多中心意大利试验评估了 FDG-PET/CT 在孤立性肺结节患者的术前癌症风险相关表现，并提出了一种节段性胸部诊断策略。
The Multicenter Italian Trial Assesses the Performance of FDG-PET /CT Related to Pre-Test Cancer Risk in Patients with Solitary Pulmonary Nodules and Introduces a Segmental Thoracic Diagnostic Strategy.
机构信息
Nuclear Medicine Unit, Ospedale del Mare, Naples, Italy
Nuclear Medicine Unit, Ospedale San Giuseppe Moscati, Avellino, Italy
出版信息
Curr Radiopharm. 2020;13(3):243-248. doi: 10.2174/1874471013666200318142210.
PURPOSE
The Italian Tailored Assessment of Lung Indeterminate Accidental Nodule (ITALIAN) trial is a trial drawn to determine the performance of 18F-FDG-PET/CT in patients with solitary pulmonary nodules (SPN), stratified for a different kind of risk. An additional end-point was to compare the diagnostic information and estimated dosimetry, provided by a segmental PET/CT (s-PET/CT) acquisition instead of a whole body PET/CT (wb-PET/CT), in order to evaluate if segmental thoracic PET/CT can be used in patients with SPN.
METHODS
18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, was retrospectively analyzed. FDG uptake in SPN was assessed by a 4-point scoring (4PS) system and a semiquantitative analysis using the ratio between SUVmax in SPN and SUVmean in mediastinal blood pool (BP), and between SUVmax in SPN and SUVmean in the liver (L). Histopathology and/or follow-up data were used as a standard of reference. Data obtained on the thoracic part of wb-PET/CT, defined as s - PET/CT, were compared with those deriving from wb-PET/CT.
RESULTS
SPNs were malignant in 180 patients (36%), benign in 175 (35%), and indeterminate in 147 (29%). The 355 patients diagnosed with a definitive SPN nature (malignant or benign) were considered for the analysis of PET performance. 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 in intermediate and high-risk patients. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT.
CONCLUSION
In patients with SPN, the pre-test likelihood of malignancy stratification allows to better define PET clinical setting and its diagnostic power. In subjects with low-intermediate pre-test likelihood of malignancy, s-PET/CT might be planned in advance. The adoption of this segmental strategy could reduce radiation exposure, scan-time, and might allow individually targeted protocols.
目的
意大利量身定制的肺部不确定偶然结节评估（ITALIAN）试验旨在确定 18F-FDG-PET/CT 在孤立性肺结节（SPN）患者中的性能，这些患者根据不同的风险进行分层。另一个终点是比较分段 PET/CT（s-PET/CT）采集与全身 PET/CT（wb-PET/CT）提供的诊断信息和估计剂量，以评估 SPN 患者是否可以使用分段性胸部 PET/CT。
方法
回顾性分析了 502 例患者的 18F-FDG-PET/CT，这些患者根据术前癌症风险进行了分层。通过 4 分评分（4PS）系统和使用 SPN 中 SUVmax 与纵隔血池（BP）中 SUVmean 之间的比值以及 SPN 中 SUVmax 与肝脏（L）中 SUVmean 之间的比值来评估 SPN 中的 FDG 摄取。组织病理学和/或随访数据被用作标准参考。与 wb-PET/CT 相比，比较了从 wb-PET/CT 上获得的胸部分段 PET/CT（s-PET/CT）数据。
结果
180 例患者（36%）的 SPN 为恶性，175 例（35%）为良性，147 例（29%）为不确定。对诊断为明确 SPN 性质（恶性或良性）的 355 例患者进行了 PET 性能分析。敏感性、特异性、阳性（PPV）和阴性（NPV）预测值以及准确性分别为 85.6%、85.7%、86%、85.2%和 85.6%。中高危患者的敏感性和 PPV 更高。13%和 3%的患者可检测到提示胸内和胸外病变的 18F-FDG 摄取。与 wb-PET/CT 相比，s-PET/CT 可节省约 2/3 的 18F-FDG 剂量、辐射暴露或扫描时间，而不会影响 PET/CT 的临床影响。
结论
在 SPN 患者中，术前恶性肿瘤可能性分层可更好地确定 PET 的临床环境及其诊断能力。在低-中度术前恶性肿瘤可能性的患者中，可能需要提前计划 s-PET/CT。采用这种分段策略可以减少辐射暴露、扫描时间，并可以允许针对个体的靶向方案。
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