1
|
García-Zoghby L, Amo-Salas M, Soriano Castrejón ÁM, García Vicente AM. Whole-body tumour burden on [18F]DCFPyL PET/CT in biochemical recurrence of prostate cancer: association with tumour biology and PSA kinetics. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06685-y. [PMID: 38520513 DOI: 10.1007/s00259-024-06685-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE The objective was to assess the association between molecular imaging (mi) variables on [18F]DCFPyL-PET/CT with clinical and disease characteristics and prostate specific antigen (PSA) related variables in patients with biochemical recurrence of prostate cancer (BRPC). MATERIAL AND METHODS We analysed patients with BRPC after radical treatment. We obtained clinical and PSA variables: International Society of Urology Pathology (ISUP) grade group, European Association of Urology (EAU) risk classification, PSA (PSA≤1ng/ml, 1 2), PSA doubling time (PSAdt) and PSA velocity (PSAvel). All PET/CT scans were reviewed with the assistance of automated Prostate Molecular Imaging Standardized Evaluation (aPROMISE) software and lesions' segmentation in positive scans was performed using this platform. Standardized uptake value (SUV) derived variables; tumour burden variables [whole-body tumour volume (wbTV), whole-body tumour lesion activity (wbTLA) and whole-body mi PSMA (wbPSMA)] and miTNM staging were obtained. Cut-off of PSA and kinetics able to predict PET/CT results were obtained. Associations between disease and mi variables were analysed using ANOVA, Kruskal-Wallis and Spearman's correlation tests. Multivariate analysis was also performed. RESULTS Two hundred and seventy-five patients were studied. [18F]DCFPyL-PET/CT were positive in 165/275 patients. In multivariate analysis, moment of biochemical recurrence, ISUP group, PSA level and PSAvel showed significant association with the detection rate. miTNM showed significant association with PSA level (p<0.001) and kinetics (p<0.001), being higher in patients with metastatic disease. Both PSA and PSAvel showed moderate correlation with wbTV, wbTLA and wbPSMA (p<0.001). A weak correlation with SUVs was found. Mean wbTV, wbTLA and wbPSMA values were significantly higher in PSA > 2ng/ml, PSAdt ≤ 6 months and PSAvel ≥ 0.2ng/ml/month groups. Also, wbTV (p=0.039) and wbPSMA (p=0.020) were significantly higher in patients with ISUP grade group 5. PSA and PSAvel cut-offs (1.15 ng/ml and 0.065 ng/ml/month) were significantly associated with a positive PET/CT. CONCLUSION Higher PSA values, unfavourable PSA kinetics and ISUP grade group 5 were robust predictive variables of larger tumour burden variables on [18F]DCFPyL PET/CT assessed by aPROMISE platform.
Collapse
Affiliation(s)
- Laura García-Zoghby
- Nuclear Medicine Department, University Hospital of Toledo, Av. del Río Guadiana, s/n, 45007, Toledo, Spain.
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Cam. Moledores, s/n, 13071, Ciudad Real, Spain
| | | | - Ana María García Vicente
- Nuclear Medicine Department, University Hospital of Toledo, Av. del Río Guadiana, s/n, 45007, Toledo, Spain
| |
Collapse
|
2
|
García Vicente AM, Lucas Lucas C, Pérez-Beteta J, Borrelli P, García Zoghby L, Amo-Salas M, Soriano Castrejón ÁM. Analytical performance validation of aPROMISE platform for prostate tumor burden, index and dominant tumor assessment with 18F-DCFPyL PET/CT. A pilot study. Sci Rep 2024; 14:3001. [PMID: 38321201 PMCID: PMC10847509 DOI: 10.1038/s41598-024-53683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/03/2024] [Indexed: 02/08/2024] Open
Abstract
To validate the performance of automated Prostate Cancer Molecular Imaging Standardized Evaluation (aPROMISE) in quantifying total prostate disease burden with 18F-DCFPyL PET/CT and to evaluate the interobserver and histopathologic concordance in the establishment of dominant and index tumor. Patients with a recent diagnosis of intermediate/high-risk prostate cancer underwent 18F-DCFPyL-PET/CT for staging purpose. In positive-18F-DCFPyL-PET/CT scans, automated prostate tumor segmentation was performed using aPROMISE software and compared to an in-house semiautomatic-manual guided segmentation procedure. SUV and volume related variables were obtained with two softwares. A blinded evaluation of dominant tumor (DT) and index tumor (IT) location was assessed by both groups of observers. In histopathological analysis, Gleason, International Society of Urological Pathology (ISUP) group, DT and IT location were obtained. We compared all the obtained variables by both software packages using intraclass correlation coefficient (ICC) and Cohen's kappa coefficient (k) for the concordance analysis. Fifty-four patients with a positive 18F-DCFPyL PET/CT were evaluated. The ICC for the SUVmax, SUVpeak, SUVmean, tumor volume (TV) and total lesion activity (TLA) was: 1, 0.833, 0.615, 0.494 and 0.950, respectively (p < 0.001 in all cases). For DT and IT detection, a high agreement was observed between both softwares (k = 0.733; p < 0.001 and k = 0.812; p < 0.001, respectively) although the concordances with histopathology were moderate (p < 0001). The analytical validation of aPROMISE showed a good performance for the SUVmax, TLA, DT and IT definition in comparison to our in-house method, although the concordance was moderate with histopathology for DT and IT.
