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Predicting solitary pulmonary lesions in breast cancer patients using 18fluorodeoxyglucose-positron emission tomography/computed tomography combined with clinicopathological characteristics

BMC Pulmonary Medicine volume 24, Article number: 595 (2024) Cite this article

Abstract

Background

Solitary pulmonary nodules (SPNs) remain difficult to diagnose for clinical therapeutic purposes in patients with a history of breast cancer. This study try to investigate the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) combined with clinicopathological predictors for the differential diagnosis of SPNs in breast cancer patients.

Methods

One hundred and twenty breast cancer patients with newly detected SPNs were enrolled in the study and divided into a primary lung cancer (PLC) group and a breast cancer metastasis (BCM) group. The clinicopathological characteristics as well as metabolic and morphological characteristics on 18F-FDG-PET/CT images of 120 patients were retrospectively reviewed. The differences of clinicopathological and 18F-FDG-PET/CT characteristics between the two groups were analyzed, and multivariate analyses for the diagnosis of SPNs were performed.

Results

Clinicopathological terms of carcinoembryonic antigen (CEA) and CA15-3 levels exhibited significant differences between PLC and BCM groups (P = 0.005 and P = 0.001, respectively). Metabolic characteristics of 18F-FDG-PET/CT images included FDG uptake, SUVmax of SPNs, hilar and/or mediastinal lymph node metastasis, SUVmax of hilar and/or mediastinal lymph node, and extrapulmonary metastasis showed significant differences between PLC and BCM groups (P = 0.004, P < 0.001, P = 0.01, P = 0.032 and P = 0.023, respectively). The lobulation sign, spicule sign, and pleural indentation sign were identified as statistically different morphological features of PLC in CT images (all P < 0.001). Among these, the SUVmax of SPNs, lobulation sign, and pleural indentation sign were valuable predictive factors for accurate diagnosis of SPNs in breast cancer patients.

Conclusions

18F-FDG-PET/CT combined with serum tumor markers are valuable for the diagnosis of SPNs in breast cancer patients.

Peer Review reports

Introduction

Solitary pulmonary nodules (SPNs) remain difficult to diagnose for clinical therapeutic purposes in patients with a history of breast cancer. Although the lung is the second most frequent site of breast cancer metastasis (BCM) and patients with pulmonary BCM have a low 5-year survival rate, primary lung cancer (PLC) is the most common second primary malignant tumor in patients with breast cancer [1, 2]. Different types of SPNs require unique treatment plans in patients with breast cancer. Systemic diagnosis and treatment protocols according to the TNM stage of breast cancer should be used for BCM patients, while the standard treatment plan for PLC involves complete excision of the tumor combined with lymph node dissection [3].

Some invasive examinations such as bronchoscopy and computed tomography guided needle biopsy are considered to be the gold standard for diagnosing SPNs. However, in some cases, even frozen sections cannot accurately differentiate primary lung cancer from metastatic tumors [4]. With the development of molecular imaging, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was recommended by the American College of Chest Physicians (ACCP) for diagnosing SPNs of more than 8 mm in diameter [5]. Quantitative parameters such as the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) can provide metabolic information beyond tumor morphology, and have been used wildly in the investigation of PLC. However, few studies have focused on 18F-FDG-PET/CT features in differentiating solitary metastases from PLC [6,7,8]. Compared to benign nodule, malignant SPN requires more attention and timely treatment, so the differentiation of different pathological types of malignant SPN is more important. In this study, we retrospectively analyzed 18F-FDG-PET/CT and clinicopathological characteristics of malignant SPNs in 120 breast cancer patients, aiming to investigate the value of 18F-FDG-PET/CT combined with clinicopathological predictors for the differential diagnosis of SPNs in breast cancer patients.

Methods

Patients

Patients who underwent 18F-FDG-PET/CT scanning at the first affiliated hospital of Anhui Medical University from May 2018 to July 2024 were retrospectively selected. The inclusion criteria were as follows: (1) female patients with pathologically confirmed breast cancer and clinical stage I-IV, with or without previous standardized treatment including surgical excision, neoadjuvant chemotherapy (NAC), and radiation therapy (RT); (2) a newly detected SPN of more than 8 mm in diameter on CT or 18F-FDG-PET/CT images; and (3) a pathological report of SPN that was available after surgical resection or CT-guided puncture. The exclusion criteria were as follows: (1) patient history of other primary malignancies; (2) benign SPN confirmed by pathology; (3) poor image quality of 18F-FDG-PET/CT .

