F-FDG-PET/CT的定性和半定量参数作为孤立性肺结节患者恶性肿瘤的预测指标

Qualitative and Semiquantitative Parameters of F-FDG-PET/CT as Predictors of Malignancy in Patients with Solitary Pulmonary Nodule.

作者信息

Corica Ferdinando, De Feo Maria Silvia, Stazza Maria Lina, Rondini Maria, Marongiu Andrea, Frantellizzi Viviana, Nuvoli Susanna, Farcomeni Alessio, De Vincentis Giuseppe, Spanu Angela

机构信息

Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, 00185 Rome, Italy.

Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy.

出版信息

Cancers (Basel). 2023 Feb 4;15(4):1000. doi: 10.3390/cancers15041000.

DOI:10.3390/cancers15041000

PMID:36831344

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9953844/

Abstract

This study aims to evaluate the reliability of qualitative and semiquantitative parameters of F-FDG PET-CT, and eventually a correlation between them, in predicting the risk of malignancy in patients with solitary pulmonary nodules (SPNs) before the diagnosis of lung cancer. A total of 146 patients were retrospectively studied according to their pre-test probability of malignancy (all patients were intermediate risk), based on radiological features and risk factors, and qualitative and semiquantitative parameters, such as SUVmax, SUVmean, TLG, and MTV, which were obtained from the FDG PET-CT scan of such patients before diagnosis. It has been observed that visual analysis correlates well with the risk of malignancy in patients with SPN; indeed, only 20% of SPNs in which FDG uptake was low or absent were found to be malignant at the cytopathological examination, while 45.45% of SPNs in which FDG uptake was moderate and 90.24% in which FDG uptake was intense were found to be malignant. The same trend was observed evaluating semiquantitative parameters, since increasing values of SUVmax, SUVmean, TLG, and MTV were observed in patients whose cytopathological examination of SPN showed the presence of lung cancer. In particular, in patients whose SPN was neoplastic, we observed a median (MAD) SUVmax of 7.89 (±2.24), median (MAD) SUVmean of 3.76 (±2.59), median (MAD) TLG of 16.36 (±15.87), and a median (MAD) MTV of 3.39 (±2.86). In contrast, in patients whose SPN was non-neoplastic, the SUVmax was 2.24 (±1.73), SUVmean 1.67 (±1.15), TLG 1.63 (±2.33), and MTV 1.20 (±1.20). Optimal cut-offs were drawn for semiquantitative parameters considered predictors of malignancy. Nodule size correlated significantly with FDG uptake intensity and with SUVmax. Finally, age and nodule size proved significant predictors of malignancy. In conclusion, considering the pre-test probability of malignancy, qualitative and semiquantitative parameters can be considered reliable tools in patients with SPN, since cut-offs for SUVmax, SUVmean, TLG, and MTV showed good sensitivity and specificity in predicting malignancy.

摘要

本研究旨在评估¹⁸F-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）定性和半定量参数的可靠性，以及最终它们之间的相关性，以预测肺癌诊断前孤立性肺结节（SPN）患者的恶性肿瘤风险。根据¹⁸F-FDG PET-CT扫描在诊断前获得的定性和半定量参数，如最大标准摄取值（SUVmax）、平均标准摄取值（SUVmean）、总病变糖酵解（TLG）和代谢体积（MTV），基于放射学特征和危险因素，对146例患者根据其恶性肿瘤的检查前概率（所有患者均为中度风险）进行回顾性研究。研究发现，视觉分析与SPN患者的恶性肿瘤风险密切相关；事实上，在细胞病理学检查中，¹⁸F摄取低或无摄取的SPN中只有20%被发现为恶性，而¹⁸F摄取中度的SPN中有45.45%以及¹⁸F摄取强烈的SPN中有90.24%被发现为恶性。在评估半定量参数时也观察到了相同的趋势，因为在SPN细胞病理学检查显示存在肺癌的患者中观察到SUVmax、SUVmean、TLG和MTV值增加。特别是，在SPN为肿瘤性的患者中，我们观察到SUVmax的中位数（平均绝对偏差）为7.89（±2.24），SUVmean的中位数（平均绝对偏差）为3.76（±2.59），TLG的中位数（平均绝对偏差）为16.36（±15.87），MTV的中位数（平均绝对偏差）为3.39（±2.86）。相比之下，在SPN为非肿瘤性的患者中，SUVmax为2.24（±1.73），SUVmean为1.67（±1.15），TLG为1.63（±2.33），MTV为1.20（±1.20）。为被视为恶性肿瘤预测指标的半定量参数绘制了最佳临界值。结节大小与¹⁸F摄取强度和SUVmax显著相关。最后，年龄和结节大小被证明是恶性肿瘤的重要预测指标。总之，考虑到恶性肿瘤的检查前概率，定性和半定量参数可被视为SPN患者的可靠工具，因为SUVmax、SUVmean、TLG和MTV的临界值在预测恶性肿瘤方面显示出良好的敏感性和特异性。