Collapse
Affiliation(s)
- Ana María García Vicente
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain.
| | | | - Julián Pérez-Beteta
- Mathematical Oncology Laboratory (MOLab), Castilla-La Mancha University, Ciudad Real, Spain
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain
| | - Pablo Borrelli
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laura García Zoghby
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain
| | - Ángel María Soriano Castrejón
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain
| |
Collapse
|
3
|
Lucas Lucas C, García Zoghby L, Amo-Salas M, Soriano Castrejón ÁM, García Vicente AM. Diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL versus 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer: a pilot study. Ann Nucl Med 2023; 37:551-560. [PMID: 37532975 DOI: 10.1007/s12149-023-01859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/09/2023] [Indexed: 08/04/2023]
Abstract
AIM To assess the diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL with respect to 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer (PCa). MATERIAL AND METHODS Patients with recent diagnosis of intermediate-/high-risk PCa without androgen deprivation therapy and previous 18F-Fluorocholine-PET/CT (negative for extraprostatic disease or with oligometastatic disease) were referred to 18F-DCFPyL-PET/CT. Patients' disease characteristic as grade group, D'Amico risk category (intermediate/high), prostate-specific antigen (PSA) closest to PET/CTs and its kinetics were obtained. The overall detection rate (DR) and molecular imaging TNM (miTNM) stage according to the prostate cancer molecular imaging standardized evaluation (PROMISE) criteria were assessed for both radiotracers, and their concordance (Kappa coefficient) was analyzed. The diagnostic and therapeutic impact of 18F-DCFPyL with respect to 18F-Fluorocholine was evaluated. RESULTS Fifty-eight patients were analyzed (84.5% high-risk). 18F-Fluorocholine showed a higher DR than 18F-DCFPyL of prostate gland involvement (100% versus 93.1%) and pelvic node disease (37.9% versus 31%; k = 0.436, p = 0.001). On the other hand, 18F-DCFPyL-PET/CT showed a higher DR of metastatic disease than 18F-Fluorocholine-PET/CT, 9/58 patients (15.5%): 3 M1a, 5 M1b and 1 M1c) versus 5/58 (8.6%) patients: 1 M1a and 4 M1b), k = 0.426; p = 0.001. No significant association was found between clinical characteristics (grade group, risk category, PSA level and kinetic) and 18F-Fluorocholine or 18F-DCFPyL results. The results of 18F-DCFPyL-PET/CT modified the previously planned treatment compared to 18F-Fluorocholine-PET/CT in 13 patients (22.4%). CONCLUSIONS 18F-Fluorocholine and 18F-DCFPyL PET/CT showed a similar DR of prostate gland and lymph node involvement, although with moderate concordance for the latter. 18F-DCFPyL was superior to 18F-Fluorocholine in detecting regional and distant metastasis with a therapeutic impact in one of every five patients.
