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Yan H, Wang L, Lei B, Ruan M, Chang C, Zhou M, Liu L, Xie W, Wang Y. The combination of maximum standardized uptake value and clinical parameters for improving the accuracy in distinguishing primary mediastinal lymphomas from thymic epithelial tumors. Quant Imaging Med Surg 2024; 14:1944-1956. [PMID: 38415117 PMCID: PMC10895101 DOI: 10.21037/qims-23-496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/24/2023] [Indexed: 02/29/2024]
Abstract
Background Anterior mediastinal masses are relatively uncommon, and mediastinal lymphomas are the malignancies most likely to be confused with thymic epithelial tumors (TETs). The aim of this study was to investigate whether the combination of 18fluorine-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) findings and clinical parameters is useful in differentiating lymphoma from TETs in anterior mediastinal masses. Methods This retrospective study consecutively included 304 patients with anterior mediastinal masses (244 TETs and 60 lymphomas) who underwent 18F-FDG PET-CT 1 to 2 weeks before tumor resection or biopsy between August 2016 and March 2022. The correlations between the maximum standardized uptake value (SUVmax) of tumors and clinical parameters of patients with histology subtypes were analyzed. Receiver operating characteristic curve analysis was used to obtain the optimal cutoff values of age, lactate dehydrogenase (LDH), tumor size, and SUVmax to predict lymphoma. Logistic regression analysis was used to identify potential predictive factors for lymphoma. Results Lymphoma was significantly associated with younger patient age, higher LDH level, larger tumor size, and higher SUVmax compared to TETs (P<0.001). In the modeling cohort, age ≤40.5 years, LDH level ≥197 U/L, tumor size ≥10.72 cm, and SUVmax ≥11.95 were identified as independent predictors for lymphoma with odds ratios of 20.14 [95% confidence interval (CI): 6.02-67.40; P<0.001], 4.89 (95% CI: 1.27-18.89; P=0.021), 8.82 (95% CI: 2.31-33.69; P=0.001), and 30.01 (95% CI: 6.59-136.72; P<0.001), respectively. The accuracy of age, LDH, tumor size, and SUVmax in predicting lymphoma was 84.8%, 67.8%, 85.2%, and 78.3% respectively. The combination of the four above parameters could improve the predictive accuracy to 89.1%, and in the validation cohort, this combination increased the predictive accuracy to 87.8%. Conclusions SUVmax on 18F-FDG PET-CT has the potential ability to discriminate lymphomas from TETs in the diagnosis of anterior mediastinal masses, and the combination of SUVmax with clinical parameters can improve the diagnostic accuracy. This combination may therefore may be helpful in avoiding unnecessary operation in patients with anterior mediastinal lymphomas.
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Affiliation(s)
- Hui Yan
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng Chang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingge Zhou
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Zhou S, Tsui P, Lin M, Chen G, Chen W, Cai X. A diagnostic model based on 18F-FDG PET/CT parameters in improving the differential diagnosis of invasive thymic epithelial tumors and anterior mediastinal lymphomas. BMC Med Imaging 2024; 24:14. [PMID: 38191331 PMCID: PMC10773031 DOI: 10.1186/s12880-023-01185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Accurately distinguishing between invasive thymic epithelial tumors (TETs) and anterior mediastinal lymphoma before surgery is crucial for subsequent treatment choices. But currently, the diagnosis of invasive TET is sometimes difficult to distinguish from anterior mediastinal lymphoma. OBJECTIVE To assess the application of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computer tomography (PET/CT) in the differential diagnosis of TETs and anterior mediastinal lymphomas. METHODS 18F-FDG PET/CT images of 133 invasive TETs and anterior mediastinal lymphomas patients were retrospectively analyzed. In particular, the tumor's longest diameter and maximum standardized uptake value (SUVmax) were evaluated. The SUVmax and longest diameter values of the two groups were analyzed by using the receiver operating characteristic (ROC) curve to determine the optimal threshold and diagnostic efficiency. RESULTS Age, myasthenia gravis, SUVmax and tumor longest diameter differed significantly between invasive TETs and anterior mediastinal lymphomas patients. The tumor location, calcification, relationship with adjacent vessels and distant metastasis differed significantly between the groups. The ROC analysis showed an AUC for SUVmax and tumor longest diameter of 0.841 and 0.737. Respectively, the cutoff values with the best diagnostic performance were 9.65 (sensitivity: 77.78%, specificity: 81.97%) and 6.65 (sensitivity: 80.56%, specificity: 62.30%) for SUVmax and tumor longest diameter. The diagnostic model of SUVmax, calcification, relationship with surrounding blood vessels, lymph node metastasis and lung metastasis in the highest AUC of 0.935 (sensitivity: 90.16%, specificity: 88.89%). In addition, we incorporated splenic involvement and metastatic sub-diaphragmatic lymph node into Model 2 as a new predictive model 3 for differential diagnosis and found a significant improvement in the diagnostic performance of Model 3. CONCLUSION The diagnostic model composed of 18F-FDG PET parameters is improving the differential diagnosis of invasive TETs and anterior mediastinal lymphomas.
