Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
J Med Imaging Radiat Sci. 2023 Sep;54(3):451-456. doi: 10.1016/j.jmir.2023.05.045. Epub 2023 Jun 23.
Assess feasibility of differentiating primary from secondary lung cancer in patients with a solid solitary malignant pulmonary lesion (SMPL) and a previously resected extrapulmonary tumor.
Patients with pathology proven primary or secondary lung cancer from a solitary pulmonary lesion and known histopathology of extrapulmonary tumor were included. Patients with a small pulmonary lesion size, multiple malignant pulmonary nodules or an active infectious/inflammatory process were excluded. Extrapulmonary tumor grade was categorized as low, intermediate and high and was matched to FDG uptake intensity of SMPL, with FDG uptake range (SMPL/Liver SUV) of <0.9 for low, 0.91-1.99 for intermediate and >2.0 for high extrapulmonary tumor grade.
Of 274 patients, 62 met the study criteria. 46 are primary and 16 are secondary lung cancer. There are 19 low, 27 intermediate and 16 high grade extrapulmonary tumors. Mean SMPL SUV is 8.2 ± 4.5 and SMPL/liver SUV is 2.4 ± 1.4. There are 37 cases (60%) with mismatched results (e.g., low FDG SMPL with intermediate or high grade extrapulmonary tumor or vice versa) and 25 matched cases (40%) that are inconclusive (e.g., low FDG with low tumor grade or high FDG with high tumor grade). Of the mismatched cases, we correctly predicted 30 cases (81%) as primary lung cancers.
A mismatch between the SMPL SUV and the extrapulmonary tumor grade could be used to differentiate a primary lung cancer from a metastasis with reasonable accuracy. Our preliminary results support the hypothesis that FDG uptake intensity of a metastatic pulmonary lesion mirrors the tumor aggressiveness of its extrapulmonary neoplasm of origin.
评估在患有实体性孤立性恶性肺病变（SMPL）和先前切除的肺外肿瘤的患者中，区分原发性和继发性肺癌的可行性。
纳入了病理学证实的原发性或继发性肺癌患者，其 SMPL 为孤立性肺病变，且已知肺外肿瘤的组织病理学。排除了 SMPL 体积小、多个恶性肺结节或活动性感染/炎症过程的患者。将肺外肿瘤分级归类为低、中和高，并与 SMPL 的 FDG 摄取强度相匹配，FDG 摄取范围（SMPL/肝脏 SUV）<0.9 为低，0.91-1.99 为中，>2.0 为高肺外肿瘤分级。
在 274 名患者中，有 62 名符合研究标准。46 例为原发性肺癌，16 例为继发性肺癌。有 19 例低分级、27 例中分级和 16 例高分级肺外肿瘤。SMPL 的平均 SUV 为 8.2±4.5，SMPL/肝脏 SUV 为 2.4±1.4。有 37 例（60%）出现不匹配结果（例如，低 FDG 的 SMPL 与中或高分级肺外肿瘤，或反之），25 例匹配结果（40%）不确定（例如，低 FDG 与低肿瘤分级或高 FDG 与高肿瘤分级）。在不匹配的病例中，我们正确预测了 30 例（81%）为原发性肺癌。
SMPL SUV 与肺外肿瘤分级之间的不匹配可用于区分原发性肺癌与转移性肺癌，具有合理的准确性。我们的初步结果支持这样一种假设，即转移性肺病变的 FDG 摄取强度反映了其肺外肿瘤起源的肿瘤侵袭性。
