| Background and objective With the wide spread of multi-slice spiral CT and enhanced of people’s healthy consciousness, and as becoming increasingly routine CT examination and the low dose spiral CT scan of the lung, the little solitary pulmonary nodules has been detected increasingly. However, two thirds of nodules are difficult to be diagnosed just from the expression of CT scans, such as the signs of sizes, shape and internal structure. As a kind of non-specific pulmonary nodules, the benign and malignant diagnosis of focal ground glass nodule(f GGN) has been more and more attend and researched. It was reported that about 63%-64% of f GGN could be malignant, if it was still persistent after anti-inflammatory treatment or dynamic follow-up. As the focal ground glass nodule, early lung adenocarcinoma is operated timely, the 5-year survival rate can be reached 100%. So the early diagnosis of the benign and malignant can effectively guide the follow-up treatments of f GGN, treat the malignant nodules timely, avoid the excessive treatment of benign lesions, also can significantly improve the prognosis of patients. 18F-FDG PET/CT has been used in the clinical widely, and it has a big advantage in the diagnosis of benign and malignant focal pulmonary nodules. But 18F-FDG is non-special tumor imaging agent, because in some inflammation or TB infection it can also be highly uptake, just as a false positive diagnosis. Just according to the metabolic state of f GGN, some research showed that the false negative rate of p GGN is 100%, and the false negative rate of m GGN is more than 60%. With the improvement of CT, the research of f GGN’s diagnosis was more and more, thisresearch was according to the imaging manifestations combined with 18F-FDG metabolism imaging. In 2011, it was put forward a new classification of lung adenocarcinoma of the pathology, from the International lung cancer research institute(IASLC), the American thoracic society(ATS)and the European respiratory society(ERS). The pathological of lung adenocarcinoma was divided into four categories: the lesion before infiltrating, micro infiltrating adenocarcinoma, infiltrating adenocarcinoma and variant infiltrating adenocarcinoma. Some reports showed the relationship between lung adenocarcinoma subtype classification and the MSCT signs, but the research of PET/CT metabolic relate and pathological subtype is less. Based on the progress of medical technology and the in-depth understanding of the lung adenocarcinoma, there was a great changes in the 21 st century for the treatment of the lung adenocarcinoma, the gene mutation individualized treatment has replaced the conventional surgery, radiotherapy, chemotherapy and other traditional methods. Individualized treatment which was based on the gene mutations detection has become a hot research topic and obtained the remarkable curative effect in clinic. The present study showed there was a obvious correlation between subtypes of lung adenocarcinoma(the 2011 IASLC/ATS/ERS new classification standard) and EGFR gene mutations. Haneda reported that the rates of EGFR gene mutation was 58% in lung adenocarcinoma with small bronchioloalveolar carcinoma subtype. The rate of EGFR gene mutation in micro type papillary adenocarcinoma was 62%. But there is no report about relation between EGFR gene mutation and PET/CT metabolic.This research contained two aspects:Correlation analysis between PET/CT characteristic imaging of Pulmonary focal ground glass nodule and its histopathologic subtype Correlation analysis between PET/CT characteristic imaging and EGFR gene mutation of lung adenocarcinoma which is characterized by ground glass noduleThe main innovation points of this study are as follows:1.Compared 18F-FDG PET/CT metabolism, imaging manisfestation with pathology of p GGN, m GGN, evaluated the value of the 18F-FDG PET/CT on diagnosing the f GGN2.Assessed the relationship between the pathological subtype with 18F-FDG PET/CT imaging findings of malignant f GGN, improving the diagnostic accuracy of f GGN imaging 3.Compared the f GGN which was confirmed early lung adenocarcinoma and pathological subtype, discussed the correlation of the imaging and metabolism imaging of 18F-FDG PET/CT with EGFR gene mutation 4.Summarized EGFR gene mutation in early lung adenocarcinoma which is characterized by f GGN,and comparing it with the imaging characteristics and pathological subtype to understand their correlation.Part1 Relevant research between 18F-FDG PET/CT imaging of Pulmonary focal ground glass nodule with histopathologic subtypeObjective 1.Compared the lung f GGN 18F-FDG PET/CT metabolism and imaging with pathology, which contained 89 cases of patients,evaluated the value of 18F-FDG PET/CT to diagnosis the p GGN and m GGN. 2.Conclused 50 cases of malignant lung noules, Compared the 18F-FDG PET/CT metabolism and imaging findings with lung adenocarcinoma pathological subtype, discussed the relevance of the pathological types and f GGN metabolism and imaging characteristics.Materials and methods Collected 89 patients who was diagnosed lung f GGN in our hospital, all patients have received 18F-FDG PET/CT examination from Mar 1st 2014 to Dec 31 2015. They were divided into two groups according to the p GGN(uncontain solid elements) and m GGN(contain solid elements). Summarized the CT imaging features : lesions of location, size, spicule sign, lobulated sign, air bronchogram sign, vacuole sign,vessel convergence sign,pleural indentation sign, and the value of 18F-FDG metabolism, compared with the pathological subtype. then evaluated the value of 18F-FDG PET/CT to diagnosis f GGN, and concluded the relationship of imaging features and metabolism with pathological subtype.Result 1.General data In the 89 patients, 39 cases were benign lesions(male 18 cases,female 21 cases,age54.95±11.482),50 cases were malignant lesions((male 14 cases,female 36 cases,age58.24±10.007). Adopted Mann-whitney test, there was no obvious correlation between age, size, begign, malignant with the benign and malignant of lesions. The size of the lesion was larger in malignant group larger,but with no statistical significance. 