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Affiliation(s)
- Shuo Zhou
- Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China
| | - Pokwan Tsui
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No. 613 West Huangpu Avenue, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Meifu Lin
- Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China
| | - Guobao Chen
- Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China
| | - Wenxin Chen
- Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou City, Fujian Province, China.
| | - Xiangran Cai
- Medical Imaging Center, First Affiliated Hospital of Jinan University, No. 613 West Huangpu Avenue, Tianhe District, Guangzhou, 510630, Guangdong, China.
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Li J, Cui N, Jiang Z, Li W, Liu W, Wang S, Wang K. Differentiating thymic epithelial tumors from mediastinal lymphomas: preoperative nomograms based on PET/CT radiomic features to minimize unnecessary anterior mediastinal surgery. J Cancer Res Clin Oncol 2023; 149:14101-14112. [PMID: 37552308 DOI: 10.1007/s00432-023-05054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Clinical feasibility nomograms were developed to facilitate the differentiation between thymic epithelial tumors (TETs) and mediastinal lymphomas (MLs), aiming to minimize the occurrence of non-therapeutic thymectomy. METHODS A total of 255 patients diagnosed with TETs or MLs underwent pre-treatment 18F-FDG PET/CT. Comprehensive clinical and imaging data were collected, including age, gender, lactate dehydrogenase (LDH) level, pathological results, presence of myasthenia gravis symptoms, B symptoms, mass size, location, morphology, margins, density, and metabolic parameters derived from PET/CT. Radiomic features were extracted from the region of interest (ROI) of the primary lesion. Feature selection techniques were employed to identify the most discriminative subset of features. Machine learning methods were utilized to build candidate models, which were subsequently evaluated based on their area under the curve (AUC). Finally, nomograms were constructed using the optimal model to provide a clinical tool for improved diagnostic accuracy. The performance of the radiomic models was evaluated by their calibration, discrimination, and clinical utility. RESULTS Several independent risk factors were identified for distinguishing TETs from MLs, including average standardized uptake value (SUVavg), LDH, age, mass size, and radiomic score (rad-score). Significance was observed in differentiating the two types of tumors based on these factors. The best clinical efficacy was demonstrated by the combined model, with an impressive AUC of 0.954. Decision curve analysis and calibration curves indicated that the combined model was clinically advantageous for discriminating TETs from MLs. Besides, the results of external validation showed a sensitivity of 0.8 and a specificity of 0.78. CONCLUSION Preoperatively, the differentiation of TETs from MLs can be facilitated by the utilization of the combined clinical information and radiomics model. This approach holds promise in minimizing the occurrence of unnecessary anterior mediastinal surgeries.
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Affiliation(s)
- Jiatong Li
- PET-CT/MRI Department, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Harbin, 150081, Heilongjiang, China
| | - Nan Cui
- PET-CT/MRI Department, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Harbin, 150081, Heilongjiang, China
| | - Zhiyun Jiang
- Radiology Department, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Harbin, 150081, Heilongjiang, China
| | - Wei Li
- Interventional Vascular Surgery Department, The 4th Affiliated Hospital of Harbin Medical University, Harbin Medical University, 37 Yiyuan Road, Harbin, 150001, Heilongjiang, China
| | - Wei Liu
- PET-CT/MRI Department, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Harbin, 150081, Heilongjiang, China
| | - Shuai Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China.
| | - Kezheng Wang
- PET-CT/MRI Department, Harbin Medical University Cancer Hospital, Harbin Medical University, 150 Haping Road, Harbin, 150081, Heilongjiang, China.