Collapse
Affiliation(s)
- Cristina Lucas Lucas
- Nuclear Medicine Department, University General Hospital, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Laura García Zoghby
- Nuclear Medicine Department, Complejo Hospitalario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain
| | | | - Ana María García Vicente
- Nuclear Medicine Department, Complejo Hospitalario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain.
| |
Collapse
|
4
|
García Vicente AM, Noriega Álvarez E, González Rodríguez JC, Soriano Castrejón ÁM. Brain Nocardiosis Defined by 18 F-Fluorocholine PET/CT. Clin Nucl Med 2023; 48:327-329. [PMID: 36727854 DOI: 10.1097/rlu.0000000000004564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Nocardia infection (nocardiosis) is usually acquired by inhalation; so pulmonary nocardiosis is the most common clinical presentation. Extrapulmonary localization occurs through hematogenous dissemination or contiguous spread. Nocardia can involve the central nervous system in a very reduced number of patients, mainly in immunocompromised. We present a case of a 56-year-old woman with a history of aggressive systemic mastocytosis, treated with chemotherapy 1 year ago. Patient reported intense headache, disorientation, and blurry vision without other symptoms being diagnosed with a rare brain nocardiosis by Nocardia cerradoensis . Neither bacteremia nor pulmonary involvement was detected. Brain PET/CT illustrated 18 F-fluorocholine avidity on brain abscesses.
Collapse
Affiliation(s)
| | - Edel Noriega Álvarez
- From the Nuclear Medicine Department, University General Hospital, Ciudad Real, Spain
| | | | | |
Collapse
|
5
|
García Vicente AM, Amo-Salas M, Sandoval Valencia H, Lozano Setien E, Soriano Castrejón ÁM. Early Recurrence Detection of Glioma Using 18 F-Fluorocholine PET/CT : GliReDe Pilot Study. Clin Nucl Med 2022; 47:856-862. [PMID: 35835092 DOI: 10.1097/rlu.0000000000004329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the usefulness of 18 F-fluorocholine PET/CT in the early diagnosis of tumor recurrence, increasing the diagnosis confidence of MRI. METHODS Patients with a previous gross total resection of glioma and the first suspicious or doubtful for recurrence MRI were prospectively included and subjected to 18 F-fluorocholine PET/CT. An independent and combined assessment of 18 F-fluorocholine PET/CT and multimodal MRI was performed classifying the studies as positive or negative for tumor recurrence. Final diagnosis (recurrence or not) was obtained by histological confirmation or clinical and imaging follow-up. The relation of SUV max and tumor-to-background ratio with progression, the diagnostic performance of imaging techniques, and their concordance (κ Cohen) were analyzed. RESULTS Twenty-four studies on 21 patients were assessed. Recurrence was diagnosed in 20 cases. PET/CT was positive in 23 cases (3 false positive), whereas MRI was positive in 15 cases (1 false positive). MRI was false negative in 6 cases. There was no false negative on 18 F-fluorocholine PET/CT. Accuracy of PET/CT versus MRI was 87.5% and 70.8%, respectively. The combined evaluation of both techniques did not show any advantage with respect to PET/CT results alone. The concordance between both imaging techniques was low (κ = 0.135; P = 0.375). SUV max and tumor-to-background ratio were related to recurrence (areas under the curve of 0.844 [ P = 0.033] and 0.869 [ P = 0.022], respectively). CONCLUSIONS 18 F-fluorocholine PET/CT was helpful for increasing the diagnostic confidence in the cases of MRI doubtful for recurrence in order to avoid a delayed diagnosis.
