Evaluation of Malignancy Risk of Ampullary Tumors Detected by Endoscopy Using 2-[18F]FDG PET/CT.

IF 4.4 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Korean Journal of Radiology Pub Date : 2024-03-01 DOI:10.3348/kjr.2023.0295
Pei-Ju Chuang, Hsiu-Po Wang, Yu-Wen Tien, Wei-Shan Chin, Min-Shu Hsieh, Chieh-Chang Chen, Tzu-Chan Hong, Chi-Lun Ko, Yen-Wen Wu, Mei-Fang Cheng
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Abstract

Objective: We aimed to investigate whether 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy.

Materials and methods: This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[18F]FDG PET/CT for endoscopy-detected ampullary tumors 5-87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test.

Results: The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in early-phase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13-36.18; P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80-13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41-19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00-14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16-21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874-0.956] vs. 0.815 [0.732-0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816-0.967) in candidates for endoscopic papillectomy.

Conclusion: Adding 2-[18F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

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利用 2-[18F]FDG PET/CT 评估内窥镜检查发现的胰腺肿瘤的恶性风险
研究目的我们旨在研究2-[18F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描(2-[18F]FDG PET/CT)是否有助于评估内镜检查发现的胰腺肿瘤的恶性风险:这项单中心回顾性队列研究分析了2007年6月至2020年12月期间因内镜检查发现胰腺肿瘤而接受2-[18F]FDG PET/CT治疗的155例患者(男79例,女76例;平均年龄(65.7±12.7)岁),这些患者在诊断性内镜检查后5-87天(中位数为7天)接受了2-[18F]FDG PET/CT治疗。最终诊断以组织病理学结果为依据。PET 成像参数与临床数据和内窥镜特征进行了比较。利用多变量逻辑回归分析和额外的引导方法生成并验证了一个基于 PET、内窥镜检查和临床结果的恶性肿瘤风险预测模型。使用 DeLong 检验将最终模型与标准内镜诊断膀胱癌进行了比较:肿瘤平均大小为 17.1 ± 7.7 毫米。64个肿瘤(41.3%)为良性,91个肿瘤(58.7%)为恶性。单变量分析发现,早期扫描血池校正峰值标准化摄取值(SUVe)≥1.7的胰腺肿瘤更有可能是恶性的(几率比[OR],16.06;95%置信区间[CI],7.13-36.18;P < 0.001)。多变量分析确定了黄疸的存在(调整 OR [aOR],4.89;95% CI,1.80-13.33;P = 0.002)、内镜检查的恶性特征(aOR,6.80;95% CI,2.41-19.20;P < 0.001)、PET SUVe ≥ 1.7(aOR,5.43;95% CI,2.00-14.72;P < 0.001)和 PET 检测到的结节病(aOR,5.03;95% CI,1.16-21.86;P = 0.041)作为恶性肿瘤的独立预测因素。结合这四个因素的模型对胰腺癌的预测优于单独的内镜诊断(曲线下面积 [AUC] 和 95% CI:0.925 [0.874-0.956] vs. 0.815 [0.732-0.873],P < 0.001)。该模型显示,内镜乳头切除术候选者的AUC为0.921(95% CI,0.816-0.967):结论:在内镜检查中加入 2-[18F]FDG PET/CT 可提高胰腺癌的诊断率,有助于完善治疗决策,尤其是在考虑内镜乳头切除术时。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Korean Journal of Radiology
Korean Journal of Radiology 医学-核医学
CiteScore
10.60
自引率
12.50%
发文量
141
审稿时长
1.3 months
期刊介绍: The inaugural issue of the Korean J Radiol came out in March 2000. Our journal aims to produce and propagate knowledge on radiologic imaging and related sciences. A unique feature of the articles published in the Journal will be their reflection of global trends in radiology combined with an East-Asian perspective. Geographic differences in disease prevalence will be reflected in the contents of papers, and this will serve to enrich our body of knowledge. World''s outstanding radiologists from many countries are serving as editorial board of our journal.
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