基于 FDG PET/CT 的代谢参数对 cN2 期非小细胞肺癌患者淋巴结转移的诊断价值。
Diagnostic utility of metabolic parameters on FDG PET/CT for lymph node metastasis in patients with cN2 non-small cell lung cancer.
机构信息
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
出版信息
BMC Cancer. 2021 Sep 2;21(1):983. doi: 10.1186/s12885-021-08688-6.
BACKGROUND
The aim of this study was to assess the diagnostic utility of metabolic parameters on fluorine-18-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) for predicting lymph node (LN) metastasis in patients with cN2 non-small cell lung cancer (NSCLC).
METHODS
We retrospectively reviewed patients who underwent surgery for cN2 NSCLC between 2007 and 2020. Those who had clinically diagnosed positive hilar and mediastinal LNs by routine CT and PET/CT imaging were investigated. To measure the metabolic parameters of LNs, the data according to maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and LN-to-primary tumor ratio of SUVmax (LPR) were examined. The diagnosis of each retrieved LN was confirmed based on histopathological examination of surgical tissue specimens. Receiver operating characteristics (ROC) curves with area under the curve (AUC) calculations and multivariate analysis by logistic regression were performed.
RESULTS
Forty-five patients with 84 clinically diagnosed positive hilar or mediastinal LNs were enrolled in the present study. Of the 84 LNs, 63 LNs were pathologically proven as positive (75%). The SUVmax, MTV, TLG, and LPR of LN metastasis were significantly higher than those of benign nodes. In the ROC analysis, the AUC value of LPR [AUC, 0.776; 95% confidence interval (CI), 0.640-0.913] was higher than that of LN SUVmax (AUC, 0.753; 95% CI, 0.626-0.880) or LN TLG3.5 (AUC, 0.746; 95% CI, 0.607-0.885). Using the optimal LPR cutoff value of 0.47, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.1, 66.7, 88.3, 58.3, and 79.8%, respectively. Multivariate analysis by logistic regression showed that LPR was an independent predictor for LN metastasis (odds ratio, 6.45; 95% CI, 1.785-23.301; P = 0.004). In the subgroup analysis of adenocarcinoma patients (n = 18; 32 LNs), TLG3.5 was a better predictor (AUC, 0.816; 95% CI, 0.639-0.985) than LPR (AUC, 0.792; 95% CI, 0.599-0.986) or LN SUVmax (AUC, 0.792; 95% CI, 0.625-0.959).
CONCLUSIONS
Our findings suggest that LPR on FDG-PET is a useful predictor for LN metastasis in patients with cN2 NSCLC. TLG can be a good predictor for LN metastasis in patients with adenocarcinoma.
背景
本研究旨在评估氟-18-氟代-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）/计算机断层扫描（CT）代谢参数在预测 cN2 非小细胞肺癌（NSCLC）患者淋巴结（LN）转移中的诊断效用。
方法
我们回顾性分析了 2007 年至 2020 年间接受 cN2 NSCLC 手术治疗的患者。对通过常规 CT 和 PET/CT 影像学诊断为阳性肺门和纵隔 LN 的患者进行了研究。为了测量 LN 的代谢参数，根据最大标准化摄取值（SUVmax）、代谢肿瘤体积（MTV）、总病变糖酵解（TLG）和 LN-原发肿瘤 SUVmax 比值（LPR）的数据进行了检查。根据手术组织标本的组织病理学检查，对每个检索到的 LN 的诊断进行了确认。通过计算曲线下面积（AUC）和多变量逻辑回归分析进行了受试者工作特征（ROC）曲线分析。
结果
本研究共纳入 45 例 84 例临床诊断为阳性肺门或纵隔 LN 的患者。在 84 个 LN 中，63 个 LN 经病理证实为阳性（75%）。LN 转移的 SUVmax、MTV、TLG 和 LPR 明显高于良性节点。在 ROC 分析中，LPR 的 AUC 值[AUC，0.776；95%置信区间（CI），0.640-0.913]高于 LN SUVmax（AUC，0.753；95%CI，0.626-0.880）或 LN TLG3.5（AUC，0.746；95%CI，0.607-0.885）。使用最佳 LPR 截断值 0.47，灵敏度、特异性、阳性预测值、阴性预测值和准确度分别为 84.1%、66.7%、88.3%、58.3%和 79.8%。多变量逻辑回归分析表明，LPR 是 LN 转移的独立预测因子（比值比，6.45；95%CI，1.785-23.301；P=0.004）。在腺癌患者（n=18；32 个 LN）的亚组分析中，TLG3.5 是比 LPR（AUC，0.792；95%CI，0.599-0.986）或 LN SUVmax（AUC，0.792；95%CI，0.625-0.959）更好的预测因子（AUC，0.816；95%CI，0.639-0.985）。
结论
我们的研究结果表明，FDG-PET 上的 LPR 是预测 cN2 NSCLC 患者 LN 转移的有用指标。TLG 可以成为预测腺癌患者 LN 转移的良好指标。
Zotero 插件