新医学2026，Vol.57Issue(8)：881-890,10.DOI:10.12464/j.issn.0253-9802.2026-0156
PET/CT影像组学鉴别肿瘤标志物阴性且FDG摄取阳性孤立性肺结节的临床价值
Clinical value of PET/CT radiomics in differentiating tumor marker-negative,FDG-avid solitary pulmonary nodules
摘要
Abstract
Objective To investigate the clinical value of an 18F-FDG PET/CT radiomics model in differentiating benign from malignant solitary pulmonary nodules with negative tumor markers and positive FDG uptake.Methods The data of 130 patients with such pulmonary nodules admitted to Baoding No.1 Central Hospital from January 2019 to December 2024 were collected.The patients were randomly divided into a training set(n=91)and an internal test set(n=39)at a ratio of 7:3.Eligible independent cases were additionally collected from the Cancer Imaging Archive(TCIA)public database as an external validation set(n=45).PET and CT radiomics features were extracted using LIFEx software.Core features were selected through intraclass correlation coefficient(ICC)stability assessment,Spearman correlation analysis,and least absolute shrinkage and selection operator(LASSO)regression.Logistic regression(LR),random forest(RF),and support vector machine(SVM)models were constructed separately.Receiver operating characteristic(ROC)curves and decision curve analysis(DCA)were used to evaluate and compare the performance of the models.Results A total of 8 key radiomics features were ultimately selected,including 4 PET features and 4 CT features.In the internal test set,the LR model showed the best performance,with an area under the curve(AUC)of 0.819(95%CI:0.738-0.892),a sensitivity of 0.792,and a specificity of 0.800.In the external validation set,the LR model also maintained the best discriminative performance,with an AUC of 0.801(95%CI:0.713-0.905),which was significantly higher than those of the RF model(AUC=0.721,P=0.041)and the SVM model(AUC=0.717,P=0.028).DCA demonstrated that the LR model yielded greater clinical net benefit in both the internal test set and the external validation set.Conclusions For difficult-to-differentiate solitary pulmonary nodules with negative tumor markers and high FDG uptake,PET/CT radiomics models,particularly the LR model,have good discriminative performance and generalizability and can provide an objective quantitative reference for preoperative decision-making.关键词
肺结节/正电子发射计算机断层显像/影像组学/预测模型/肿瘤标志物阴性Key words
Solitary pulmonary nodule/PET/CT/Radiomics/Prediction model/Negative tumor markers分类
医药卫生引用本文复制引用
张建媛,席永昌,尤立强,张建阳,张力丹,田晓媛..PET/CT影像组学鉴别肿瘤标志物阴性且FDG摄取阳性孤立性肺结节的临床价值[J].新医学,2026,57(8):881-890,10.基金项目
河北省医学科学研究课题计划项目(20232029) （20232029）
保定市科技计划项目(2241ZF262) （2241ZF262）