This study was approved by the ethics committee of Anhui Medical University and was conducted in accordance with the Declaration of Helsinki. This is a retrospective study and no personally identifiable information was included. Therefore, informed consent was waived by our institution.

Interpretation of clinicopathological characteristics

Clinicopathological characteristics of breast cancer patients included age, smoking history, serum levels of carcinoembryonic antigen (CEA) and CA15-3, pathological T and N stages, clinical stage (I, II, III, and IV), therapy method (surgery/surgery + NAC/surgery + RT), and disease-free interval (DFI) between the date of breast cancer resection and that of SPN detection (month). The TNM staging and clinical staging was determined according to the 8th edition of the American Joint Committee on Cancer (AJCC). Positive CEA indicated a serum CEA level > 5 ng/ml and positive CA15-3 indicated serum CA153 level > 26 ng/ml.

18F-FDG-PET/CT image acquisition

Image acquisition was performed using a biography 64 TruePoint PET-CT scanner (SiemensHealthcare, Knoxville, TN) and the radiochemical purity of the 18F-FDG imaging agent (Nanjing Jiangyuan Andike Positron Research and Development Co., Ltd.) was greater than 95%. The patient fasted for more than 6 h prior to the examination and blood sugar level was controlled near 11.0 mmol/L. PET/CT scanning was performed 1 h after the 18F-FDG imaging agent was injected intravenously (3.7–5.55 MBq/Kg). The scanning range was from the cranial vault to the mid femur. PET imaging was acquired in 3D mode with 1.5 min/bed, and CT images were used for attenuation correction and iterative reconstruction to obtain PET images. Helical CT scan parameters were as follows: tube voltage, 120 kV; tube current, automatically adjusted according to tissue density with CARE Dose 4D technology; slice thickness, 5–3.75 mm; and reconstruction interval, 5–3.75 mm. Whole or local coronal, sagittal, and axial PET-CT fusion images were obtained respectively.

18F-FDG-PET/CT image interpretation

Two radiologists with more than 10 years of experience in PET/CT diagnosis reviewed PET/CT images and measured PET parameters using the MedEx Workstation (MedEx Tech-Trade Corp, Beijing). Evaluation discrepancies between the two radiologists were resolved by consensus. Metabolic parameters of pulmonary lesions, including, MTV and TLG, were measured; the SUVmax of the mediastinum and/or hilum metastatic adenopathy was also measured. The region of interest (ROI) was manually marked along the edge of the lesion on the CT image, and then the workstation automatically measured the SUVmax and MTV according to ROI. TLG was calculated according to the equation: TLG = SUVmean × MTV(cm3). The criteria for hilar and/or mediastinal lymph node metastasis were as follows: (1) short-axis diameter larger than 10 mm; (2) CT attenuation value lower than 70 HU; and 3)uptake of FDG higher than mediastinal blood pool uptake. The criteria for axillary lymph node metastasis were as follows: (1) long-axis diameter larger than 10 mm or short-axis diameter larger than 5 mm; (2) and uptake of FDG higher than that of background. For extrapulmonary metastasis, the criterion was extrapulmonary lesions with high FDG uptake detected by 18F-FDG-PET/CT (SUVmax ≥ 2.5), regardless of the lesions size.

Morphological features of SPNs on high resolution CT image included the following: size of the SPN (both maximum and minimum axial diameter; location (peripheral: outer 1/3 of lung field/central: inner 2/3 of lung field); laterality (homolateral: the same side with breast cancer/contralateral: opposite side of breast cancer); opacity [pure ground glass nodule (pGGN)/mixed GGN (mGGN)/solid]; border definition (well defined/ill defined); lobulation sign (+/–); spicule sign (+/–); vascular convergence sign (+/–); pleural indentation sign (+/–); and bronchus encapsulated air sign (+/–).

Statistical analysis

All statistical processes were performed using SPSS 19.0 (IBM, Armonk, NY, USA). Kappa and intraclass correlation (ICC) tests were used to determine the consistency of the measurement results between the two radiologists, with Kappa > 0.8 or ICC > 0.7 indicating satisfaction. Continuous variables included age, CEA level, CA15-3 level, and PET-CT parameters; these variables were described as medians (interquartile range) because they did not conform to normal distribution. Differences in the continuous variables were compared using Mann–Whitney U tests and differences of categorical variables were compared using Fisher’s exact test. Logistic regression was used for multivariate analyses. P < 0.05 was considered statistically significant.