Collapse
Affiliation(s)
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real
| | | | | | | |
Collapse
|
6
|
García Vicente AM, Pena Pardo FJ, Amo-Salas M, Villena Martín M, López Menéndez C, Soriano Castrejón ÁM, Pérez-Beteta J. Prognostic Potential of Postoperative 18F-Fluorocholine PET/CT in Patients With High-Grade Glioma. Clinical Validation of FuMeGA Postoperative PET Criteria. Clin Nucl Med 2022; 47:480-487. [PMID: 35426853 DOI: 10.1097/rlu.0000000000004127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the prognostic performance of postoperative 18F-fluorocholine PET/CT in patients with high-grade glioma (HGG). METHODS Patients with HGG who underwent preoperative and postoperative 18F-fluorocholine PET/CT were prospectively enrolled in the study. Postoperative MRI was classified as complete versus incomplete resection. Postoperative 18F-fluorocholine PET/CT was classified as negative (complete) or positive for metabolic residual tumor (incomplete resection) using a 5-point score system. The correlation of positive locations on PET/CT with the sites of subsequent tumor recurrence was evaluated. The concordance of postoperative imaging techniques (Cohen κ) and their relation with progression-free survival and overall survival were assessed using Kaplan-Meier method and Cox regression analysis. RESULTS Fifty-one studies, belonging to 47 patients, were assessed. Four patients underwent 2 postoperative 18F-fluorocholine PET/CT scans as they needed a second tumor resection for recurrence. In the follow-up, 42 patients progressed, and 37 died. Concordance between postoperative PET/CT and MRI assessment was poor. Resection grade on MRI did not show any significant association with prognosis. In multivariate analysis, only age and postoperative PET/CT showed significant association with progression-free survival (hazard ratio [HR], 1.03 [1.01-1.06, P = 0.006] and 1.88 [0.96-3.71, P = 0.067], respectively) and overall survival (HR, 1.04 [1.01-1.07, P = 0.004] and 2.63 [1.22-5.68, P = 0.014], respectively). Postoperative positive 18F-fluorocholine PET/CT locations correlated with the sites of subsequent tumor recurrence in 81.82% of cases. CONCLUSION Postoperative 18F-fluorocholine PET/CT seems superior to postoperative MRI in the outcome prediction of patients with HGG, outperforming it in the identification of the most probable location of tumor recurrence.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Julián Pérez-Beteta
- Mathematical Oncology Laboratory (MôLAB), Castilla-La Mancha University, Ciudad Real, Spain
| |
Collapse
|
7
|
García Vicente AM, Pérez-Beteta J, Bosque JJ, Soriano Castrejón ÁM, Pérez-García VM. Multiple and Diffuse Gliomas by 18F-Fluorocholine PET/CT: Two Sides of the Same Coin. Clin Nucl Med 2022; 47:e457-e465. [PMID: 35507438 DOI: 10.1097/rlu.0000000000004145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Gliomas are characterized by an inherent diffuse and irregular morphology that prevents defining a boundary between tumor and healthy tissue, both in imaging assessment and surgical field. The effective identification of the extent of the disease in diffuse and multiple gliomas is crucial for their management but doing so by radiological means can be challenging. We present a broad spectrum of diffuse and multiple gliomas using 18F-fluorocholine PET/CT, demonstrating the potential of metabolic imaging in the evaluation of these gliomas, with implications in patient clinical management and outcome.
Collapse
Affiliation(s)
| | - Julian Pérez-Beteta
- Mathematical Oncology Laboratory, Castilla-La Mancha University, Ciudad Real, Spain
| | - Jesús J Bosque
- Mathematical Oncology Laboratory, Castilla-La Mancha University, Ciudad Real, Spain
| | | | | |
Collapse
|
8
|
Jiménez Londoño GA, García Vicente AM, Bosque JJ, Amo-Salas M, Pérez-Beteta J, Honguero-Martinez AF, Pérez-García VM, Soriano Castrejón ÁM. SUVmax to tumor perimeter distance: a robust radiomics prognostic biomarker in resectable non-small cell lung cancer patients. Eur Radiol 2022; 32:3889-3902. [PMID: 35133484 DOI: 10.1007/s00330-021-08523-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prognostic value of novel geometric variables obtained from pre-treatment [18F]FDG PET/CT with respect to classical ones in patients with non-small cell lung cancer (NSCLC). METHODS Retrospective study including stage I-III NSCLC patients with baseline [18F]FDG PET/CT. Clinical, histopathologic, and metabolic parameters were obtained. After tumor segmentation, SUV and volume-based variables, global texture, sphericity, and two novel parameters, normalized SUVpeak to centroid distance (nSCD) and normalized SUVmax to perimeter distance (nSPD), were obtained. Early recurrence (ER) and short-term mortality (STM) were used as end points. Univariate logistic regression and multivariate logistic regression with respect to ER and STM were performed. RESULTS A cohort of 173 patients was selected. ER was detected in 49/104 of patients with recurrent disease. Additionally, 100 patients died and 53 had STM. Age, pathologic lymphovascular invasion, lymph nodal infiltration, TNM stage, nSCD, and nSPD were associated with ER, although only age (aOR = 1.06, p = 0.002), pathologic lymphovascular invasion (aOR = 3.40, p = 0.022), and nSPD (aOR = 0.02, p = 0.018) were significant independent predictors of ER in multivariate analysis. Age, lymph nodal infiltration, TNM stage, nSCD, and nSPD were predictors of STM. Age (aOR = 1.05, p = 0.006), lymph nodal infiltration (aOR = 2.72, p = 0.005), and nSPD (aOR = 0.03, p = 0.022) were significantly associated with STM in multivariate analysis. Coefficient of variation (COV) and SUVmean/SUVmax ratio did not show significant predictive value with respect to ER or STM. CONCLUSION The geometric variables, nSCD and nSPD, are robust biomarkers of the poorest outcome prediction of patients with NSCLC with respect to classical PET variables. KEY POINTS • In NSCLC patients, it is crucial to find prognostic parameters since TNM system alone cannot explain the variation in lung cancer survival. • Age, lymphovascular invasion, lymph nodal infiltration, and metabolic geometrical parameters were useful as prognostic parameters. • The displacement grade of the highest point of metabolic activity towards the periphery assessed by geometric variables obtained from [18F]FDG PET/CT was a robust biomarker of the poorest outcome prediction of patients with NSCLC.
