Abstract：Objective: To investigate the value of the maximum standardized uptake value(SUVmax) of 18F-FDG PET/CT metabolic parameters in the diagnosis of non-small cell lung cancer pulmonary neuroendocrine tumors, and the correlation between SUVmax and Ki-67 index. Methods: Twenty-seven patients with non-small cell lung cancer pulmonary neuroendocrine tumors confirmed by pathology were included retrospectively. They were divided into large cell neuroendocrine lung carcinoma group(16 cases) and carcinoid group(11 cases). And the carcinoid group was divided into typical carcinoid group(6 cases) and atypical carcinoid group(5 cases). All cases were divided into lymph node metastasis group(14 cases) and non-lymph node metastasis group(13 cases). All patients underwent 18F-FDG PET/CT examination within 6 weeks before operation. To compare the difference of SUVmax and Ki-67 index between large cell lung cancer group and carcinoid group, typical carcinoid group and atypical carcinoid group, the ROC curve was drawn, the area under curve(AUC) was calculated and the diagnostic threshold was defined. The difference of SUVmax between lymph node metastasis group and non-lymph node metastasis group were compared. The correlation between SUVmax and Ki-67 index, maximum diameter of tumors and tumor stage were analyzed by Spearman correlation analysis. Results: The SUVmax and Ki-67 indices of large cell lung cancer were significantly higher than those of carcinoid(P=0.001; P<0.001). There was no statistical difference between the SUVmax and Ki-67 indices of typical carcinoid and atypical carcinoid. The best diagnostic threshold of SUVmax for differentiating carcinoid from large cell lung cancer was 7.1, AUC was 0.794(P=0.001), sensitivity was 69.23%, specificity was 78.57%. There was no difference in SUVmax between lymph node metastasis group and non-lymph node metastasis group. SUVmax was correlated with Ki-67 index(R=0.665, P<0.001) and the maximum diameter of tumors(R=0.726, P<0.001), but not with the stage of tumors. Conclusion: 18F-FDG PET/CT can be used in the differential diagnosis of large cell lung cancer and carcinoid, but cann’t distinguish non-typical and typical carcinoid. It can have high accucacy when 2.0 was set the positive diagnostic threshold.
何 巍，穆晓东. 18F-FDG PET/CT在非小细胞肺癌肺神经内分泌肿瘤诊断中的价值[J]. 中国临床医学影像杂志, 2019, 30(10): 690-693.
HE Wei, MU Xiao-dong. Diagnostic value of 18F-FDG PET/CT in non-small cell lung cancer pulmonary neuroendocrine tumors. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(10): 690-693.
[1]Dincer HE, Podgaetz E, Andrade RS. Pulmonary neuroendocrine tumors: part Ⅰ. spectrum and characteristics of tumors[J]. J Bronchol Interv Pulmonol, 2015, 22(3): 267-273.
[2]Patnaik S, Liu J, Dong M, et al. Prognostic value of 18F-FDG PET/CT in surgical non-small cell lung cancer: A meta-analysis[J]. PLoS One, 2016, 11(1): e0146195.
[3]Turkmen C, Sonmezoglu K, Toker A, et al. The additional value of FDG PET imaging for distinguishing N0 or N1 from N2 stage in preoperative staging of non-small cell lung cancer in region where the prevalence of inflammatory lung disease is high[J]. Clin Nucl Med, 2007, 32(8): 607-612.
[4]Zhu D, Wang Y, Wang L, et al. Prognostic value of the maximum standardized uptake value of pre-treatment primary lesions in small-cell lung cancer on 18F-FDG PET/CT: A meta-analysis[J]. Acta Radiologica, 2017, 59(9): 1082-1090.
[5]Chong S, Lee KS, Chung MJ, et al. Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings[J]. Radiographics, 2006, 26(1): 41-57.
[6]Beasley MB, Brambilla E, Travis WD. The 2004 world health organization classification of lung tumors[J]. Semin Roentgenol, 2005, 40(2): 90-97.
[7]Mirsadraee S, Oswal D, Alizadeh Y, et al. The 7th lung cancer TNM classification and staging system: Review of the changes and implications[J]. World J Radiol, 2012, 4(4): 128-134.
[8]Oberg K, Hellman P, Ferolla P, et al. Neuroendocrine bronchial and thymic tumors: ESMO clinical practice guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2012, 23(Suppl 7): vii120-vii123.
[9]Filosso PL, Ferolla P, Guerrera F, et al. Multidisciplinary management of advanced lung neuroendocrine tumors[J]. J Thorac Dis, 2015, 7(Suppl 2): S163-171.
[10]Bromińska B, Czepczyński R, Gabryel P, et al. 18F-FDG PET/CT and nestin expression as prognostic tools in pulmonary neuroendocrine tumours[J]. Nucl Med Commun, 2019, 40(4): 353-360.
[11]Uhlen N, Grundberg O, Jacobsson H, et al. 18F-FDG PET/CT diagnosis of bronchopulmonary carcinoids versus pulmonary hamartomas[J]. Clin Nucl Med, 2016, 41(4): 263-267.
[12]Moore W, Freiberg E, Bishawi M, et al. FDG-PET imaging in patients with pulmonary carcinoid tumor[J]. Clin Nucl Med. 2013, 38(7): 501-505.
[13]Belhocine T, Foidart J, Rigo P, et al. Fluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumours: correlations with the pathological indexes p53 and Ki-67[J]. Nucl Med Commun, 2002, 23(8): 727-734.
[14]Sundin A, Eriksson B, Bergstr?觟m M, et al. Pet in the diagnosis of neuroendocrine tumors[J]. Ann N Y Acad Sci, 2004, 1014(1): 246-257.
[15]Lococo F, Treglia G, Cesario A, et al. Functional imaging evaluation in the detection, diagnosis, and histologic differentiation of pulmonary neuroendocrine tumors[J]. Thorac Surg Clin, 2014, 24(3): 285-292.
[16]Zhan P, Xie H, Xu C, et al. Management strategy of solitary pulmonary nodules[J]. J Thorac Dis, 2013, 5(6): 824-829.
[17]Ost DE, Gould MK. Decision making in patients with pulmonary nodules[J]. Am J Respir Crit Care Med, 2012, 185(4): 363-372.
[18]Menon SS, Guruvayoorappan C, Sakthivel KM, et al. Ki-67 protein as a tumour proliferation marker[J]. Clin Chim Acta, 2019, 491: 39-45.