Results

Clinicopathological characteristics

A total of 142 breast cancer cases with SPNs were detected by PET-CT at our institution from May 2018 to July 2024. There were 10 patients with insufficient clinicopathological data and another 8 with poor PET-CT image quality that were excluded from the study. We also excluded 4 patients with history of other primary malignancies. Finally, 120 patients with breast cancer were enrolled in the study, including 82 cases of invasive ductal carcinoma, 31 of ductal carcinoma in situ, 5 of adenosquamous carcinoma, and 2 of mucoepidermoid carcinoma. For the clinical stage,9 patients were in stage I,58 patients were in stage II,33 patients were in stage III, and 20 patients were in stage IV. The study populations were divided into a PLC group (n = 72) and BCM group (n = 48) according to the pathological type of the SPN. The diagnosis method and pathological types of SPNs are shown in Fig. 1.

Fig. 1
figure 1

Enrolled patients flowchart

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SPNs, solitary pulmonary nodules

The clinicopathological characteristics of patients are shown in Table 1. The median age of patients was 59 (36,76) years, and only 14.1% of enrolled patients (17/120) had a history of smoking. CEA-positive and CA15-3-positive patients represented 12.5% (15/120) and 5.0% (6/120) of enrolled patients, respectively. For difference analysis of clinicopathological characteristics, only serum CEA and CA15-3 levels exhibited significant differences between the two groups (P = 0.005 and P = 0.001, respectively). The other terms, including age, smoking history, clinical stage, therapy methods, and DFI, exhibited no differences between the PLC and BCM groups. The clinicopathological differences between the PLC and BCM groups are shown in Table 2.

Table 1 Clinicopathological characteristics of breast cancer patients
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Table 2 Clinicopathological differences between patients in PLC group and BCM group
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Reliability of measurements

The interobserver Kappa values for SUVmax of SPN, TLG of SPN, MTV of SPN and SUVmax of hilar and/or mediastinal lymph node were 0.932 (0.776–0.956),0.812 (0.722–0.895),0.843 (0.693–0.876) and 0.658 (0.514–0.769),and corresponding intraobserver ICC values were 0.914 (0.752–0.951),0.887 (0.721–0.944),0.851 (0.675–0.891),and 0.758 (0.673–0.817) respectively.The interobserver Kappa values for mediastinal and/or hilar lymph node metastases, axillary lymph node metastases, and extrapulmonary organ metastases were 0.854 (0.676–0.903),0.882 (0.764–0.905) and 0.877 (0.703–0.924),and corresponding intraobserver ICC values were 0.814 (0.764–0.897),0.876 (0.775–0.921) and 0.795 (0.665–0.834) respectively.The interobserver Kappa values for morphological characteristics included location, laterality, opacity, border, lobulation sign, spicule sign, vascular convergence sign, pleural indentation sign, and bronchus encapsulated air sign were 0.943 (0.879–0.955),0.927 (0.864–0.962),0.915 (0.851–0.936),0.873 (0.774–0.902),0.855 (0.731–0.893),0.861 (0.761–0.889),0.915 (0.824–0.946),0.902 (0.832–0.931) and 0.838 (0.754–0.899),and corresponding intraobserver ICC values were 0.937 (0.845–0.961),0.921 (0.801–0.965),0.922 (0.841–0.948),0.912 (0.856–0.935),0.865 (0.765–0.913),0.877 (0.714–0.898),0.875 (0.779–0.914),0.898 (0.815–0.943) and 0.921 (0.843–0.961) respectively.All P < 0.05.

Metabolic characteristics on 18F-FDG-PET/CT images

When the SUVmax = 2.5 was used as the threshold value in 18F-FDG-PET/CT images, there were 91 cases with positive FDG uptake in 120 patients, including 48 cases in the PLC group (66.7%) and 43 cases in the BCM group (89.6%); the FDG uptake is a valuable indicator in differentiating PLC from BCM (P = 0.004). The average SUVmax value of SPNs in the 120 cases was 2.67 (0.45,4.48), and the SUVmax of the BCM group was significantly higher than that of the PLC group; the difference between the two groups was statistically significant [1.443 (0.687,2.375) vs. 4.530 (1.404,6.161), P < 0.001]. When SUVmax=3.12 was chosen as the threshold value, SUVmax of SPN had the best diagnostic efficiency based on ROC curve (AUC = 0.776,sensitivity = 0.706 and specificity = 0.667).There were no statistical differences in TLG or MTV of SPNs between the two groups (Table 3; Figs. 2 and 3).

