Chen Xianqiu, Xu Xin, Chrysikos Serafeim, Zhao Mengmeng, Zhou Ying
Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Medical Affairs, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Transl Lung Cancer Res. 2022 Sep;11(9):1926-1935. doi: 10.21037/tlcr-22-611.
Fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been proven to be valuable in guiding the diagnosis and management of sarcoidosis. However, its differential value for sarcoidosis is unclear. The objective of this study was to explore the value of 18F-FDG PET/CT in differentiation sarcoidosis from lung cancer with lymph node metastasis.
A total of 361 consecutively diagnosed sarcoidosis patients and 1,944 consecutively diagnosed lung cancer patients at Shanghai Pulmonary Hospital were retrospectively reviewed. Among them, 85 patients diagnosed with sarcoidosis and 94 lung cancer patients with lymph node metastasis were enrolled. Demographic data and 18F-FDG PET/CT parameters were analyzed by the chi-square test or independent sample Student's test. Receiver operating characteristic (ROC) curves were generated to identify cut-off values. Multivariate logistic regression was performed to identify independent predictors of sarcoidosis on 18F-FDG PET/CT, and those with P<0.1 were included in a regression model using the forward log rank (LR) method to generate a ROC curve.
The ratio of extrapulmonary lymph node involvement in sarcoidosis patients was significantly higher than that in lung cancer patients (64.7% . 29.8%, P<0.001). After adjusting for gender and age, extrapulmonary lymph node involvement [odds ratio (OR): 3.160; 95% confidence interval (CI): 1.105-9.035], maximum standardized uptake value (SUVmax) of mediastinum/hilar lymph nodes >13.86 (OR: 3.245; 95% CI: 1.045-10.083), and short axis of the corresponding lymph node >11.5 mm (OR: 5.470; 95% CI: 1.149-26.037) on 18F-FDG PET/CT were independent predictors of sarcoidosis, with a sensitivity and specificity of 77.5% and 69.3%, respectively. The area under the curve was 0.769.
18F-FDG PET/CT could be helpful to distinguish sarcoidosis from lung cancer patients with lymph node metastasis.
氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）已被证明在结节病的诊断和管理中具有重要价值。然而，其对结节病的鉴别价值尚不清楚。本研究的目的是探讨18F-FDG PET/CT在鉴别结节病与伴有淋巴结转移的肺癌中的价值。
回顾性分析上海肺科医院连续诊断的361例结节病患者和1944例连续诊断的肺癌患者。其中，纳入85例诊断为结节病的患者和94例伴有淋巴结转移的肺癌患者。通过卡方检验或独立样本t检验分析人口统计学数据和18F-FDG PET/CT参数。绘制受试者工作特征（ROC）曲线以确定临界值。进行多变量逻辑回归以确定18F-FDG PET/CT上结节病的独立预测因素，并将P<0.1的因素纳入使用前向对数秩（LR）方法的回归模型以生成ROC曲线。
结节病患者肺外淋巴结受累的比例显著高于肺癌患者（64.7%对29.8%，P<0.001）。在调整性别和年龄后，肺外淋巴结受累[比值比（OR）：3.160；95%置信区间（CI）：1.105-9.035]、18F-FDG PET/CT上纵隔/肺门淋巴结最大标准化摄取值（SUVmax）>13.86（OR：3.245；95%CI：1.045-10.083）以及相应淋巴结短轴>11.5mm（OR：5.470；95%CI：1.149-26.037）是结节病的独立预测因素，敏感性和特异性分别为77.5%和69.3%。曲线下面积为0.769。
18F-FDG PET/CT有助于鉴别结节病与伴有淋巴结转移的肺癌患者。
