18F-FDG PET/CT预测肺外周亚实性结节Ⅰ期肺腺癌脏层胸膜浸润的临床研究

18F-FDG PET/CT prediction of visceral pleural invasion of stage-1 lung adenocarcinoma with peripheral subsolid nodule

目的探讨亚实性结节(SSN)Ⅰ期肺腺癌的临床与18F-FDG PET/CT相关性及18F-FDG PET/CT预测脏层胸膜浸润(VPI)的研究。方法回顾性收集65例SSN肺腺癌Ⅰ期病例的临床、18F-FDG PET/CT和病理资料,探讨结节大小、结节实性成分大小与SUVmax的相关性,并对结节SUVmax、结节与胸膜间距离预测VPI作诊断效能评价。结果SSN的结节大小(rs=0.778,P<0.001)和实性成分大小(rs=0.803,P<0.001)均与SUVmax呈高度正相关性。PSN组SUVmax中位数1.8比pGGN组中位数0.6高(P<0.001)。病理VPI阳性组SUVmax的中位数2.0高于阴性组0.9(P<0.001)。病理VPI阳性组结节与胸膜的距离中位数0.0 mm比阴性组的中位数5.0 mm要小(P<0.001)。预测VPI绘制ROC曲线,SUVmax的曲线下面积(AUC)为0.787,临界值为SUVmax大于1.0时,灵敏度、特异度分别为100%、60%。结节与胸膜间距离的AUC为0.755,临界值为小于4.0 mm时,灵敏度、特异度分别为96.7%、57.1%。而两个变量联合诊断的AUC为0.902,预测概率临界值大于0.38,其灵敏度、特异度为96.7%、71.4%。结论SSNⅠ期肺腺癌的结节大小和实性成分大小均与结节SUVmax呈高度正相关。SUVmax、结节与胸膜间距离可帮助预测病理VPI,具有一定的临床价值。

Objective To explore the value of 18F-FDG PET/CT in stage-1 lung adenocarcinoma with subsolid nodules(SSN)for predicting visceral pleural invasion(VPI).Methods The clinical,18F-FDG PET/CT and pathological data of 65 patients with stage 1 lung adenocarcinoma with SSN were retrospectively analyzed to investigate the correlation between nodule size,size of solid component in the nodule,and SUVmax in 18F-FDG PET/CT.The diagnostic efficacy of SUVmax and the distance between nodule and pleura for predicting VPI were evaluated.Results Both nodule size(rs=0.778,P<0.001)and solid component size(rs=0.803,P<0.001)of SSN were highly positively correlated with SUVmax.The median SUVmax was significantly higher(P<0.001)in the part-solid nodules(1.8)than the pure ground glass nodules(0.6).The median SUVmax was also significantly higher(P<0.001)in the pathologic VPI-positive(2.0)than the VPI-negative(0.9)groups.The median distance between the nodules and the pleura was significantly closer(P<0.001)in the pathological VPI-positive(0 mm)than that of VPI-negative(5.0 mm)groups.The area under the receiver operating characteristic curve(AUC)of SUVmax was 0.787 with 100%sensitivity and 60%specificity using the SUVmax>1.0 cut-off value.The AUC of the distance between the nodule and pleura was 0.755 with 96.7%sensitivity and 57.1%specificity using the<4.0 mm cut-off value.The AUC for the both variables combined was 0.902 with 96.7%sensitivity and 71.4%specificity using the>0.38 predictive probability cut-off value.Conclusion The size of total nodule and the solid component of lung adenocarcinoma manifested as SSN are highly positively correlated with the SUVmax of the nodules.Both SUVmax and the distance between the nodule and pleura can help to predict pathological VPI.