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Byrd CT, Trope WL, Bhandari P, Konsker HB, Moradi F, Lui NS, Liou DZ, Backhus LM, Berry MF, Shrager JB. Positron emission tomography/computed tomography differentiates resectable thymoma from anterior mediastinal lymphoma. J Thorac Cardiovasc Surg 2023; 165:371-381.e1. [PMID: 35568521 DOI: 10.1016/j.jtcvs.2022.02.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Discrete anterior mediastinal masses most often represent thymoma or lymphoma. Lymphoma treatment is nonsurgical and requires biopsy. Noninvasive thymoma is ideally resected without biopsy, which may potentiate pleural metastases. This study sought to determine if clinical criteria or positron emission tomography/computed tomography could accurately differentiate the 2, guiding a direct surgery versus biopsy decision. METHODS A total of 48 subjects with resectable thymoma and 29 subjects with anterior mediastinal lymphoma treated from 2006 to 2019 were retrospectively examined. All had pretreatment positron emission tomography/computed tomography and appeared resectable (solitary, without clear invasion or metastasis). Reliability of clinical criteria (age and B symptoms) and positron emission tomography/computed tomography maximum standardized uptake value were assessed in differentiating thymoma and lymphoma using Wilcoxon rank-sum test, chi-square test, and logistic regression. Receiver operating characteristic analysis identified the maximum standardized uptake value threshold most associated with thymoma. RESULTS There was no association between tumor type and age group (P = .183) between those with thymoma versus anterior mediastinal lymphoma. Patients with thymoma were less likely to report B symptoms (P < .001). The median maximum standardized uptake value of thymoma and lymphoma differed dramatically: 4.35 versus 18.00 (P < .001). Maximum standardized uptake value was independently associated with tumor type on multivariable regression. On receiver operating characteristic analysis, lower maximum standardized uptake value was associated with thymoma. Maximum standardized uptake value less than 12.85 was associated with thymoma with 100.00% sensitivity and 88.89% positive predictive value. Maximum standardized uptake value less than 7.50 demonstrated 100.00% positive predictive value for thymoma. CONCLUSIONS Positron emission tomography/computed tomography maximum standardized uptake value of resectable anterior mediastinal masses may help guide a direct surgery versus biopsy decision. Tumors with maximum standardized uptake value less than 7.50 are likely thymoma and thus perhaps appropriately resected without biopsy. Tumors with maximum standardized uptake value greater than 7.50 should be biopsied to rule out lymphoma. Lymphoma is likely with maximum standardized uptake value greater than 12.85.
