75%、maxCT 和 SUVmax 对区分 c-0/I 期腺癌中的 LGA 与非 LGA 非常有用。