Collapse
Affiliation(s)
| | - Ana Maria García Vicente
- Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Jesús J Bosque
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Mariano Amo-Salas
- Department of Mathematics, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Julián Pérez-Beteta
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | | | - Víctor M Pérez-García
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | | |
Collapse
|
9
|
Tello Galán MJ, García Vicente AM, Pérez Beteta J, Amo Salas M, Jiménez Londoño GA, Pena Pardo FJ, Soriano Castrejón ÁM, Pérez García VM. Global heterogeneity assessed with 18F-FDG PET/CT. Relation with biological variables and prognosis in locally advanced breast cancer. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
van Gómez López O, García Vicente AM, Honguero Martínez AF, Jiménez Londoño GA, Vega Caicedo CH, León Atance P, Soriano Castrejón ÁM. (18)F-FDG-PET/CT in the assessment of pulmonary solitary nodules: comparison of different analysis methods and risk variables in the prediction of malignancy. Transl Lung Cancer Res 2015. [PMID: 26207210 DOI: 10.3978/j.issn.2218-6751.2015.05.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of different metabolical, morphological and clinical criteria for correct presurgical classification of the solitary pulmonary nodule (SPN). METHODS Fifty-five patients, with SPN were retrospectively analyzed. All patients underwent preoperative (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT). Maximum diameter in CT, maximum standard uptake value (SUVmax), histopathologic result, age, smoking history and gender were obtained. Different criteria were established to classify a SPN as malignant: (I) visually detectable metabolism, (II) SUVmax >2.5 regardless of SPN diameter, (III) SUVmax threshold depending of SPN diameter, and (IV) ratio SUVmax/diameter greater than 1. For each criterion, statistical diagnostic parameters were obtained. Receiver operating characteristic (ROC) analysis was performed to select the best diagnostic SUVmax and SUVmax/diameter cutoff. Additionally, a predictive model of malignancy of the SPN was derived by multivariate logistic regression. RESULTS Fifteen SPN (27.3%) were benign and 40 (72.7%) malignant. The mean values ± standard deviation (SD) of SPN diameter and SUVmax were 1.93±0.57 cm and 3.93±2.67 respectively. Sensitivity (Se) and specificity (Sp) of the different diagnostic criteria were (I): 97.5% and 13.1%; (II) 67.5% and 53.3%; (III) 70% and 53.3%; and (IV) 85% and 33.3%, respectively. The SUVmax cut-off value with the best diagnostic performance was 1.95 (Se: 80%; Sp: 53.3%). The predictive model had a Se of 87.5% and Sp of 46.7%. The SUVmax was independent variables to predict malignancy. CONCLUSIONS The assessment by semiquantitative methods did not improve the Se of visual analysis. The limited Sp was independent on the method used. However, the predictive model combining SUVmax and age was the best diagnostic approach.
Collapse
Affiliation(s)
- Ober van Gómez López
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Ana María García Vicente
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Antonio Francisco Honguero Martínez
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Germán Andrés Jiménez Londoño
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Carlos Hugo Vega Caicedo
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Pablo León Atance
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| | - Ángel María Soriano Castrejón
- 1 Nuclear Medicine Department, University General Hospital of Ciudad Real, Ciudad Real, Spain ; 2 Department of Thoracic Surgery, University Hospital of Albacete, Albacete, Spain
| |
Collapse
|