^18F-FDG PET/CT诊断孤立性肺结节良恶性的效能分析

Efficacy of ^18F-FDG PET/CT in the differential diagnosis of benign and malignant solitary pulmonary nodules

目的探讨18F-脱氧葡萄糖(FDG)PET/CT显像最大标准摄取值(SUVmax)对孤立性肺结节(SPN)良、恶性的诊断效能。方法回顾性分析2017年9月至2019年6月连云港市第一人民医院84例SPN患者[男39例,女45例;年龄34~81(平均61.1)岁]的^18F-FDG PET/CT显像资料。以病理结果为"金标准",分析良、恶性结节间SUVmax差异,组间比较采用Mann-Whitney U检验;应用受试者工作特征(ROC)曲线,探讨诊断结节良、恶性的SUVmax最佳界值,分析其诊断效能。结果病理证实共54例恶性结节,30例良性结节,病灶SUVmax分别为5.48±4.08和1.70(0.73,3.33)(U=443.50,P=0.001)。84例中58例为实性结节,26例为亚实性结节。亚实性结节组中良、恶性结节的SUVmax差异无统计学意义(U=56.00,P>0.05)。对58例实性结节SUVmax进行ROC曲线分析,诊断良、恶性的最佳界值为1.85,对应的灵敏度、特异性、准确性、阴性预测值、阳性预测值分别为97.06%(33/34)、62.50%(15/24)、82.76%(48/58)、15/16、78.57%(33/42)。结论恶性SPN较良性SPN ^18F-FDG摄取高;应用SUVmax1.85诊断实性结节良恶性有较高的灵敏度、阴性预测值及准确性;亚实性结节SUVmax的良恶性诊断价值有限。

Objective To analyze the value of maximum standardized uptake value(SUVmax)of 18F-fluorodeoxyglucose(FDG)PET/CT in differentiating the malignant solitary pulmonary nodules(SPN)from benign ones.Methods ^18F-FDG PET/CT imaging data of 84 patients(39 males,45 females;age:34-81(average:61.1)years)with SPN in the First People′s Hospital of Lianyungang between September 2017 and June 2019 were retrospectively analyzed.The pathological results were taken as the gold standard.Differences of SUVmax between benign and malignant SPN were analyzed with Mann-Whitney U test,and the best cut-off value for the diagnosis of benign and malignant SPN was measured by receiver operating characteristic(ROC)curve.The diagnostic efficacy was analyzed based on SUVmax.Results The pathological results confirmed 54 patients with malignant SPN,and 30 patients with benign SPN.SUVmax of malignant group was significantly higher than that of benign group(5.48±4.08 vs 1.70(0.73,3.33);U=443.50,P=0.001).The 84 SPN included 58 solid SPN and 26 subsolid SPN.SUVmax of malignant subsolid SPN and benign ones were not significantly different(U=56.00,P>0.05).The diagnostic value of SUVmax in 58 cases of solid nodules were analyzed based on ROC curves,and the optimal cut-off value was 1.85.The corresponding diagnostic sensitivity,specificity,accuracy,negative predictive value and positive predictive value were 97.06%(33/34),62.50%(15/24),82.76%(48/58),15/16,78.57%(33/42),respectively.Conclusions ^18F-FDG uptake of malignant SPN were higher than benign ones.The diagnosis of benign and malignant solid SPNs based on SUVmax 1.85 has high sensitivity,negative predictive value and accuracy.SUVmax has limited diagnostic value on subsolid SPN.