Sun Xiaolin, Gu Weiqing, Yuan Hui, Wang Siyun, Yang Yang, Evangelista Laura, Zhang Liyan, Jiang Lei
PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Transl Lung Cancer Res. 2022 Aug;11(8):1643-1656. doi: 10.21037/tlcr-22-509.
Adenoid cystic carcinoma (ACC) of the lung (ACCL) is a rare malignancy and includes primary ACCL (PACCL) and secondary ACCL (SACCL) metastasized from the ACC of the head and neck. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) has been shown to be useful in the differential diagnosis between primary and metastatic lung lesions. This study retrospectively investigated the role of F-FDG PET/CT in combination with clinicopathological findings in the management of patients with primary or secondary ACCL.
Clinicopathological characteristics and F-FDG PET/CT metabolic parameters of 29 patients with PACCL and 11 patients with SACCL with pathological confirmation as gold standard were retrospectively collected. The association between PET/CT metabolic parameters and clinicopathological features was explored. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal maximum standard uptake value (SUV) cut-off value to distinguish PACCL from SACCL. The prognostic value of PET/CT metabolic parameters and clinicopathological features was evaluated by Cox regression analysis.
SACCL patients more often presented with multiple ACC lesions in the peripheral lung (81.8% 17.2%, P<0.05) and tended to be asymptomatic compared to patients with PACCL (72.7% versus 27.6%, P<0.05). The SUV was significantly higher in PACCL patients compared to SACCL patients (median 4.4 2.8, P<0.05). Furthermore, at a cut-off value of 3.2 for SUV, the sensitivity and specificity of F-FDG PET/CT in distinguishing PACCL from SACCL were 82.8% and 72.7%, respectively. Higher SUV of ACCL was observed in patients with clinical symptoms, fewer ACC lesions, or larger tumor size (P<0.05). The median PFS of ACCL patients was 71.1 months, and the 12- and 24-month PFS rates were 96.1% and 91.6%, respectively. Univariate Cox regression analysis showed that SACCL from metastasis, lesions located at the peripheral lung or multiple ACC lesions present in the lung, were associated with poorer PFS (P<0.05). However, multivariate Cox regression analysis showed that none of the variables examined were independent predictors of prognosis.
The use of F-FDG PET/CT in combination with assessment of clinicopathological features was helpful in distinguishing PACCL from SACCL, which could provide guidance for clinical decision making.
肺腺样囊性癌（ACCL）是一种罕见的恶性肿瘤，包括原发性肺腺样囊性癌（PACCL）和头颈部腺样囊性癌转移所致的继发性肺腺样囊性癌（SACCL）。氟-18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）已被证明在原发性和转移性肺病变的鉴别诊断中有用。本研究回顾性调查了F-FDG PET/CT联合临床病理结果在原发性或继发性ACCL患者管理中的作用。
回顾性收集29例经病理证实的PACCL患者和11例SACCL患者的临床病理特征及F-FDG PET/CT代谢参数，以病理结果作为金标准。探讨PET/CT代谢参数与临床病理特征之间的关联。采用受试者操作特征（ROC）曲线分析确定区分PACCL和SACCL的最佳最大标准摄取值（SUV）临界值。通过Cox回归分析评估PET/CT代谢参数和临床病理特征的预后价值。
与PACCL患者相比，SACCL患者更常表现为外周肺多发ACCL病变（81.8%对17.2%，P<0.05），且往往无症状（72.7%对27.6%，P<0.05）。PACCL患者的SUV显著高于SACCL患者（中位数4.4对2.8，P<0.05）。此外，当SUV临界值为3.2时，F-FDG PET/CT区分PACCL和SACCL的敏感性和特异性分别为82.8%和72.7%。ACCL患者中，有临床症状、ACCL病变较少或肿瘤体积较大者的SUV较高（P<0.05）。ACCL患者的中位无进展生存期（PFS）为71.1个月，12个月和24个月的PFS率分别为96.1%和91.6%。单因素Cox回归分析显示，转移所致的SACCL、位于外周肺的病变或肺内多发ACCL病变与较差的PFS相关（P<0.05）。然而，多因素Cox回归分析显示，所检查的变量均不是预后的独立预测因素。
F-FDG PET/CT联合临床病理特征评估有助于区分PACCL和SACCL，可为临床决策提供指导。
