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Title: [Potential value of FDG PET-CT in predicting occult lymph node metastasis in clinical stage ⅠA lung adenocarcinoma].
Author: Lyu L, Liu Y, Wang XY, Zhang ZK, Tao XL, Yang L, Wu N.
Journal: Zhonghua Zhong Liu Za Zhi; 2019 Jun 23; 41(6):441-447. PubMed ID: 31216830.
Abstract:
Objective: To investigate the predictive value of (18)F-FDG PET-CT scan for occult lymph node metastasis in patients with stage ⅠA lung adenocarcinoma. Methods: The image and pathological data of 272 patients with stage ⅠA lung adenocarcinoma from October 2006 to September 2015 were retrospectively analyzed. All patients underwent preoperative (18)F-FDG PET-CT scan followed by lobectomy and systematic lymph node dissection. The correlation between occult lymph node metastasis and the maximum standardized uptake value (SUV(max)) of primary tumor as well as other clinicopathological factors was analyzed to screen the risk factors of occult lymph node metastasis in stage ⅠA lung adenocarcinoma. Results: Occult lymph node metastasis was detected in 50 patients (18.4%), with 24 (8.8%) patients of pN1 involvement and 26 (9.6%) of pN2 involvement. Among the 272 patients enrolled, 39 had pure ground glass nodule, 59 had part-solid nodule and 174 had solid nodule. All patients with pure ground glass nodule or nodule≤1 cm were pN0. For the 233 patients with part-solid and solid nodule, no lymph node metastasis was found in T1a stage (tumor length ≤1 cm). Primary tumor SUV(max) (Z=-5.663, P<0.001), nodule type (χ(2)=21.586, P<0.001), tumor location (χ(2)= 12.790, P< 0.001), histological grade (χ(2)= 22.784, P< 0.001) and visceral pleural invasion (χ(2)=5.357, P=0.021) showed significant differences between occult lymph node metastasis group (pN+ ) and non-lymph node metastasis group (pN0). With SUV(max)=2.405 as cut-off value, the sensitivity and specificity for predicting occult lymph node metastasis were 90.0% and 61.7%, the area under curve was 0.761(95%CI=0.700~0.823), and the negative predictive value was 95.8%. Multivariate analysis revealed that SUV(max) >2.405 (P<0.001), central location (P=0.030) and higher histological grade (P=0.024) were independent predictors of occult lymph node metastasis. Conclusions: For clinical stage ⅠA adenocarcinoma, primary tumor SUV(max) > 2.405, central location and higher histological grade were independent risk factors for occult lymph node metastasis. Systematic lymph node dissection may be avoided in lung adenocarcinoma with pure ground glass density, tumor length ≤1 cm or SUV(max) ≤ 2.405, due to the very low probability of nodal involvement. 目的： 探讨(18)氟－脱氧葡萄糖((18)F－FDG)PET－CT对临床ⅠA期肺腺癌患者隐匿性淋巴结转移的预测价值。 方法： 回顾性分析2006年10月至2015年9月272例临床ⅠA期肺腺癌患者的影像和病理资料，所有患者均于术前行PET－CT检查，并行解剖性肺叶切除和系统性淋巴结清扫。分析肿瘤原发灶PET－CT最大标准化摄取值(SUV(max))及其他临床病理特征与隐匿性淋巴结转移的关系，筛选临床ⅠA期肺腺癌隐匿性淋巴结转移的危险因素。 结果： 共50例(18.4%)患者出现隐匿性淋巴结转移，其中pN1期24例(8.8%)，pN2期26例(9.6%)。纯磨玻璃结节39例，部分实性结节59例，实性结节174例。所有纯磨玻璃结节患者均未出现隐匿性淋巴结转移。对233例实性和部分实性患者的临床病理特征与隐匿性淋巴结转移的关系进行统计分析，结果显示，T1a期(肿瘤长径≤1 cm)患者均未见淋巴结转移，原发灶SUV(max)(Z＝－5.663, P<0.001)、结节类型(χ(2)＝21.586, P<0.001)、原发灶位置(χ(2)＝12.790，P<0.001)、病理分级(χ(2)＝22.784，P<0.001)、脏层胸膜受侵(χ(2)＝5.357, P＝0.021)在隐匿性淋巴结转移组(pN＋)与无淋巴结转移组(pN0)间的差异有统计学意义。以SUV(max)为2.405为界值，预测隐匿性淋巴结转移的灵敏度和特异度分别为90.0%和61.7%，曲线下面积为0.761(95% CI为0.700～0.823)，阴性预测值为95.8%。多因素Logistic回归分析显示，原发灶SUV(max)>2.405(P<0.001)、原发灶位置为中央(P＝0.030)和病理分级高(P＝0.024)为隐匿性淋巴结转移的独立危险因素。 结论： 临床ⅠA期肺腺癌原发灶SUV(max)>2.405、原发灶位置为中央和病理分级高为隐匿性淋巴结转移的独立危险因素。原发灶影像学表现为纯磨玻璃密度、肿瘤长径≤1 cm、SUV(max)≤2.405的患者出现隐匿性淋巴结转移的概率较低，或可避免行系统性淋巴结清扫。.

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