| Objective:1.To analyze the value of 18F-FDG PET/CT glucose metabolic activity parameter SUVmax(maximum of standardized uptake value)in differentiating and diagnosing the malignancy(including pathological stage,pathological differentiation and pathological subtypes)of primary lung adenocarcinoma diagnosed at the first time,and explore the correlation with it's clinical pathology.2.To analyze the basic clinical data,clinical relevant history and some typical CT imaging features of?3cm lung adenocarcinoma lesions and their correlation with different pathological subtypes,and to explore the prognostic risk evaluation of these factors in different pathological subtypes of lung adenocarcinoma.3.To compare and analyze the diagnostic efficacy of SUVmax combined with basic clinical data,clinical relevant history and typical CT imaging features for?3cm lung adenocarcinoma lesions of different pathological subtypes,and to explore the value of clinical diagnosis and treatment.Methods:1.The value of SUVmax in the differential diagnosis of the primary malignant degree of primary lung adenocarcinoma:PET and CT images together with clinic pathological data were collected from 85 patients with primary lung adenocarcinoma confirmed by pathology department from Jiangsu University Hospital from 2015 to 2018.Retrospective measurement of the semi-quantitative parameter SUVmax of PET/CT,and analyzation of the difference of SUVmax between 85 patients with primary lung adenocarcinoma in the first diagnosis and lesions..In 55 patients with lung adenocarcinoma,55 patients with pathologically clear differentiation were compared,and the degree of differentiation and SUVmax of lesions were compared.58 out of 85 patients with lung adenocarcinoma who were?3 cm and pathologically clear pathological subtypes were analyzed,and the correlations between different pathological types and SUVmax of lesions were compared.2.Clinical based data?clinical related medical history and typical CT imaging characteristics.Efficacy evaluation of prognosis risk of primary?3cm lung adenocarcinoma lesions:statistical analysis of 58 cases of?3cm lung adenocarcinoma lesion pathological classification and clinical basic data(age,gender)and clinically relevant medical history(smoking history,family history,current medical history),and analysis of their relevance.The pathological type and typical CT features of 58 cases of?3cm lung adenocarcinoma lesions(incidence site,lesion maximum diameter,boundary,lobulation sign,burr sign,pleural indentation sign,vascular bundle sign,air bronchus sign,vacuole sign)and analyze its relevance.3.The research results above were compared and analyzed to investigate the diagnostic effect of SUVmax.Combined with basic clinical data,clinical related history and typical CT imaging features,the lesions of?3cm lung adenocarcinoma of different pathological subtypes were analyzed.Results:1.In 85 patients with lung adenocarcinoma,the median SUVmax of pT1,pT2+pT3,and pT4tumors were 5.15(2.58~7.29),12.56(8.83~17.05),and 18.58(16.99~19.53),respectively.The difference was statistically significant,and in the later the stage of the disease,the SUVmax was higher(?2=16.64,P<0.001).Based on the 7.765 threshold and the SUVmax<7.675,the sensitivity and specificity of pT1 lung adenocarcinoma were 81.58%and 70.59%,respectively,and the area under the curve was 0.767(P<0.001).At a cutoff value of 16.6,the sensitivity and specificity of pT4 lung adenocarcinoma were 80%and 73.68%,respectively,and the area under the curve was 0.755(P<0.001).The median SUVmax of glucose metabolism activity in the three groups of well-differentiated,moderately differentiated,and poorly differentiated tumors were 6.3(3.38~10.28),7.42(5.17~11.47),and 18.46(13.65~20.79),respectively.The difference was statistically significant and differentiated.The lower the degree,the larger the SUVmax(?~2=17.38,P<0.001).At 9.89,the sensitivity and specificity of poorly differentiated lung adenocarcinoma were 71.43%and 93.75%,respectively,and the area under the curve was 0.893(P<0.001).The median SUVmax of the tumors in the low-risk group and the high-risk group were 4.07(2.04-4.91)and 12.28(9.64~18.39),respectively.The difference between the two groups was statistically significant(?2=15.97,P<0.001).The lesion with a poor prognosis(high risk group)has a higher SUVmax.With a cutoff value of 5.25 and SUVmax>5.25,the sensitivity and specificity of invasive lung adenocarcinoma were 83.33%and 81.8%,respectively,and the area under the curve was 0.828(P<0.001).2.58 cases of primary lung adenocarcinoma lesions?3cm were divided into two groups according to the prognosis,22 cases in low-risk group(including AIS and MIA)and 36 cases in high-risk group(IAC).After statistical analysis,gender and border(tumor lung interface)were statistically significant(P<0.05)in different subtypes of primary lung adenocarcinoma lesions of?3 cm.Age,clinically relevant medical history(including smoking history,family history,current medical history),maximum lesion diameter,and location of the disease were not statistically significant in distinguishing between low-risk group and high-risk group(P>0.05).In terms of CT features,the difference between the two groups in the incidence of ground glass density and air bronchogram was statistically significant(P<0.05),while the lobulated sign,burr sign,pleural indentation sign,vascular bundle sign,There was no significant difference in vacuolar sign between the two groups(P>0.05).Based on the above CT features,the sensitivity and specificity for the diagnosis of low-risk lung adenocarcinoma were 75.0%and 86.4%,respectively.3.SUVmax combined with CT features for?3cm of the first diagnosis of primary lung adenocarcinoma lesions different subtypes prognosis risk assessment efficacy:high-risk lung adenocarcinoma group SUVmax is significantly higher than the low-risk lung adenocarcinoma group,and with 5.25 as The optimal cut-off value was distinguished between the low-risk lung adenocarcinoma group and the high-risk lung adenocarcinoma group.The area under the curve was0.828(P<0.001).The optimal threshold value of 5.25 for SUVmax was used as the PET/CT risk assessment standard.At this time,the sensitivity and specificity of 18F-FDG PET/CT semi-quantitative parameter SUVmax for the diagnosis of high-risk lung adenocarcinoma(IAC)were 83.33%and 81.8%,respectively.The sensitivity and specificity of SUVmax combined with CT features in the risk assessment of high-risk lung adenocarcinoma were 91.7%and 68.2%,respectively.Conclusions:1.The SUVmax value of the primary diagnosis of primary lung adenocarcinoma has a high level of correlation with the degree of malignancy(including pT stage,pathological differentiation and pathological subtype).The later stage,the lower the degree of pathological differentiation,IAC prompt lung adenocarcinoma malignant degree is higher,corresponding SUVmax is higher.2.The prognostic risk of lung adenocarcinoma lesions?3 cm was strongly correlated with gender,boundary,ground glass density,and air bronchial sign.In female patients,lung adenocarcinoma lesions?3cm with unclear boundary,ground glass density,and visible air bronchial sign often indicated a better prognosis.3.The combination of SUVmax and typical CT features can improve the sensitivity of the prognosis risk assessment of lung adenocarcinoma lesions?3 cm to a certain extent. |
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