Department of Nuclear Medicine, Guangxi Medical University Cancer Hospital, Nanning 530021, China.
Hell J Nucl Med. 2024 May-Aug;27(2):78-84. doi: 10.1967/s002449912720. Epub 2024 Aug 6.
To explore the potential of intratumoral metabolism and its heterogeneous parameters, as measured by preoperative fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) imaging, to predict mediastinal occult lymph node metastasis in cN0 lung invasive adenocarcinoma.
Seventy five patients were consecutively enrolled from January 2018 to December 2022. All patients underwent F-FDG PET/CT scans within two weeks before surgery, and had mediastinal lymph node metastasis confirmed by pathologic diagnosis after surgery. Metabolic parameters including the maximum standardized uptake value (SUVmax), mean SUV (SUVmean), maximum average SUV (SUVpeak), tumor metabolic volume (MTV), and metabolic heterogeneity (HF) were measured. The relationship between primary focal metabolism, its heterogeneity parameters, and occult mediastinal lymph node metastasis was analyzed using an independent-sample t-test, analysis of covariance, and Mann-Whitney U test. A multivariate logistic regression model was used to analyze independent risk factors for mediastinal lymph node metastasis, while the receiver operating characteristic (ROC) curve assessed the predictive value of metabolic heterogeneity parameters for mediastinal occult lymph node metastasis.
A total of 20 out of 75 patients (26.7%) were pathologically confirmed to have mediastinal lymph node metastasis. Analysis of covariance showed that the SUVmax, SUVmean, SUVpeak and MTV were significantly higher in patients with metastasis than in those without (all P<0.05). The metabolic heterogeneity parameters HF2 and HF3 were significantly higher in patients with mediastinal lymph node metastasis than in those without (P=0.013, 0.001), but not HF1. Multivariate Logistic regression analysis identified that tumor size, SUVmax, SUVpeak, lymph node SUVmax, and HF2 of the primary tumor as independent risk factors for mediastinal lymph node metastasis. Metabolic heterogeneity 3 demonstrated high predictive value for mediastinal occult lymph node metastasis (AUC=0.720, P=0.004).
Metabolism and heterogeneity, as measured by preoperative F-FDG PET/CT in lung invasive adenocarcinoma, potentially have clinical value for predicting mediastinal occult lymph node metastasis.
探讨术前氟-18-氟代脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）成像测量的肿瘤内代谢及其异质性参数，预测 cN0 肺浸润性腺癌纵隔隐匿性淋巴结转移的潜能。
2018 年 1 月至 2022 年 12 月，连续纳入 75 例患者。所有患者均在术前两周内行 F-FDG PET/CT 扫描，并在术后经病理诊断证实存在纵隔淋巴结转移。测量代谢参数，包括最大标准化摄取值（SUVmax）、平均 SUV（SUVmean）、最大平均 SUV（SUVpeak）、肿瘤代谢体积（MTV）和代谢异质性（HF）。采用独立样本 t 检验、协方差分析和 Mann-Whitney U 检验分析原发灶代谢及其异质性参数与隐匿性纵隔淋巴结转移的关系。采用多变量 logistic 回归模型分析纵隔淋巴结转移的独立危险因素，而受试者工作特征（ROC）曲线评估代谢异质性参数对纵隔隐匿性淋巴结转移的预测价值。
75 例患者中，共有 20 例（26.7%）经病理证实存在纵隔淋巴结转移。协方差分析显示，转移组患者的 SUVmax、SUVmean、SUVpeak 和 MTV 均显著高于无转移组（均 P<0.05）。转移组患者的代谢异质性参数 HF2 和 HF3 显著高于无转移组（P=0.013、0.001），但 HF1 无显著差异。多变量 Logistic 回归分析确定肿瘤大小、SUVmax、SUVpeak、淋巴结 SUVmax 和原发肿瘤的 HF2 为纵隔淋巴结转移的独立危险因素。代谢异质性 3 对纵隔隐匿性淋巴结转移具有较高的预测价值（AUC=0.720，P=0.004）。
术前 F-FDG PET/CT 测量的肺癌浸润性腺癌的代谢和异质性，可能对预测纵隔隐匿性淋巴结转移具有临床价值。
