超级迭代PET/CT定量参数联合癌胚抗原鉴别良、恶性孤立性肺结节

Super-iterative PET/CT quantitative parameters combined with carcinoembryonic antigen for differentiating benign and malignant solitary pulmonary nodules

目的观察超级迭代PET/CT定量参数联合癌胚抗原(CEA)鉴别良、恶性孤立性肺结节(SPN)的价值。方法选取95例SPN患者,根据术后病理结果将其分为恶性组(n=75)及良性组(n=20)。比较肺结节最大标准摄取值(SUV max)、峰值标准摄取值(SUV peak)、最大瘦体标准摄取值(SUL max)、峰值瘦体标准摄取值(SUL peak)及CEA组间差异;绘制受试者工作特征曲线,观察以上参数单独及联合诊断良、恶性SPN的效能。结果恶性组结节SUV max、SUV peak、SUL max、SUL peak及患者CEA均显著大于良性组(P均<0.05)。恶性组TNMⅡ期及存在淋巴结转移肺结节的SUV max、SUV peak、SUL max、SUL peak及患者CEA均显著大于TNMⅠ期及无明显淋巴结转移者(P均<0.05)。分别以2.01、1.14、1.08、0.83及4.69 ng/ml为SUV max、SUV peak、SUL max、SUL peak及患者CEA诊断良、恶性SPN的最佳截断值,其曲线下面积(AUC)分别为0.831、0.710、0.795、0.822及0.782;联合上述五项参数的AUC为0.913,大于各单一参数的AUC(Z=5.163、8.415、6.480、6.277、6.594,P均<0.05)。结论超级迭代PET/CT定量参数联合CEA可鉴别诊断良、恶性SPN,并有助于评估肺癌TNM分期及淋巴结转移。

Objective To observe the value of super-iterative PET/CT quantitative parameters combined with carcinoembryonic antigen(CEA)for differentiating benign and malignant solitary pulmonary nodules(SPN).Methods Totally 95 patients with SPN were enrolled and divided into malignant group(n=75)and benign group(n=20)according to postoperative pathological results.The maximum standard uptake value(SUV max),peak standard uptake value(SUV peak),the maximum standard uptake value normalized by lean body mass(SUL max)and peak standard uptake value normalized by lean body mass(SUL peak)of pulmonary nodules,as well as CEA were obtained and compared between groups.The receiver operating characteristic curves were drawn,and the efficacies of above parameters alone and the combination for differentiating benign and malignant SPN were observed.Results SUV max,SUV peak,SUL max,SUL peak of pulmonary nodules and patients'CEA in malignant group were significantly higher than those of benign group(all P<0.05).In malignant group,SUV max,SUV peak,SUL max,SUL peak of TNM stageⅡpulmonary nodules and with lymph node metastasis,as well as patients'CEA were all significantly higher than those of TNM stageⅠand without lymph node metastasis SPN(all P<0.05).Taken 2.01,1.14,1.08,0.83 and 4.69 ng/ml as the best cut-off value of SUV max,SUV peak,SUL max,SUL peak and CEA for diagnosing benign and malignant SPN,respectively,the area under the curve(AUC)was 0.831,0.710,0.795,0.822 and 0.782,respectively.The AUC of combination of the above 5 parameters was 0.913,significantly higher than that of each parameter alone(Z=5.163,8.415,6.480,6.277,6.594,all P<0.05).Conclusion Super-iterative PET/CT quantitative parameters combined with CEA could be used for differentiating benign and malignant SPN,being helpful to evaluating TNM stage and lymph node metastasis of SPN.