2. Collected 35 cases of f GGN, compared the 18F-FDG PET/CT metabolism and imaging findings with benign and malignant, The data used X±s. The two groups were adopted T test. The lobulated sign and spicule sign has great value in diagnosis of benign and malignant of f GGN(P<0.05). For the metabolism of 18F-FDG,different reference index of sensitivity, specificity, accuracy, the Youden index compared with the rate of four case table c2 test,on the basis of SUVmax≧0.8,the diagnostic specificity(57.1%), sensitivity(71.4%) were the best. Compared with 18F-FDG PET,CT imaging, 18F-FDG PET/CT can get a better specificity(81.0%) and sensitivity(85.7%). 3. Collected 59 cases of m GGN, compaed the 18F-FDG PET/CT metabolism and imaging findings with benign and malignant. The data used `X±s. the two groups were adopted T test. The lobulation sign,spiculation sign and pleural indentation sign great value in diagnosis of benign and malignant of m GGN(P<0.05). For the metabolism of 18F-FDG, different reference index of sensitivity,specificity,accuracy, the Youden index compared with the rate of four case table c2 test, on the basis of SUVmax≥2, the diagnostic specificity(66.7%) and sensitivity(77.8%)were the best, 18F-FDG PET/CT can get a better accuracy( 83.3%) and sensitivity(94.4%) compared with 18F-FDG PET with CT. 4. The 50 cases of malignant f GGN divided into three groups based on the new classification of lung adenocarcinoma, includsd the Pre invasion, micro infiltrating adenocarcinoma and infiltrating adenocarcinoma. Compared the 18F-FDG PET/CT metabolism and imaging features with pathological types, The two groups were adopted the T test. The metabolism of micro invasive adenocarcinoma and invasive adenocarcinoma was significantly higher than preinvasive lesions, and there was significant statistical significance. And the infiltrating adenocarcinoma will be with spicule sign, lobulated sign, air bronchogram sign, vacuole sign in CT scanning then other groups(P < 0.05). Also the 18F-FDG metabolism was significantly higher than that of preinvasive lesions and micro invasive adenocarcinoma.Conclusion 1. The diagnosis of benign and malignant f GGN have no correlation with age,gender,and the location, the larger lesion could be high possibility malignant. 2. For the p GGN, when the SUVmax≥0.8, the diagnosis specificity and sensitivity are the best for metabolism p GGN. 18F-FDG PET/CT have better accuracy(81.0%) and apecility(85.7%) combined with18F-FDG PET and CT imaging. 3. For the m GGN, when the SUVmax≥2,the diagnostic specificity and sensitivity are the best for numerical metabolism m GGN. 18F-FDG PET/CT have better accuracy(83.3%) and apecility(94.4%) combined with18F-FDG PET and CT imaging. 4. Compared the lung adenocarcinoma pathology with 18F-FDG PET-CT metabolism and imaging of the malignant f GGN, which accorded to the new classification of lung adenocarcinoma pathology, spicule sign, lobulated sign, air bronchogram sign, vacuole sign in CT scanning and 18F-FDG metabolism can be diagonsed infiltrating adenocarcinoma, more than micro infiltrating adenocarcinoma and infiltrating adenocarcinoma.Part2 Relevant research between 18F-FDG PET/CT metabolism and imaging, pathological subtypes and EGFR gene mutation of focal ground glass nodule in lung adenocarcinomaObjectives Explored the correlation between 18F-FDG PET/CT metabolism and imaging signs,pathology subtype with EGFR gene mutation of focal ground glass nodule lung adenocarcinoma.Materials and Methods Collected 42 cases of focal ground glass nodule in lung adenocarcinoma. which was diagnosed by CT guided biopsy or surgery from Mar 1, 2014 to Dec 31,2015 in our hospital. Collected pathological subtype and EGFR gene mutations, which was acquired by Arms-PCR. Based on the pathological subtype of lung adenocarcinoma n standarded by IASLC/ATS/ERS in 2011. To explore the correlation of clinic,18F-FDG PET/CT metabolism and imaging signs,pathology subtype with EGFR gene mutation in focal ground glass nodule clinic.Results The rate of EGFR gene mutation was 76.2%(32/42), contained 82.8% of women(24/29), 61.5% of men(8/13), It is no significant statistical different. It was a higher mutation rate 82.9%(29/35) in smokers than non-smokers patients′mutation, there was significant statistical difference. The data was input into SPSS17.0 and adopted X2 test of pathological subtype, which contained /CT imaging with EGFR gene mutation. There was no correlation between them. There was no correlation between 18F-FDG PET metabolism and EGFR gene mutation, which were adopted Mann-whitney test. On the basis of lung adenocarcinoma by IASLC/ATS/ERS standard in 2011, the rate of EGFR gene mutation ratio was 94.1%( 16/17) in alveolus adenocarcinoma,including, 71.4% for papilla type(5/7), 50% for micro-papilla type(1/2). Solid type is given priority to with mucus for 100%(2/2)mutation. that mutation always been found in the papilla and alveolus type adopted X2 test.Conclusion: 1. Deletion mutation of exon19 and point mutations of 2573(L858R) in exon21 have always been found frequently, with high mutation rate of 25%(8/32), 59.4%(19/32), respectively.2. This phenomenon was dominant in women and more non-smokers especially. 3. From the correlation analysis between 18F-FDG PET/CT metabolism/ radiographic signs and pathology type, significant difference has been found in the part of the edge shape(leaf, burr). 4. For the IASLC/ATS/ERS in 2011 lung adenocarcinoma new classification standard, EGFR gene mutations always been found in the papilla and alveolus type(P<0.05). |
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