PET/CT联合CT三维重建在鉴别早期肺腺癌不同病理亚型中的价值

Value of PET/CT Combined with CT Three-dimensional Reconstruction in Distinguishing Different Pathological Subtypes of Early Lung Adenocarcinoma

背景与目的早期肺腺癌中病理亚型以贴壁为主型的浸润性腺癌(lepidic predominant invasive adenocarcinoma,LPA)与原位腺癌(adenocarcinomainsitu,AIS)、微浸润性腺癌(microinvasiveadenocarcinoma,MIA)的良好预后相似,临床上也迫切需要能够区分LPA与非LPA型浸润性腺癌(non-lepidicpredominantinvasive adenocarcinoma,non-LPA)的手段,本研究拟通过正电子发射型计算机断层显像(positronemissioncomputed tomography, PET)/计算机断层扫描(computed tomography, CT)的最大标准化摄取值(maximal standard uptake value,SUVmax)和CT三维重建后参数探讨术前影像学表现为部分实性结节(part-solidnodules,PSNs)的早期肺腺癌不同病理亚型间的关系。方法回顾性分析2016年1月-2019年1月于江苏省苏北人民医院胸外科行解剖性肺切除术且影像学表现为PSNs的早期肺腺癌患者资料,所有患者胸部增强CT和PET/CT资料完整可获取,利用Mimics软件行三维重建,获取肿瘤体积、肿瘤三维平均CT值(3-dimensional mean-CT value, 3Dm-CT)、SUVmax等数据,采用SPSS 25.0进行统计分析,Graph Pad Prism 8.3.0绘制受试者工作曲线(receiver operating curve, ROC),P<0.05为差异有统计学意义。结果最终共计67例患者纳入本研究,按病理亚型不同将所有患者分为两组,AIS、MIA及浸润性腺癌(invasive adenocarcinoma, IAC)中的LPA归为低危组28例(41.8%),其余non-LPA如腺泡型(acinar pattern-predominantadeno-carcinoma,APA)、乳头型(papillarypattern-predominantadenocarcinoma,PPA)、微乳头型(micropapillary pattern-predominant adeno-carcinoma, MPA)归为高危组39例(58.2%),两组间SUVmax(t=3.153,P=0.002)、肿瘤体积(t=3.331, P=0.001)、实性/磨玻璃成分体积(t=2.74, P=0.006)/(t=3.127, P=0.002)、实性/磨玻璃成分3Dm-CT(t=3.655, P<0.001)/(t=7.082, P<0.001)均具有显著统计学意义。ROC曲线提示:SUVmax[曲线下面积(area under curve, AUC)=0.727]、肿瘤体积(AUC=0.740)、磨玻璃成分体积(AUC=0.725)、实性成分3Dm-CT(AUC=0.763)、磨玻璃成分3Dm-CT(AUC=0.756)预测效能最佳。将上述AUC>0.7的协变量纳入多因素ROC曲线分析,获得联合预测因子(AUC=0.835)具有中等以上预测价值。结论 PET/CT中SUVmax和CT三维重建参数与影像学表现为PSNs的早期肺腺癌的不同病理亚型具有显著相关性,联合SUVmax、肿瘤体积、磨玻璃成分体积和实性/磨玻璃成分3Dm-CT对鉴别表现为PSNs的早期肺腺癌的病理亚型具有一定价值。

Background and objective The good prognosis of lepidic predominant invasive adenocarcinoma(LPA) and adenocarcinoma in situ(AIS)/microinvasive adenocarcinoma(MIA) in the pathological subtypes of early lung adenocarcinoma is similar, and the means to distinguish LPA from non-LPA is urgently needed in clinical practice. This study intends to analyze the correlation between positron emission computed tomography(PET)/computed tomography(CT) maximal standard uptake value(SUVmax) with CT three-dimensional reconstruction parameters and the pathological subtypes of early lung adenocarcinoma with part-solid nodules(PSNs) in preoperative imaging. Methods The data of early lung adenocarcinoma patients who underwent anatomical pneumonectomy at the Department of Thoracic Surgery of Northern Jiangsu People’s Hospital from January 2016 to January 2019 retrospectively analyzed and subsolid nodules on imaging were showed. All patients with enhanced chest CT and PET/CT data can be obtained completely, using Mimics software to perform three-dimensional reconstruction to obtain tumor volume, 3-dimensional mean-CT value(3 Dm-CT) of tumor and SUVmax, using SPSS 25.0 for statistical analysis and GraphPad Prism 8.3.0 for drawing receiver operating curve(ROC). P<0.05 indicates that the difference is statistically significant. Results 67 patients were included in this study. All patients were divided into two groups according to different pathological subtypes. AIS, MIA and LPA in invasive adenocarcinoma(IAC) were in the low-risk group, 28 cases(41.8%), and the remaining non-LPA were in high-risk group, 39 cases(58.2%). SUVmax(t=3.153, P=0.002), tumor volume(t=3.331, P=0.001), solid/ground glass component volume(t=2.74, P=0.006)/(t=3.127, P=0.002) and 3 Dm-CT of solid/ground glass component(t=3.655, P<0.001)/(t=7.082, P<0.001) between the two groups were all statistically significant. ROC curve prompts: SUVmax [area under curve(AUC)=0.727], tumor volume(AUC=0.740), ground glass component volume(AUC=0.725), 3 Dm-CT of solid components(AUC=0.763), 3 Dm-CT of ground glass components(AUC=0.756) have the best predictive performance. The above-mentioned covariates with AUC>0.7 were included in the multivariate ROC curve analysis, and the joint predictor(AUC=0.835) was obtained with medium or above predictive value. Conclusion PET/CT SUVmax and CT three-dimensional reconstruction parameters have a significant correlation with the different pathological subtypes of early lung adenocarcinoma with PSNs in imaging. The combination of SUVmax, tumor volume, ground glass component volume and 3 Dm-CT of solid/ground glass component CT value has certain value in identifying the pathological subtype of early stage lung adenocarcinoma with PSNs nodules in imaging.