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Affiliation(s)
- Catherine T Byrd
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Winston L Trope
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Harrison B Konsker
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University School of Medicine, Stanford, Calif
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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Wang G, Du L, Lu X, Liu J, Zhang M, Pan Y, Meng X, Xu X, Guan Z, Yang J. Multiparameter diagnostic model based on 18F-FDG PET and clinical characteristics can differentiate thymic epithelial tumors from thymic lymphomas. BMC Cancer 2022; 22:895. [PMID: 35974323 PMCID: PMC9382789 DOI: 10.1186/s12885-022-09988-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of combined multiparametric 18F-fluorodeoxyglucose positron emission tomography (18FDG PET) with clinical characteristics in differentiating thymic epithelial tumors (TETs) from thymic lymphomas. PATIENTS AND METHODS A total of 173 patients with 80 TETs and 93 thymic lymphomas who underwent 18F-FDG PET/CT before treatment were enrolled in this retrospective study. All patients were confirmed by pathology, and baseline characteristics and clinical data were also collected. The semi-parameters of 18F-FDG PET/CT, including lesion size, SUVmax (maximum standard uptake value), SUVmean (mean standard uptake value), TLG (total lesion glycolysis), MTV (metabolic tumor volume) and SUVR (tumor-to-normal liver standard uptake value ratio) were evaluated. The differential diagnostic efficacy was evaluated using the receiver operating characteristic (ROC) curve. Integrated discriminatory improvement (IDI) and net reclassification improvement (NRI), and Delong test were used to evaluate the improvement in diagnostic efficacy. The clinical efficacy was evaluated by decision curve analysis (DCA). RESULTS Age, clinical symptoms, and metabolic parameters differed significantly between patients with TETs and thymic lymphomas. The ROC curve analysis of SUVR showed the highest differentiating diagnostic value (sensitivity = 0.763; specificity = 0.888; area under the curve [AUC] = 0.881). The combined diagnostics model of age, clinical symptoms and SUVR resulted in the highest AUC of 0.964 (sensitivity = 0.882, specificity = 0.963). Compared with SUVR, the diagnostic efficiency of the model was improved significantly. The DCA also confirmed the clinical efficacy of the model. CONCLUSIONS The multiparameter diagnosis model based on 18F-FDG PET and clinical characteristics had excellent value in the differential diagnosis of TETs and thymic lymphomas.
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Affiliation(s)
- Guanyun Wang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China.,Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lei Du
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xia Lu
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mingyu Zhang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yue Pan
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiaolin Meng
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiaodan Xu
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zhiwei Guan
- Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Jigang Yang
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
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He W, Xia C, Chen X, Yu J, Liu J, Pu H, Li X, Liu S, Chen X, Peng L. Computed Tomography-Based Radiomics for Differentiation of Thymic Epithelial Tumors and Lymphomas in Anterior Mediastinum. Front Oncol 2022; 12:869982. [PMID: 35646676 PMCID: PMC9136168 DOI: 10.3389/fonc.2022.869982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the differential diagnostic performance of computed tomography (CT)-based radiomics in thymic epithelial tumors (TETs) and lymphomas in anterior mediastinum. Methods There were 149 patients with TETs and 93 patients with lymphomas enrolled. These patients were assigned to a training set (n = 171) and an external validation set (n = 71). Dedicated radiomics prototype software was used to segment lesions on preoperative chest enhanced CT images and extract features. The multivariable logistic regression algorithm was used to construct three models according to clinico-radiologic features, radiomics features, and combined features, respectively. Performance of the three models was compared by using the area under the receiver operating characteristic curves (AUCs). Decision curve analysis was used to evaluate clinical utility of the three models. Results For clinico-radiologic model, radiomics signature model, and combined model, the AUCs were 0.860, 0.965, 0.975 and 0.843, 0.961, 0.955 in the training cohort and the test cohort, respectively (all P<0.05). The accuracies of each model were 0.836, 0.895, 0.918 and 0.845, 0.901, 0.859 in the two cohorts, respectively (all P<0.05). Compared with the clinico-radiologic model, better diagnostic performances were found in the radiomics signature model and the combined model. Conclusions Radiomics signature model and combined model exhibit outstanding and comparable differential diagnostic performances between TETs and lymphomas. The CT-based radiomics analysis might serve as an effective tool for accurately differentiating TETs from lymphomas before treatment.
