^(18)F-FDG PET/CT预测浸润性肺腺癌WHO(2021)组织学分级  

^(18)F-FDG PET/CT in Predicting WHO(2021)Histological Grades of Invasive Pulmonary Adenocarcinoma

作　　者：石琴 张依凡 杨易[1] 潘博[1] 倪明 SHI Qin;ZHANG Yifan;YANG Yi;PAN Bo;NI Ming(Department of Nuclear Medicine,Division of Life Sciences and Medicine,the First Affiliated Hospital of USTC,University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)核医学科,安徽合肥230001

出　　处：《中国医学影像学杂志》2025年第2期171-176,178,共7页Chinese Journal of Medical Imaging

基　　金：科大医学人工智能联合基金(MAI2022Q017)。

摘　　要：目的探讨^(18)F-FDG PET/CT预测浸润性肺腺癌WHO(2021)分类中组织学分级的作用。资料与方法回顾性分析2015年5月—2023年8月中国科学技术大学附属第一医院255例经手术病理证实为浸润性肺腺癌患者的临床、病理和PET/CT资料。根据WHO(2021)分级进行三级肿瘤分级。比较3种分级肿瘤的临床病理特征、最大标准化摄取值(SUVmax)、肿瘤代谢体积、糖酵解总量和CT表现。采用Logistic回归分析筛选3级肿瘤的独立预测因子,采用受试者工作特征曲线评估性能。结果较高的肿瘤分级与男性患者(χ^(2)=11.803,P=0.003)、吸烟史(χ^(2)=7.702,P=0.021)、肿瘤最大径(H=20.548,P=0.002)、淋巴结转移(P<0.001)、脉管癌栓(χ^(2)=33.270,P<0.001)、胸膜侵犯(χ^(2)=15.116,P=0.001)及气道播散有关(χ^(2)=17.867,P<0.001)。随着肿瘤级别提高,SUVmax(H=71.488,P<0.001)、糖酵解总量(H=30.658,P<0.001)和CT纯实性表现比例(χ^(2)=28.872,P<0.001)显著增加。SUVmax增高(OR=1.234,95%CI 1.141~1.334,P<0.001)和CT纯实性表现(OR=2.205,95%CI 1.166~4.171,P=0.015)是3级肿瘤的独立预测因子。SUVmax、CT实性表现及两者联合预测3级肿瘤的曲线下面积分别为0.793、0.641、0.804,其中最佳截断SUVmax为6.08。结论SUVmax和CT实性表现是3级浸润性肺腺癌的独立预测因子,术前^(18)F-FDG PET/CT可辅助评估肺腺癌分级,有助于改善治疗决策。Purpose To investigate the role of ^(18)F-FDG PET/CT in predicting histological grade of invasive pulmonary adenocarcinoma in the WHO(2021)classification.Materials and Methods The Clinical,pathological and PET/CT data of 255 patients with invasive pulmonary adenocarcinoma confirmed by surgical pathology were retrospectively analyzed from May 2015 to August 2023.Tertiary tumor grading was performed according to the WHO(2021)classification.The clinicopathologic features,maximum standardized uptake value(SUVmax),maximum standardized uptake,total lesion glycolysis and CT imaging findings were compared among the three tumor grades.Logistic regression analysis was used to screen the independent predictors for grade 3 tumors,and performance evaluation was performed using receiver operating characteristic curve.Results Higher tumor grade was associated with male sex(χ^(2)=11.803,P=0.003),smoking history(χ^(2)=7.702,P=0.021),maximum tumor diameter(H=20.548,P=0.002),lymph node metastasis(P<0.001),vascular cancer thrombus(χ^(2)=33.270,P<0.001),pleural invasion(χ^(2)=15.116,P=0.001)and airway spread(χ^(2)=17.867,P<0.001).SUVmax(H=71.488,P<0.001),total lesion glycolysis(H=30.658,P<0.001)and the proportion of pure solid tumors on CT image(χ^(2)=28.872,P<0.001)all increased significantly with higher tumor grade.A higher SUVmax(OR=1.234,95%CI 1.141-1.334,P<0.001)and pure solid appearance(OR=2.205,95%CI 1.166-4.171,P=0.015)were independent predictors of grade 3 tumors.The area under the receiver operating characteristic curve for SUVmax,CT solid appearance and the combination for predicting grade 3 tumors was 0.793,0.641 and 0.804,respectively,with the SUVmax cut-off of 6.08.Conclusion SUVmax and CT solid appearance are independent predictive factors for grade 3 invasive pulmonary adenocarcinoma.Preoperative ^(18)F-FDG PET/CT can assist in evaluating the grading of invasive pulmonary adenocarcinoma,which improves treatment decision-making.

关 键 词：肺肿瘤 肺腺癌 国际疾病分类法 体层摄影术 X线计算机 正电子发射断层显像术 氟脱氧葡萄糖F18 病理学 外科 预测 

分 类 号：R445.6[医药卫生—影像医学与核医学] R734.2[医药卫生—诊断学]