Construction and validation of the predictive models for the pathological invasion of early lung adenocarcinoma presenting as ground glass nodules based on 18F-FDG PET/CT / 中华核医学与分子影像杂志

ABSTRACT

Objective:To construct and verify of the predictive models for pathologic invasion of early lung adenocarcinoma with ground glass nodules (GGNs) based on 18F-FDG PET/CT. Methods:A retrospective analysis was conducted on 149 patients (44 males, 105 females; age (61.1±8.9) years) with pre-invasive lesions/minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) confirmed by pathology after surgery in the First People′s Hospital of Changzhou from October 2011 to October 2019. All patients underwent PET/CT for GGNs. GGNs were randomly divided into a modeling group and validation group with the proportion of 1∶1. Mann-Whitney U test or χ2 test was used to compare the qualitative morphological characteristics (shape, edge characteristics, etc.), quantitative parameters (consolidation-to-tumor ratio, attenuation value of the ground glass opacity (GGO) component on CT (CT GGO), etc.) and quantitative functional parameters (SUV max and SUV index(GGNs SUV max/liver SUV mean) of pre-invasive lesions/MIA and IAC. Logistic regression analysis was used to construct the models, and the ROC curve was used to verify the models′ robustness. Different AUCs were compared by Delong test. Results:A total of 170 GGNs were removed by surgery and confirmed pathologically. In the modeling group ( n=89), the proportion of mixed GGNs, irregular shape, edge characteristics, bronchiectasis/twist/truncation sign, GGNs maximum diameter and solid component maximum diameter, consolidation-to-tumor ratio, CT GGO, SUV max and SUV index in IAC group were significantly higher than those in pre-invasive/MIA group ( χ2 values 5.00-23.40, z values from -6.53 to -2.70, all P<0.05). Models 1-3 were constructed based on the qualitative parameters (GGNs type, edge characteristics), quantitative parameters (CT GGO, SUV index), combined qualitative and quantitative parameters (GGNs type, edge characteristics, SUV index) of PET/CT, respectively, and the AUCs of ROC were 0.896, 0.880 and 0.931 in the modeling group, respectively. And the AUC of model 2 was not decreased significantly in the validation group ( n=81; AUC=0.802; z=0.81, P=0.417). Conclusion:The model combined with morphological and functional quantitative parameters of 18F-FDG PET/CT can effectively predict the pathological invasion of early lung adenocarcinoma, and the constructed model is robust.