Department of Graduate School, Dalian Medical University, Dalian, China.
Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China.
Ann Nucl Med. 2024 Nov;38(11):904-912. doi: 10.1007/s12149-024-01964-y. Epub 2024 Jul 29.
This study aims to evaluate the value of the dynamic and static quantitative metabolic parameters derived from F-fluorodeoxyglucose (FDG)-positron emission tomography/CT (PET/CT) in the differential diagnosis of metastatic from non-metastatic lymph nodes (LNs) in lung cancer and to validate them based on the results of a previous study.
One hundred and twenty-one patients with lung nodules or masses detected on chest CT scan underwent F-FDG PET/CT dynamic + static imaging with informed consent. A retrospective collection of 126 LNs in 37 patients with lung cancer was pathologically confirmed. Static image analysis parameters include LN-SUV and LN-SUV/primary tumor SUV (LN-SUV/PT-SUV). Dynamic metabolic parameters including the net influx rate (K) and the surrogate of perfusion (K) and of each LN were obtained by applying the irreversible two-tissue compartment model using in-house Matlab software. K/K was then calculated as a separate marker. Based on the pathological findings, we divided into a metastatic group and a non-metastatic group. The χ test was used to evaluate the agreement of the individual and combined diagnosis of each metabolic parameter with the gold standard. The receiver-operating characteristic (ROC) analysis was performed for each parameter to determine the diagnostic efficacy in differentiating non-metastatic from metastatic LNs with high FDG-avid. P < 0.05 was considered statistically significant.
Among the 126 FDG-avid LNs confirmed by pathology, 70 LNs were metastatic, and 56 LNs were non-metastatic. For ROC analysis, in separate assays, the dynamic metabolic parameter K [sensitivity (SEN) of 84.30%, specificity (SPE) of 94.60%, accuracy of 88.89%, and AUC of 0.895] had a better diagnostic value than the static metabolic parameter SUV (SEN of 82.90%, SPE of 62.50%, accuracy of 74.60%, and AUC of 0.727) in differentiating between metastatic from non-metastatic LNs groups, respectively. In the combined diagnosis group, the combined SUV + K diagnosis had a better diagnostic value in the differential diagnosis of metastatic from non-metastatic LNs, with SEN, SPE, accuracy, and AUC of 84.3%, 94.6%, 88.89%, and 0.907, respectively.
When the cutoff value of K was 0.022 ml/g/min, it had a high diagnostic value in the differential diagnosis between metastasis and non-metastasis in FDG-avid LNs of lung cancer, especially in improving the specificity. The combination of SUV and K is expected to be a reliable metabolic parameter for N-staging of lung cancer.
本研究旨在评估氟-18 氟代脱氧葡萄糖（FDG）-正电子发射断层扫描/计算机断层扫描（PET/CT）的动态和静态定量代谢参数在肺癌转移性和非转移性淋巴结（LNs）鉴别诊断中的价值，并基于之前的研究结果进行验证。
121 名经胸部 CT 扫描发现肺部结节或肿块的患者在知情同意的情况下接受 F-FDG PET/CT 动态+静态成像。回顾性收集了 37 名肺癌患者的 126 个 LN，这些 LN 均经病理证实。静态图像分析参数包括 LN-SUV 和 LN-SUV/原发性肿瘤 SUV（LN-SUV/PT-SUV）。应用内部 Matlab 软件，采用不可逆双组织室模型，获得了包括净流入率（K）和灌注替代物（K）在内的每个 LN 的动态代谢参数。然后，将 K/K 作为一个单独的标志物进行计算。根据病理结果，我们将其分为转移性组和非转移性组。使用 χ 检验评估每个代谢参数的单独和联合诊断与金标准的一致性。对每个参数进行受试者工作特征（ROC）分析，以确定区分高 FDG 摄取的非转移性和转移性 LN 的诊断效能。P<0.05 被认为具有统计学意义。
在经病理证实的 126 个 FDG 摄取的 LN 中，70 个为转移性，56 个为非转移性。在单独的检测中，动态代谢参数 K[灵敏度（SEN）为 84.30%，特异性（SPE）为 94.60%，准确性为 88.89%，曲线下面积（AUC）为 0.895]的诊断价值优于静态代谢参数 SUV[SEN 为 82.90%，SPE 为 62.50%，准确性为 74.60%，AUC 为 0.727]，用于区分转移性和非转移性 LN 组。在联合诊断组中，SUV+K 联合诊断在鉴别转移性和非转移性 LN 方面具有更好的诊断价值，其 SEN、SPE、准确性和 AUC 分别为 84.3%、94.6%、88.89%和 0.907。
当 K 的截断值为 0.022ml/g/min 时，它在 FDG 摄取的肺癌 LN 中对转移和非转移的鉴别诊断具有较高的诊断价值，特别是在提高特异性方面。SUV 和 K 的联合有望成为肺癌 N 分期的可靠代谢参数。
