Clinical Value of 18F-FDG PET/CT in Prediction of Visceral Pleural Invasion of Subsolid Nodule Stage I Lung Adenocarcinoma

Published:February 13, 2020DOI:

      Rationale and Objectives

      This study investigated the utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting visceral pleural invasion (VPI) of subsolid nodule (SSN) stage I lung adenocarcinoma.

      Materials and Methods

      A retrospective analysis of 18F-FDG PET/CT data from 65 postsurgical cases with surgical pathology-confirmed SSN lung adenocarcinoma identified significant VPI predictors using multivariate logistic regression.


      Nodule and solid component sizes, solid component-to-tumor ratios, pleural indentations, distances between nodules and pleura, and maximum standardized uptake values (SUVmax) differed significantly between VPI-positive (n = 30) and VPI-negative (n = 35) cases on univariate analysis. The distance between the nodule and pleura and SUVmax were significant independent VPI predictors on multivariate analysis. Areas under the curve of the distance between the nodule and pleura and SUVmax on receiver operating characteristic curves were 0.76 and 0.79, respectively; both factors were 0.90. The area under the curve of combined predictors was significantly superior to the distance between the nodule and pleura only but not SUVmax alone. The threshold of the distance between the nodule and pleura, to predict VPI was 4.50 mm, with 96.67% sensitivity, and 57.14% specificity. The threshold of SUVmax to predict VPI was 1.05, with 100% sensitivity and 60% specificity. The sensitivity and specificity of model 2 using the independent predictive factors were 96.67%, and 71.43%, respectively.


      Distance between the nodule and pleura and SUVmax are independent predictors of VPI in SSN stage I lung adenocarcinoma. Further, combining these factors improves their predictive ability.

      Key Words


      AUC (area under the curve), CI (confidence interval), CT (computed tomography), CTR (solid component to tumor ratio), FDG (fluorodeoxyglucose), GGN (ground glass nodules), GGO (ground glass opacity), HE (hematoxylin and eosin), HRCT (high-resolution computed tomography), +LR (positive likelihood ratio), –LR (negative likelihood ratio), M (median), NPV (negative predictive value), OR (odds ratio), PET (positron emission tomography), PPV (positive predictive value), PSN (part-solid nodule), ROC (receiver operating characteristic), SSN (subsolid nodule), SUVmax (maximum standardized uptake value), TNM (tumor-node-metastasis), VIF (variance inflation factor), VPI (visceral pleural invasion)
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