目的:最大标准化摄取值(SUVmax)是临床分期非小细胞肺癌(NSCLC)的正电子发射断层扫描/计算机断层扫描中广泛使用的指标,然而,SUVmax的可靠性仍然存在争议。我们在此旨在评估半定量参数的有效性,包括尺寸,SUVmax,代谢性肿瘤体积(MTV),总病变糖酵解(TLG)和异质性因子(HF),在正电子发射断层扫描/计算机断层扫描中评估原发性肿瘤和淋巴结(LN)。设计了一种新颖的评分系统来评估半定量参数的作用,并直观地评估淋巴结分期的LN。
方法:病理性非小细胞肺癌患者,在2014年至2019年期间诊断为I-III期临床分期,参加了这项研究。患者人口统计学,包括年龄,性别,肿瘤位置,直径,肿瘤淋巴结转移分期,以及SUVmax,MTV,原发性肿瘤和LN的TLG和HF参数,被记录在案。
结果:分析包括319例患者和963例LN。患者的平均年龄为61.62岁,91.5%是男性。腺癌与LN转移具有组织学相关性(P=0.043)。研究结果表明,肿瘤大小,SUVmax,MTV,TLG和HF对LN转移的检测没有显著影响。相反,非鳞状细胞癌,LN表现出比肝脏更高的FDG水平,LN大小,SUVmax,MTV和TLG为危险因素(P<0.0001)。确定的LN尺寸的截止值为1.05cm,4.055forSUVmax,MTV为1.805cm3,TLG为5.485。评分系统包含这些参数,视觉评估表明,≥3分的转移风险增加14.33倍.
结论:我们设计了一种新的评分系统,并证明在NSCLC患者中,评分≥3的LN具有很高的转移可能性。这种创新的评分系统可以作为一种有价值的工具,以减轻侵入性病理分期评估中的过度和极端措施。
OBJECTIVE: The maximum standardised uptake value (
SUVmax) is a widely utilised metric in positron emission tomography/computed tomography for clinically staging non-small-cell lung cancer (NSCLC), yet the reliability of
SUVmax remains controversial. We herein aimed to assess the effectiveness of semi-quantitative parameters, encompassing size,
SUVmax, metabolic tumour volume (MTV), total lesion glycolysis (TLG) and heterogeneity factor (HF), in evaluating both primary tumours and lymph nodes (LNs) on positron emission tomography/computed tomography. A novel scoring system was devised to appraise the role of semi-quantitative parameters and visually evaluate LNs for nodal staging.
METHODS: Patients with pathological NSCLC, diagnosed between 2014 and 2019 and clinically staged I-III, were enrolled in the study. Patient demographics, including age, sex, tumour location, diameter, tumour-node-metastasis stage, as well as SUVmax, MTV, TLG and HF parameters of primary tumours and LNs, were documented.
RESULTS: The analysis comprised 319 patients and 963 LNs. Patients had a mean age of 61.62 years, with 91.5% being male. Adenocarcinoma exhibited a histological association with LN metastasis (P=0.043). The study findings revealed that tumour size,
SUVmax, MTV, TLG and HF did not significantly affect the detection of LN metastasis. Conversely, non-squamous cell carcinoma, LNs exhibiting higher FDG levels than the liver, LN size, SUVmax, MTV and TLG were identified as risk factors (P<0.0001). The identified cut-off values were 1.05cm for LN size, 4.055 for
SUVmax, 1.805cm3 for MTV and 5.485 for TLG. The scoring system incorporated these parameters, and visual assessment indicated that a score of ≥3 increased the risk of metastasis by 14.33 times.
CONCLUSIONS: We devised a novel scoring system and demonstrated that LNs with a score of ≥3 in patients with NSCLC have a high likelihood of metastasis. This innovative scoring system can serve as a valuable tool to mitigate excessive and extreme measures in the assessment of invasive pathological staging.