Table 3 Differences of 18F-FDG-PET/CT characteristics between patients in PLC group and BCM group
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Fig. 2
figure 2

18F-FDG-PET/CT images of BCM and PLC. (A–D) A 63-year-old patient with BCM. PET/CT showed a SPN with SUVmax of 6.47,TLG of 6.48,and MTV of 3.33. SUVmax of hilar lymph node was 7.72. (E-H) A 67 year-old patient with PLC. PET/CT showed a SPN with SUVmax of 2.98,TLG of 34.3,and MTV of 4.65. SUVmax of hilar lymph node was 4.05

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Fig. 3
figure 3

ROC curve of SUVmax of SPN and SUVmax of Hilar and/or mediastinal lymph node for the diagnose of BCM and PLC. ROC curve showed both SUVmax of SPN and lymph node had high diagnostic efficiency for BCM and PLC

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Metastasis incidence of hilar and/or mediastinal lymph node, axillary lymph node, and extrapulmonary organs was 58.8%, 31.3%, and 38.7%, respectively. 18F-FDG-PET/CT detected 50 cases and 21 cases of mediastinal and/or hilar lymph node metastases in the PLC group (69.4%) and BCM group (43.8%), respectively; the incidence of lymph node metastases showed statistical difference between the two groups (P = 0.01). Moreover, the SUVmax of lymph nodes in the two groups also demonstrated a statistical difference [2.65 (1.65,5.31) vs. 5.57 (2.44,6.38), P = 0.032] (Table 3; Fig. 2).When SUVmax of lymph nodes= 4.45 was chosen as the threshold value, SUVmax had the best diagnostic efficiency based on ROC curve (AUC = 0.798,sensitivity = 0.706 and specificity = 0.667) (Fig. 3).

18F-FDG-PET/CT detected 23 cases and 15 cases of axillary lymph node metastases in the PLC group (31.2%) and in the BCM group (31.3%), respectively. Both the incidence and the SUVmax of axillary lymph node metastasis showed no statistical difference between the two groups (P = 1.0 and P = 0.068, respectively). 18F-FDG-PET/CT also detected metastases in other organs, including liver (11/120, 8.8%), bone (8/120, 6.7%),and brain (3/120, 2.5%), and the extrapulmonary metastasis incidence showed statistical difference between the two groups (P = 0.P23). The differences of 18F-FDG-PET/CT characteristics between the PLC and BCM groups are shown in Table 3.

Morphological characteristics on 18F-FDG-PET/CT images

Morphological features of SPNs on 18F-FDG-PET/CT images were also observed (Fig. 4). There were zero cases of pGGN (0%) and 6 cases of mGGN (12.5%) in the BCM group, which was statistically lower than that in the PLC group (P = 0.001). In the PLC group, compared with the BCM group, the lobulation sign, spicule sign, and pleural indentation sign were identified as statistically different morphological features on PET/CT images (all P < 0.001). There were no statistical differences in terms of tumor location, size, border, or vascular convergence sign between the two groups. The differences in morphological characteristics between the PLC and BCM groups are shown in Table 4.

Fig. 4
figure 4

Morphological characteristics of SPN. (A-F) The mGGN (A), spicule sign (B, C), pleural indentation sign (B, C) and lobulation sign (C) were common in PLC.(G-L) BCM presented as round and solid lesion, with rare morphological signs

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Table 4 Differences of morphological features between patients in PLC group and BCM group
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Multivariate analysis for the diagnosis of SPNs in breast cancer patients

Logistic regression revealed that SUVmax of SPNs [OR-value (95% CI):1.61 (1.12,2.31),P = 0.01] and some morphological characteristics including lobulation sign [OR-value (95% CI):0.109 (0.024,0.498),P = 0.004] and pleural indentation sign [OR-value (95% CI):0.54 (0.028,1.05),P = 0.03] were significant predictors for the diagnosis of SPNs in breast cancer patients. The clinicopathological factors and other 18F-FDG-PET/CT characteristics did not have significant statistical value in differentiating PLC from BCM.