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Affiliation(s)
- Wenzhang He
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huaxia Pu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shengmei Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyue Chen
- Computed Tomography (CT) Collaboration, Siemens Healthineers, Chengdu, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Zhao L, Wang H, Shi J. 18F-FDG PET/CT characteristics of solitary fibrous tumour of the pleura: single institution experience. Ann Nucl Med 2022; 36:429-438. [PMID: 35137364 DOI: 10.1007/s12149-022-01723-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND To date, published studies have shown that 18F-FDG PET/CT and CT have limited value in differentiating benign and malignant solitary fibrous tumours of the pleura (SFTP). This study aimed to determine whether the metabolic and morphological characteristics of 18F-FDG PET/CT can be a valuable addition to diagnostic tools for SFTPs. METHODS From January 2016 to November 2021, we performed a retrospective review in 32 SFTPs patients who underwent 18F-FDG PET/CT scan. All the SFTP diagnoses were confirmed by surgical resection or biopsy samples. The metabolic parameters (including SUVmax, SUVmean, MTV, TLG, and SULmax) were obtained from 18F-FDG PET/CT images. RESULTS Thirty-two patients with SFTP were consecutively identified. The malignant SFTPs have higher Ki-67 expression (P = 0.005). The study observed that tumour heterogeneity without contrast injection (P = 0.001) and intratumor blood vessels (P = 0.047) were morphological features associated with malignant SFTP. Malignant SFTP was more frequently observed with higher SUVmax values (P = 0.001), higher SUVmean values (P = 0.001), higher TLG values (P = 0.006), and higher SULmax values (P < 0.001). For predicting malignant SFTP, the AUC values of SUVmax, SUVmean, TLG, and SULmax obtained by the area under curve analysis were 0.970 (95% CI 0.907-1.000; P = 0.001), 0.874 (95% CI 0.675-1.000; P = 0.009), 0.807 (95% CI 0.654-0.961; P = 0.031), and 0.911 (95% CI 0.747-1.000; P = 0.004), respectively. CONCLUSION The study showed that metabolic and morphological features were useful for distinguishing malignant from benign SFTPs.
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Affiliation(s)
- Long Zhao
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - HuoQiang Wang
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Bu L, Tu N, Wang K, Zhou Y, Xie X, Han X, Lin H, Feng H. Relationship between 18F-FDG PET/CT Semi-Quantitative Parameters and International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society Classification in Lung Adenocarcinomas. Korean J Radiol 2022; 23:112-123. [PMID: 34983098 PMCID: PMC8743143 DOI: 10.3348/kjr.2021.0455] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the relationship between 18F-FDG PET/CT semi-quantitative parameters and the International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histopathologic classification, including histological subtypes, proliferation activity, and somatic mutations. Materials and Methods This retrospective study included 419 patients (150 males, 269 females; median age, 59.0 years; age range, 23.0–84.0 years) who had undergone surgical removal of stage IA–IIIA lung adenocarcinoma and had preoperative PET/CT data of lung tumors. The maximum standardized uptake values (SUVmax), background-subtracted volume (BSV), and background-subtracted lesion activity (BSL) derived from PET/CT were measured. The IASLC/ATS/ERS subtypes, Ki67 score, and epidermal growth factor/anaplastic lymphoma kinase (EGFR/ALK) mutation status were evaluated. The PET/CT semi-quantitative parameters were compared between the tumor subtypes using the Mann–Whitney U test or the Kruskal–Wallis test. The optimum cutoff values of the PET/CT semi-quantitative parameters for distinguishing the IASLC/ATS/ERS subtypes were calculated using receiver operating characteristic curve analysis. The correlation between the PET/CT semi-quantitative parameters and pathological parameters was analyzed using Spearman’s correlation. Statistical significance was set at p < 0.05. Results SUVmax, BSV, and BSL values were significantly higher in invasive adenocarcinoma (IA) than in minimally IA (MIA), and the values were higher in MIA than in adenocarcinoma in situ (AIS) (all p < 0.05). Remarkably, an SUVmax of 0.90 and a BSL of 3.62 were shown to be the optimal cutoff values for differentiating MIA from AIS, manifesting as pure ground-glass nodules with 100% sensitivity and specificity. Metabolic-volumetric parameters (BSV and BSL) were better potential independent factors than metabolic parameters (SUVmax) in differentiating growth patterns. SUVmax and BSL, rather than BSV, were strongly or moderately correlated with Ki67 in most subtypes, except for the micropapillary and solid predominant groups. PET/CT parameters were not correlated with EGFR/ALK mutation status. Conclusion As noninvasive surrogates, preoperative PET/CT semi-quantitative parameters could imply IASLC/ATS/ERS subtypes and Ki67 index and thus may contribute to improved management of precise surgery and postoperative adjuvant therapy.
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Affiliation(s)
- Lihong Bu
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ning Tu
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Wang
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ying Zhou
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xinli Xie
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xingmin Han
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huiqin Lin
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyan Feng
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China.
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