PET-CT预测ⅠA期肺腺癌隐匿性淋巴结转移的临床价值分析

Analysis of the clinical value of PET-CT in predicting occult lymph node metastasis in stage IA lung adenocarcinoma

目的探讨18氟-脱氧葡萄糖(^(18)F-FDG)PET-CT预测ⅠA期肺腺癌隐匿性淋巴结转移的临床价值。方法对我院2018年5月至2021年3月收治的70例ⅠA期肺腺癌患者影像学及病理资料进行回顾性分析,均于术前行PET-CT检查,并实施解剖性肺叶切除及淋巴结清扫。对肿瘤原发灶PET-CT最大标准化摄取值(SUV_(max))进行分析,并评价临床病理特征与隐匿性淋巴结转移的相关性,筛选危险因素。结果本组70例患者中12例出现隐匿性淋巴结转移(17.14%),其中N1期5例,N2期7例,N0期患者原发灶长径与N+期患者无显著差异(P>0.05),N0期患者原发灶SUV_(max)、结节类型、原发灶位置、病理分级与N+期患者有显著差异(P<0.05)。将原发灶SUV_(max)、原发灶位置、病理分级纳入多因素Logistic回归方程中,结果显示原发灶SUV_(max)>2.405、病变中央、病理分级高为隐匿性淋巴结转移的独立危险因素(P<0.05)。结论原发灶SUV_(max)>2.405、病变中央、病理分级高为ⅠA期肺腺癌患者发生隐匿性淋巴结转移的危险因素,术前N分期参考原发肿瘤PET-CT摄取情况可提高对淋巴结的预测价值。

Objective To explore the clinical value of ^(18)F-FDG PET-CT in predicting occult lymph node metastasis in stage IA lung adenocarcinoma.Methods The imaging and pathological data of 70 patients with stage IA lung adenocarcinoma admitted to our hospital from May 2018 to March 2021 were retrospectively analyzed.PET-CT was performed before surgery,and anatomical lobectomy and lymph nodes were performed.The maximum standardized uptake value(SUV_(max))of PET-CT in the primary tumor was analyzed,and the correlation between clinicopathological characteristics and occult lymph node metastasis was evaluated,and risk factors were screened.Results Of the 70 patients in this group,12 had occult lymph node metastasis(17.14%),of which 5 were in N1 stage and 7 were in N2 stage.There was no significant difference between the primary tumor length in N0 stage and N+stage patients(P>0.05).There were significant differences in the SUV_(max),nodule type,location and pathological grade of the primary tumor in patients with N0 stage and those in N+stage(P<0.05).The SUV_(max) of the primary tumor,the location of the primary tumor,and the pathological grade were incorporated into the multivariate logistic regression equation.The results showed that the SUV_(max) of the primary tumor>2.405,the center of the lesion,and the high pathological grade were independent risk factors for occult lymph node metastasis(P<0.05).Conclusion The primary tumor SUV_(max)>2.405,the center of the lesion,and the high pathological grade are risk factors for occult lymph node metastasis in patients with stage IA lung adenocarcinoma.The preoperative N stage can improve the predictive value of lymph nodes by referring to the PET-CT uptake of the primary tumor.