Department of Nuclear Medicine, Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, China.
AJR Am J Roentgenol. 2019 Nov;213(5):W236-W245. doi: 10.2214/AJR.19.21382. Epub 2019 Jul 30.
The purpose of this study is to evaluate high-resolution CT (HRCT) combined with PET/CT for preoperative differentiation of invasive adenocarcinoma (IAC) from preinvasive lesions and minimally invasive adenocarcinoma (MIA) (the combination of which is hereafter referred to as preinvasive-MIA) in lung adenocarcinoma manifesting as ground-glass opacity nodules (GGNs) 3 cm or smaller. We retrospectively analyzed the data of patients with lung adenocarcinoma with GGNs that were 3 cm or smaller between November 2011 and November 2018. The HRCT and PET/CT parameters for GGNs were compared to differentiate between IAC and preinvasive-MIA. Qualitative and quantitative parameters were analyzed using univariate and multivariate logistic regression models. The diagnostic performance of different parameters was compared using ROC curves and the McNemar test. The study enrolled 89 patients (24 men and 65 women) with lung adenocarcinoma who had a mean (± SD) age of 60.1 ± 8.1 years (range, 36-78 years). The proportions of mixed GGN type, polygonal or irregular shape, lobulated or spiculated edge, and dilated, distorted, or cutoff bronchial sign were higher for IAC GGNs than for preinvasive-MIA GGNs, and the attenuation value of the ground-glass opacity component on CT (CT), maximum standardized uptake value, and the standardized uptake value (SUV) index (i.e., the ratio of the tumor maximum SUV to the liver mean SUV) for IAC GGNs were also higher ( = 0.001-0.022). Logistic regression analyses showed that the CT and SUV index were independent predictors for IAC GGNs. The accuracy of CT in combination with the SUV index for predicting IAC was 81.4% on a per-GGN basis and 85.4% on a per-patient basis. The combined HRCT and PET/CT modality had higher sensitivity and accuracy than did morphologic features, HRCT, and PET/CT measurement parameters alone ( < 0.001). The combined HRCT and PET/CT modality is an effective method to preoperatively identify IAC in lung adenocarcinoma manifesting as GGNs 3 cm or smaller.
本研究旨在评估高分辨率 CT（HRCT）联合 PET/CT 对直径≤3cm 磨玻璃密度结节（GGN）肺腺癌中浸润性腺癌（IAC）与浸润前病变和微浸润性腺癌（MIA）（以下简称浸润前-MIA）的术前鉴别。我们回顾性分析了 2011 年 11 月至 2018 年 11 月期间直径≤3cm 的 GGN 肺腺癌患者的资料。比较 GGN 的 HRCT 和 PET/CT 参数，以鉴别 IAC 和浸润前-MIA。采用单变量和多变量逻辑回归模型分析定性和定量参数。通过 ROC 曲线和 McNemar 检验比较不同参数的诊断性能。 该研究纳入了 89 例（男 24 例，女 65 例）肺腺癌患者，平均年龄（±标准差）为 60.1±8.1 岁（范围 36-78 岁）。与浸润前-MIA GGN 相比，混合 GGN 类型、多边形或不规则形状、分叶或棘突状边缘以及扩张、扭曲或截断支气管征在 IAC GGN 中更为常见，而 CT 上磨玻璃密度成分的衰减值（CT）、最大标准化摄取值（SUV）和 SUV 指数（即肿瘤最大 SUV 与肝脏平均 SUV 的比值）在 IAC GGN 中也更高（=0.001-0.022）。逻辑回归分析显示，CT 和 SUV 指数是 IAC GGN 的独立预测因子。基于 GGN 预测 IAC 的 CT 和 SUV 指数的准确率分别为 81.4%和 85.4%。基于患者预测 IAC 的 HRCT 和 PET/CT 联合模式的敏感性和准确率均高于形态特征、HRCT 和 PET/CT 测量参数单独使用（<0.001）。 HRCT 和 PET/CT 联合模式是术前识别直径≤3cm GGN 肺腺癌中 IAC 的有效方法。
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