正电子发射断层扫描/计算机断层扫描鉴别可切除胸腺瘤和前纵隔淋巴瘤

SCI

18 April 2022

Positron Emission Tomography/Computed Tomography differentiates resectable thymoma from anterior mediastinal lymphoma

(The Journal of Thoracic and Cardiovascular Surgery, IF: 5.209)

• Catherine T. Byrd, MD, Winston L. Trope, BE, Prasha Bhandari, MPH, Harrison B.Konsker, Farshad Moradi, MD, Natalie S. Lui, MD, Douglas Z. Liou, MD, Leah M.Backhus, MD, Mark F. Berry, MD, Joseph B. Shrager, MD

• CORRESPONDENCE TO: shrager@stanford.edu

Objective 目的

Discrete anterior mediastinal masses most often represent thymoma or lymphoma. Lymphoma treatment is non-surgical and requires biopsy. Non-invasive thymoma is ideally resected without biopsy, which may potentiate pleural metastases. This study sought to determine if clinical criteria and/or PET/CT could accurately differentiate the two, guiding a direct surgery vs. biopsy decision.

前纵隔离散性肿块通常代表胸腺瘤或淋巴瘤。通常以非手术方式治疗淋巴瘤并且需要活检。而非侵袭性胸腺瘤最好不经活检就切除，因为活检可能会加剧胸膜转移。本项研究试图确定临床标准和/或PET/CT是否能够准确区分这两种疾病，从而指导直接手术和活检决定。

Methods 方法

48 subjects with resectable thymoma and 29 with anterior mediastinal lymphoma treated from 2006-2019 were retrospectively examined. All had pre-treatment PET/CT and appeared resectable (solitary, without clear invasion or metastasis). Reliability of clinical criteria (age and B symptoms) and PET/CT SUVmax were assessed in differentiating thymoma and lymphoma using Wilcoxon rank-sum test, chi-square test, and logistic regression. ROC analysis identified the SUVmax threshold most associated with thymoma.

回顾性分析2006-2019年间收治的48例可切除胸腺瘤和29例前纵隔淋巴瘤患者。所有患者均在治疗前接受PET/CT检查，并提示可切除（单发，无明显浸润或转移）。采用Wilcoxon秩和检验、卡方检验和逻辑回归分析，评估临床标准（年龄和B类症状）和PET/CT SUVmax在区分胸腺瘤和淋巴瘤方面的可靠性。ROC分析确定了与胸腺瘤最相关的SUVmax阈值。

Results 结果

There was no association between tumor type and age group (p = 0.183) between those with thymoma vs. anterior mediastinal lymphoma. Thymoma patients were less likely to report B symptoms (p <0.001). The median SUVmax of thymoma and lymphoma differed dramatically: 4.35 v. 18.00, p <0.001. SUVmax was independently associated with tumor type on multivariable regression. On ROC analysis, lower SUVmax was associated with thymoma. SUVmax <12.85 was associated with thymoma with 100.00% sensitivity and 88.89% positive predictive value. SUVmax < 7.50 demonstrated 100.00% positive predictive value for thymoma.

胸腺瘤患者与前纵隔淋巴瘤患者之间，肿瘤类型与年龄组（p = 0.183）之间无相关性。胸腺瘤患者报告B类症状的可能性较低（p<0.001）。胸腺瘤和淋巴瘤的SUVmax中位数差异显著：4.35对18.00，p<0.001。在多变量回归中，SUVmax与肿瘤类型独立相关。ROC分析显示，SUVmax降低与胸腺瘤相关。SUVmax<12.85与胸腺瘤相关，敏感性为100.00%，阳性预测值为88.89%。SUVmax<7.50对胸腺瘤的阳性预测值为100.00%。

Conclusion 结论

PET/CT SUVmax of resectable anterior mediastinal masses may help guide a direct surgery vs. biopsy decision. Tumors with SUVmax <7.50 are likely thymoma and thus perhaps appropriately resected without biopsy. Tumors with SUVmax >7.50 should be biopsied to rule out lymphoma. Lymphoma is likely with SUVmax >12.85.

可切除前纵隔肿块的PET/CT SUVmax有助于指导直接手术或进行活检的决策制定。SUVmax<7.50的肿瘤很可能是胸腺瘤，因此可以在不进行活检的情况下适当切除。SUVmax>7.50的肿瘤应进行活检以排除淋巴瘤。SUVmax>12.85可能是淋巴瘤。

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