| Purpose: To investigate the imaging features of misdiagnosis of 18F-FDG PET/CT in solitary pulmonary adenocarcinoma,and to analyze the relationship between PET/CT signs and pathological classification.Methods: 201 cases of solitary pulmonary nodules with complete PET/CT diagnostic data and confirmed by pathology as lung adenocarcinoma were collected.In 201 patients,135 cases were pathologically diagnosed.66 cases were pathologically diagnosed by biopsy(CT biopsy,fiberoptic bronchoscopy or ultrasound-guided biopsy).In 2011,the American Thoracic Society(ATS),the International Association for the Study of Lung Cancer(IASLC)and the European Respiratory Society(ERS)were classified for the first time in the international division of adenocarcinoma of the lung.The classification methods applied to small biopsy specimens,surgical excision specimens and cytology were first proposed.In the new classification,lung adenocarcinoma includes invasive adenocarcinoma(IAC),minimally invasive adenocarcinoma(MIA),preinvasive lesions [ adenocarcinoma in situ(AIS),atypical adenomatous hyperplasia(AAH)] and variant in the lung in 2015.According to the new criteria,the main classification was confirmed,including acinar type,papillary type,adherent type,solid type and mixed type.In view of the high heterogeneity of lung adenocarcinoma,the most common type was classified.According to the above classification and classification criteria,in the 201 cases of this study,the whole tissue was not taken from the whole tissue due to the existence of biopsy,and AIS,MIA were not diagnosed.In 201 patients,there were 187 cases of invasive adenocarcinoma and 7 cases of variant type.7 cases were diagnosed as metastasis of lung adenocarcinoma.In invasive adenocarcinoma,there were 93 cases of acinar type,46 cases of papillary type,16 cases with adherent type,21 cases of solid type and 11 cases of mixed type.PET/CT features include: maximum standardized uptake value and the morphologies of nodules.Solid nodules in 191 cases,of which CT features including lobulation,pleural retraction,speculation,Bronchial truncation,Internal bronchus puncture,Bronchial gathered,gathered through small calcification,with cavity or vacuole and obstructive pneumonia around nodules.GGO included 10 cases,all of which were mixed ground glass nodule(m GGN).Logistics regression was used to analyze the misjudged factors of PET/CT imaging in isolated lung adenocarcinoma,and to test the level of ? =0.05.The relationship between the classification of lung adenocarcinoma and the PET/CT imaging features was analyzed by square cross-over analysis.In the conformance judgment of PET/CT and pathological diagnosis,independent t test was used to analyze the SUVmax of different nodules(solid nodules/GGO),and whether the aspect ratio was an indicator of misjudgment.Results: 1.PET/CT diagnosis was correct in 190 cases,with the accuracy of 94.5%.11 cases of diagnosis were misdiagnosed,of which 10 cases were misdiagnosed as inflammation and 1 were misdiagnosed as tuberculosis.2.In the case of this group,the male was slightly more than the female.Among them,107 were male and 94 were female.The age distribution was 28-78 years,and the average age was 57.7±9.5 years.At the age of 60-69 years,the number of patients was the largest,including 72 cases,accounting for 35.8% of the total number.50-59 years old patients were the second,including 68 cases,accounting for 33.8%.40-49 years accounted for third,including 33 cases,accounting for 16.2%.From this set of data,we can see that the age of onset of lung adenocarcinoma is mainly in 40-69 years,accounting for about 85.5%,while 7 cases were less than 40 years,accounting for 3.5%,21 cases of patients were over 70 years,accounting for 10.4%.3.There were 84 cases of nodules in the left lung,of which 52 cases were in the upper lobe and 32 cases of lower lobe.In the right lung,there were 117 cases,of which 65 cases were in the upper lobe,18 cases in the middle lobe and 34 cases in the lower lobe.It shows that the nodules mainly occur in the two upper lobe and overlap with the mainly location of the tuberculosis.4.In 201 cases,the diameter of the nodule was divided into long diameter and short diameter.Nodules in the long and short diameter segmented into 11-20 mm,21-30 mm and ? 