Discussion

The differential diagnosis of SPNs in breast cancer patients is clinically difficult, which directly affects selection of appropriate therapy protocols for each patient. According to a retrospective study of 52 patients with newly detected SPNs after breast cancer resection surgery, the proportions of BCM and PLC were similar [9]. Therefore, it is important to find a non-invasive and effective method for the differential diagnosis of SPNs in breast cancer patients. The National Comprehensive Cancer Network (2020.1 version) has reported that 18F-FDG-PET/CT is helpful in identifying regional lymph node metastases and/or distant metastases in locally advanced breast cancer, especially when used in addition to standard staging studies [10]. Moreover, 18F-FDG-PET/CT has been included in a global strategy for characterizing SPNs with the clinical likelihood of malignancy and, therefore, it remains an appropriate management option for diagnosing SPNs in breast cancer patients [11].

CEA is a glycoprotein involved in cell adhesion and is important in both pulmonary adenocarcinoma and breast cancer [12, 13]. CA15-3 is a carbohydrate-containing protein antigen of the transmembrane glycoprotein MUC-1, and is primarily important in breast cancer [14]. A previous study by Katelyn N showed that both of the two tumor markers were useful in the management of metastatic breast cancer [15]. In our study of clinicopathological characteristics, serum CEA and CA15-3 levels were statistically different between the PLC and BCM groups, which is consistent with previous studies. However, only 19.4% of PLC patients were positive for CEA and only 16.7% of BCM patients were positive for CA153 in our study, indicating that CEA and CA153 levels had high specificity but low sensitivity for the diagnosis of SPNs. This result was in accordance with a prior study by Wang and also explained the contradictory result of multivariate analysis, and proved single tumor marker serum CEA or CA15-3 was not a significant predictor for differential diagnosis of SPNs [13]. Previous studies have concluded that DFI is a significant predictor for the differential diagnosis of SPNs in different pathological types of cancer. However, these significant differences were not identified in this study, which may be due to different follow-up time in our study or too long of a period of DFI. Alternatively, the absence of follow-up may have resulted in biased data [16, 17]. A few other studies have indicated that age might also be a valuable clinical feature for differential diagnosis of SPNs, and breast cancer patients were younger on average compared to lung cancer patients [18]. However, this trend was not found in our study, which may have resulted from different sample sizes or different pathological types of lung cancer in each study.

For the metabolic characteristics of 18F-FDG-PET/CT images, the type of FDG-uptake was a valuable index in the diagnosis of SPNs. When an SUVmax threshold of 2.5 was used to designate a lesion as positive FDG-uptake, the pathological type of most FDG-uptake negative lesions was primary pulmonary adenocarcinoma, and presented morphologically as pGGN or mGGN [19]. Additionally, the average SUVmax of SPNs in the BCM group was also significantly higher than that in the PLC group, suggesting that the SUVmax is a significant predictor in the diagnosis of SPNs. Furthermore, this suggests that lower an SUVmax in the PLC group may be affected by FDG-uptake negative lesions. Previous studies have suggested that the SUVmax has a limited diagnostic effect for SPNs, which contradicts our results and may be explained by smaller sample sizes and different pathological types of enrolled PLC cases [9, 17].

Our study also revealed that the incidence of hilar and/or mediastinal lymph node metastasis was obviously higher in the PLC group than in the BCM group, which is consistent with traditional perspective. 18F-FDG-PET/CT that was reported to have a high level of sensitivity (81.3%) and specificity (79.4%) in the diagnosis of hilar and/or mediastinal lymph node metastasis, suggesting that PLC should be considered first in breast cancer patients once hilar and/or mediastinal adenopathy is found on 18F-FDG-PET/CT [20, 21]. Although the incidence of hilar and/or mediastinal lymph node metastasis was higher in lung cancer patients, the average SUVmax of hilar and/or mediastinal lymph node metastasis in the PLC group was significantly lower than that in the BCM group. This result was consistent with the SUVmax of SPNs in the two groups, and may also be explained by FDG-uptake negative lesions in the PLC group, which may have led to FDG-uptake negative lymph node metastasis. On the contrary, the incidence of axillary lymph nodes was similar in the PLC and BCM groups, suggesting that axillary lymph node metastasis may only be associated with primary breast cancer rather than metastases [1, 22].

