Predicting the nature of pleural effusion in patients with lung adenocarcinoma based on 18F-FDG PET/CT

Yi Li,Wei Mu,Yan Huang,Xiao Song,Lei Jiang,Yuan Li

doi:10.1186/s13550-021-00850-2

Abstract

BackgroundThis study aims to establish a predictive model on the basis of 18F-FDG PET/CT for diagnosing the nature of pleural effusion (PE) in patients with lung adenocarcinoma.MethodsLung adenocarcinoma patients with PE who underwent 18F-FDG PET/CT were collected and divided into training and test cohorts. PET/CT parameters and clinical information in the training cohort were collected to estimate the independent predictive factors of malignant pleural effusion (MPE) and to establish a predictive model. This model was then applied to the test cohort to evaluate the diagnostic efficacy.ResultsA total of 413 lung adenocarcinoma patients with PE were enrolled in this study, including 245 patients with MPE and 168 patients with benign PE (BPE). The patients were divided into training (289 patients) and test (124 patients) cohorts. CEA, SUVmax of tumor and attachment to the pleura, obstructive atelectasis or pneumonia, SUVmax of pleura, and SUVmax of PE were identified as independent significant factors of MPE and were used to construct a predictive model, which was graphically represented as a nomogram. This predictive model showed good discrimination with the area under the curve (AUC) of 0.970 (95% CI 0.954–0.986) and good calibration. Application of the nomogram in the test cohort still gave good discrimination with AUC of 0.979 (95% CI 0.961–0.998) and good calibration. Decision curve analysis demonstrated that this nomogram was clinically useful.ConclusionsOur predictive model based on 18F-FDG PET/CT showed good diagnostic performance for PE, which was helpful to differentiate MPE from BPE in patients with lung adenocarcinoma.

Highlights

This study aims to establish a predictive model on the basis of 18F-FDG PET/computed tomography (CT) for diagnosing the nature of pleural effusion (PE) in patients with lung adenocarcinoma
This study aims to establish a predictive model based on 18FFDG positron emission tomography/CT (PET/CT) parameters and to provide effective guidance for clinicians to differentiate malignant pleural effusion (MPE) from benign PE (BPE)
The diagnosis of MPE was established on the basis of malignant cells found in the cytological or histological examination of the pleural fluid or pleura, which was obtained within 4 weeks before or after the 18F-FDG PET/CT scan

Summary

Introduction

This study aims to establish a predictive model on the basis of 18F-FDG PET/CT for diagnosing the nature of pleural effusion (PE) in patients with lung adenocarcinoma. Methods: Lung adenocarcinoma patients with PE who underwent 18F-FDG PET/CT were collected and divided into training and test cohorts. PET/CT parameters and clinical information in the training cohort were collected to estimate the independent predictive factors of malignant pleural effusion (MPE) and to establish a predictive model. This model was applied to the test cohort to evaluate the diagnostic efficacy. Thoracentesis is often the first clinical method to diagnose MPE, but the sensitivity of cytological diagnosis based on the pleural fluid is at most 60% [8]. These procedures are invasive and even failed because of the patients’ physical condition or unqualified specimens [11]

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