^(18)F-FDG PET/CT代谢参数评估肺浸润性腺癌病理亚型及组织学分级的价值

Value of ^(18)F-FDG PET/CT metabolic parameters in predicting pathological subtype and histological grade of lung invasive adenocarcinoma

目的研究^(18)F-FDG PET/CT代谢参数与肺腺癌组织学分级和病理各亚型组间差异,并确定肺腺癌组织学分级的代谢参数临界值。方法收集75例经病理证实为原发性肺腺癌患者的PET/CT图像,测量PET/CT代谢参数最大标准化摄取值(maximum standardized uptake value,SUVmax)、平均标准化摄取值(SUVmean)、代谢体积(metabolic tumor volume,MTV)和总病变糖酵解量(total lesion glycolysis,TLG)。分析肺腺癌的病理亚型及组织学分级与肿瘤SUVmax、SUVmean、MTV、TLG的关系;绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估PET/CT各代谢参数评估肺腺癌组织学分级的诊断效能并确定组织学分级间各代谢参数截断值。结果SUVmax、SUVmean、TLG在病理亚型分组及组织学分级中组间差异有统计学意义(P<0.05),并且微乳头为主型、实体为主型代谢参数高于其它分组,高级别组织学分级代谢参数高于低级别组织学分级;ROC曲线分析确定低级别肺腺癌SUVmax截断值为3.848(敏感性79.5%,特异性90.0%),SUVmen截断值为2.358(敏感性77.3%,特异性90.0%);确定高级别肺腺癌SUVmax截断值为10.422(敏感性81.0%,特异性84.1%),SUVmean截断值为6.298(敏感性81.0%,特异性86.4%),TLG截断值为126.06(敏感性81.0%,特异性86.4%)。结论PET/CT代谢参数在病理亚型及组织学分级中的相关性可以用于临床制定治疗方案及判断预后复发风险;确定了PET/CT代谢参数SUVmax、SUVmean在肺腺癌组织分级的截断值,并且有较高的灵敏性和特异性,可以用于肺腺癌分级的诊断。

Objective:To investigate the differences of metabolic parameters of PET/CT with histological grade and pathological subtypes of lung adenocarcinoma,and to determine the cut-off values of metabolic parameters for histological grade of lung adenocarcinoma.Methods:PET/CT images of 75 patients with primary lung adenocarcinoma confirmed by pathology were collected.The PET/CT metabolic parameters SUVmax,SUVmean,MTV and TLG were measured.The relationship between pathological subtypes and histological grades of lung adenocarcinoma and SUVmax,SUVmean,MTV,TLG were analyzed.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of PET/CT metabolic parameters in evaluating the histological grade of lung adenocarcinoma,and the cut-off values of metabolic parameters between histological grades were determined.Results:There were significant differences in SUVmax,SUVmean,and TLG among pathological subtypes and histological grades(P<0.05).The metabolic parameters of micropapillary type and solid type were higher than those of other groups,and the metabolic parameters of high grade were higher than those of low grade.ROC curve analysis determined that the SUVmax cut-off value was 3.848(sensitivity 79.5%,specificity 90.0%),and the SUVmen cut-off value was 2.358(sensitivity 77.3%,specificity 90.0%)in low-grade lung adenocarcinoma.The cut-off values of SUVmax,SUVmean and TLG of high-grade lung adenocarcinoma were 10.422(sensitivity 81.0%,specificity 84.1%),6.298(sensitivity 81.0%,specificity 86.4%)and 126.06(sensitivity 81.0%,specificity 86.4%).Conclusion:The correlation of PET/CT metabolic parameters in pathological subtypes and histological grades can be used to make clinical treatment plans and determine the risk of prognostic recurrence.The cut-off values of SUVmax and SUVmean of PET/CT metabolic parameters in the grading of lung adenocarcinoma are determined,and they have high sensitivity and specificity,which can be used for the diagnosis of lung adenocarcinoma grading.