Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou.
Department of Radiology, Xuzhou Cancer Hospital, Xuzhou.
Nucl Med Commun. 2021 Dec 1;42(12):1328-1335. doi: 10.1097/MNM.0000000000001462.
Sublobar resection is suitable for peripheral cT1N0M0 non-small-cell lung cancer (NSCLC). The traditional PET-CT criterion (lymph node size ≥1.0 cm or SUVmax ≥2.5) for predicting lymph nodes metastasis (LNM) has unsatisfactory performance.
We explore the clinical role of preoperative SUVmax and the size of the primary lesions for predicting peripheral cT1 NSCLC LNM.
We retrospectively analyzed 174 peripheral cT1 NSCLC patients underwent preoperative 18F-FDG PET-CT and divided into the LNM and non-LNM group by pathology. We compared the differences of primary lesions' baseline characteristics between the two groups. The risk factors of LNM were determined by univariate and multivariate analysis, and we assessed the diagnostic efficacy with the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value (NPV).
Of the enrolled cases, the incidence of LNM was 24.7%. The preoperative SUVmax >6.3 or size >2.3 cm of the primary lesions were independent risk factors of peripheral cT1 NSCLC LNM (ORs, 95% CIs were 6.18 (2.40-15.92) and 3.03 (1.35-6.81). The sensitivity, NPV of SUVmax >6.3 or size >2.3 cm of the primary lesions were higher than the traditional PET-CT criterion for predicting LNM (100.0 vs. 86.0%, 100.0 vs. 89.7%). A Hosmer-Lemeshow test showed a goodness-of-fit (P = 0.479).
The excellent sensitivity and NPV of preoperative of the SUVmax >6.3 or size >2.3 cm of the primary lesions based on 18F-FDG PET-CT might identify the patients at low-risk LNM in peripheral cT1 NSCLC.
亚肺叶切除术适用于外周型 T1N0M0 期非小细胞肺癌（NSCLC）。预测淋巴结转移（LNM）的传统 PET-CT 标准（淋巴结大小≥1.0cm 或 SUVmax≥2.5）表现不佳。
我们旨在探讨术前 SUVmax 和原发肿瘤大小对预测外周型 T1 NSCLC LNM 的临床作用。
我们回顾性分析了 174 例接受术前 18F-FDG PET-CT 检查的外周型 T1 NSCLC 患者，根据病理结果分为 LNM 组和非 LNM 组。我们比较了两组患者原发肿瘤基线特征的差异。采用单因素和多因素分析确定 LNM 的危险因素，并通过受试者工作特征曲线（ROC）下面积（AUC）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）评估诊断效能。
本研究中 LNM 的发生率为 24.7%。术前 SUVmax＞6.3 或原发肿瘤大小＞2.3cm 是外周型 T1 NSCLC LNM 的独立危险因素（OR 值及其 95%CI 分别为 6.18（2.40-15.92）和 3.03（1.35-6.81））。SUVmax＞6.3 或原发肿瘤大小＞2.3cm 的敏感性和 NPV 均高于传统 PET-CT 标准预测 LNM（100.0%比 86.0%，100.0%比 89.7%）。Hosmer-Lemeshow 检验显示拟合优度良好（P=0.479）。
基于 18F-FDG PET-CT 的术前 SUVmax＞6.3 或原发肿瘤大小＞2.3cm 具有良好的敏感性和 NPV，有助于识别外周型 T1 NSCLC 中 LNM 低风险患者。