For the morphological analysis of 18F-FDG-PET/CT images, some classical features of PLC, including opacity, lobulation sign, spicule sign, and pleural indentation sign were significant predictors in the diagnosis of SPNs in breast cancer patients. These morphological features might reflect histologic differences in tumor progression between BCM and PLC. More than 90% of PLC cases in our study were pulmonary adenocarcinoma, which can present as pure acinar or mixed acinar types in pathology, corresponding to GGO or mGGO on 18F-FDG-PET/CT images [23]. Previous research had reported that most cases of BCM present as a radiological solid lesion, except with a pathological lepidic growth pattern along the alveolar walls in rare cases [24]. Lobulation sign of SPNs is caused by different or uneven growth rates within the same tumor, which indicates heterogeneity of lung cancer [25]. Spicule sign was related with thicken interlobular septal and obstructed pulmonary vessels or lymphatic channels filled with tumor cells, which indicated an invasive growth pattern of lung cancer [26]. Pleural indentation sign represented retraction of the visceral pleura towards the pulmonary lesion, which was more common in invasive adenocarcinoma with lepidic growth than in adenocarcinoma in situ [27]. Lobulation sign, spicule sign, and pleural indentation were all found to be predictive factors of invasive lung cancer with a positive predictive value up to 90% [26].

In the study, the pathological type of 84.7%(61/72)cases in PLC group was adenocarcinoma, which may cause SUVmax of SPN in PLC group was lower than BCM group.Previous studies had also found that adenocarcinoma was the main pathological type of subsequent lung cancer in breast cancer patients, but the physiopathology underlying this phenomenon is still unclear [4, 28].Tanner Smida found that high level of estrogen was a driving factor for non-small cell lung cancer (NSCLC) cells, which can explain that pulmonary adenocarcinoma was prone to occur in breast cancer patients with high expression of estrogen [especially breast cancer with estrogen receptor(ER)(+) ] [29]. For molecular mechanism, Yan Wang proved that TRIM73, DLX6 and CNGB1 were unique mutations of lung adenocarcinoma patients with previous breast cancer, and the expression levels of FGF10 and VEGFA genes were significantly increased in these patients.Though this was a preliminary study with a small sample size, the result indicated that the occurrence of subsequent lung adenocarcinoma may be related to gene mutation [30].

This study has some limitations. First, the molecular biological features of breast cancer, including estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2, were not included in this study because of the long enrollment period and absence of pathological data. Second, different pathological types of breast cancer and PLC were not studied within groups due to the limitation of sample size.

In conclusion, some morphological and metabolic parameters of 18F-FDG-PET/CT in combination with serum tumor markers were useful for the diagnosis of SPNs in breast cancer patients. Specifically, SUVmax of SPNs, and morphological characteristics including lobulation sign and pleural indentation sign were the most valuable predictive factors for accurate diagnosis.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

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Funding

This work was supported by the Research Project of Anhui Province (CN) (grant number: 2021xkj134) and the Research Fund of Anhui Institute of translational medicine (CN) (grant number: 2022zhyx-B14).

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Authors and Affiliations

  1. Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, China

    Yangyang Xue, Yanhui He & Alei Xu

  2. Department of Radiology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, China

    Weishu Hou & Xiaohu Li

Authors
  1. Yangyang Xue
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  2. Weishu Hou
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  3. Yanhui He
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  4. Alei Xu
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Contributions

Yy X collected and analyze PET/CT data of patients, and was a major contributor in writing the manuscript.Ws H collected and analyzed clinical data of patients, and was a major contributor in writing the manuscript. Yh H was responsible for statistical analysis of the research.Al X provided figures of the manuscript. Xh L confirmed the manuscript and results.All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaohu Li.

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Ethics approval and consent to participate

This study was approved by the Anhui Medical University University of Technology Human Research Ethics Committee. This is a retrospective study and no personally identifiable information was included. Therefore, the informed consent was waived by the Anhui Medical University University of Technology Human Research Ethics Committee.

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The authors declare no competing interests.

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Xue, Y., Hou, W., He, Y. et al. Predicting solitary pulmonary lesions in breast cancer patients using 18fluorodeoxyglucose-positron emission tomography/computed tomography combined with clinicopathological characteristics. BMC Pulm Med 24, 595 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12890-024-03418-7

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12890-024-03418-7

Keywords

BMC Pulmonary Medicine

ISSN: 1471-2466

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