Xu Wenmin, Li Hansen, Guo Ziqian, Zhang Linqi, Zhang Rusen, Zhang Long
Department of Endoscopy, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China.
Department of Nuclear Medicine, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China.
Front Oncol. 2022 Aug 12;12:972096. doi: 10.3389/fonc.2022.972096. eCollection 2022.
To evaluate the detection ability of F-FDG PET/CT for identifying high-risk lesions (high-risk adenomas and adenocarcinoma) from incidental focal colorectal F-FDG uptake foci combining maximum standard uptake value (SUVmax) and localized colonic wall thickening (CWT). The secondary objective was to investigate the factors of missed detection of high-risk adenomas by F-FDG PET/CT.
A total of 6394 patients who underwent F-FDG PET/CT in our hospital from August 2019 to December 2021 were retrospectively analysed, and 145 patients with incidental focal colorectal F-FDG uptake foci were identified. The optimal cut-off value of SUVmax for F-FDG PET/CT diagnosis of high-risk lesions was determined by receiver operating characteristic (ROC) curves. SUVmax and localized CWT were combined to identify high-risk lesions from incidental focal colorectal F-FDG uptake foci. The characteristics of incidental adenomas detected and high-risk adenomas missed by F-FDG PET/CT were compared.
Of the 6394 patients, 145 patients were found to have incidental focal colorectal FDG uptake foci (2.3%), and 44 patients underwent colonoscopy and pathological examination at the same time. In fact, 45 lesions, including 12 low-risk lesions and 33 high-risk lesions (22 high-risk adenomas, 11 adenocarcinoma), were found by colonoscopy. The area under the ROC curve of SUVmax for low-risk lesions and high-risk lesions was 0.737, and the optimal cut-off value was 6.45 (with a sensitivity of 87.9% and specificity of 58.3%). When SUVmax ≥6.45, the combination of localized CWT parameters has little influence on the sensitivity and specificity of detection; when SUVmax <6.45, the combination of localized CWT parameters can improve the specificity of detection of high-risk lesions, but the sensitivity has little change. In addition, the size of high-risk adenomas discovered incidentally by F-FDG PET/CT was larger than that of high-risk adenomas missed, but there was no significant difference in lesion location, pathological type or intraepithelial neoplasia between the two groups.
The combination of SUVmax and localized CWT parameters of F-FDG PET/CT helped identify high-risk lesions from incidental focal colorectal F-FDG uptake foci, especially for lesions with SUVmax <6.45. Lesion size may be the only factor in F-FDG PET/CT missing high-risk adenomas.
结合最大标准摄取值（SUVmax）和局限性结肠壁增厚（CWT），评估F-FDG PET/CT从偶然发现的局灶性结直肠F-FDG摄取灶中识别高危病变（高危腺瘤和腺癌）的检测能力。次要目的是研究F-FDG PET/CT漏诊高危腺瘤的因素。
回顾性分析2019年8月至2021年12月在我院接受F-FDG PET/CT检查的6394例患者，确定145例有偶然发现的局灶性结直肠F-FDG摄取灶的患者。通过受试者操作特征（ROC）曲线确定F-FDG PET/CT诊断高危病变的SUVmax最佳截断值。结合SUVmax和局限性CWT，从偶然发现的局灶性结直肠F-FDG摄取灶中识别高危病变。比较F-FDG PET/CT检测到的偶然腺瘤和漏诊的高危腺瘤的特征。
6394例患者中，145例（2.3%）有偶然发现的局灶性结直肠FDG摄取灶，44例同时接受了结肠镜检查和病理检查。事实上，结肠镜检查发现45个病变，包括12个低危病变和33个高危病变（22个高危腺瘤，11个腺癌）。低危病变和高危病变的SUVmax的ROC曲线下面积为0.737，最佳截断值为6.45（灵敏度为87.9%，特异度为58.3%）。当SUVmax≥6.45时，局限性CWT参数的组合对检测的灵敏度和特异度影响不大；当SUVmax<6.45时，局限性CWT参数的组合可提高高危病变检测的特异度，但灵敏度变化不大。此外，F-FDG PET/CT偶然发现的高危腺瘤的大小大于漏诊的高危腺瘤，但两组在病变位置、病理类型或上皮内瘤变方面无显著差异。
F-FDG PET/CT的SUVmax和局限性CWT参数的组合有助于从偶然发现的局灶性结直肠F-FDG摄取灶中识别高危病变，尤其是对于SUVmax<6.45的病变。病变大小可能是F-FDG PET/CT漏诊高危腺瘤的唯一因素。