10 mm.With the short diameter into 11-20 mm,including 131 cases,accounting for 65.2%.In the second,short diameter into 21-30 mm,including 48 cases,accounting for 23.9%;finally,with the short diameter into ?10mm including 22 patients,accounting for 10.9%.The mean diameter of short diameter is 16.7±5.0mm.The length into 21-30 mm rank the first place,there were 100 cases,accounting for 49.8% of the total number;the length into 21-30 mm with 95 cases,accounting for 47.3%;the length into < = 10 mm were only 6 cases,accounting for 3%.The average length is 20.4±5.5mm.With logistics regression analysis,there was no correlation between the size of nodules and the diagnosis of PET/CT in this group(p>0.05).In this study,in 201 cases of lung adenocarcinoma,the average ratio of the longitudinal and transverse diameter was 1.2±0.6.There were 190 cases in which the PET/CT diagnosis was consistency with the pathological diagnosis,and the mean value of the longitudinal and transverse diameter was 1.2±0.2.In the 11 patients in inconsistency diagnosis,the average ratio of longitudinal and transverse ratio was 1.3±0.2.There was no significant difference between them via the t test.5.In 201 cases,Solid nodules in 191 cases,of which CT features including lobulation,pleural retraction,spicule sign,bronchial truncation,Internal bronchus puncture,bronchial gathered,gathered through small calcification,with cavity or vacuole and obstructive pneumonia around nodules.GGO included 10 cases,all of which were mixed ground glass nodule(m GGN).In the CT signs of lung adenocarcinoma,lobular sign,pleura traction and spicule sign ranked the top three,accounting for 89.1%,78.6% and 55.2%,respectively.6.In 201 patients with lung adenocarcinoma,the distribution of SUVmax was 0-20.7,with a mean of 7.0±4.3.In comparison the diagnosis of gold standard pathology with PET/CT,the right diagnosis of PET/CT are 190 cases,the average value of SUVmax was 7.2±4.3;the inconsistency diagnosis of PET/CT and pathological are 11 cases,the average value of SUVmax is 2.9±1.7.Through logistics regression analysis,there were statistical difference(p<0.05).In this study,there were 23 cases of SUVmax < 2.5,of which 5 cases were misdiagnosed via PET/CT,and the rate of misdiagnosis was about 22%.SUVmax is more than 2.5 in 178 cases,6 cases were misdiagnosed,the misdiagnosis rate is about 3.3%.The t test analysis showed that there were significant differences between them(p=0.04).In 201 cases,10 cases of GGO were found,the mean value of SUVmax was 2.5±2.9,and 191 cases of solid nodules,the average value of SUVmax was 7.2±4.2.The t test analysis showed that there were significant differences between them(p=0.04).Among the 10 GGO patients,1 cases were misdiagnosed and the misdiagnosis rate was 10%,and among the 191 real nodules,10 cases were misdiagnosed and the misdiagnosis rate was 5.2%.7.Applying regression analysis to analyze which factors influenced the misdiagnosis of PET/CT,the result were obstructive pneumonia around the nodules(OR=0.097,95%CI: 0.016-0.600,p=0.012)and SUVmax(OR=0.650,95%CI: 0.498-0.848,p= 0.002)with statistical difference.8.With square cross-over analysis,there was no significant correlation between the morphological and metabolic values(SUVmax)of isolated pulmonary adenocarcinoma and the classification of pathology(p>0.05).Conclude: The diagnostic efficiency of 18F-FDG PET/CT in solitary pulmonary nodules was very high,and the accuracy is 94.5%.In this group,there was little difference in sex.And the nodules mainly occur in the two upper lobe and overlap with the mainly location of the tuberculosis.Lobule sign,pleura traction and burr sign were the top three over other CT signs,accounting for 89.1%,78.6% and 55.2%,respectively.It was indicated that the appearance of these signs was more likely to be malignant tumors.With the logistics regression analysis,this study showed metabolic values(SUVmax)and obstructive pneumonia were the two important factors leading to misdiagnosis.And via square cross-over analysis,there was no significant correlation between the morphological and metabolic value(SUVmax)of PET/CT signs and the pathological classification.The pathological diagnosis was still the gold standard for the diagnosis of lung adenocarcinoma. |
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