OBJECTIVES CT-guided biopsy of indeterminate lung lesions sometimes provides insufficient histological results due to tumor necrosis. Functional and metabolic methods such as DWI-MR and PET-CT may help by directing sample collection to a lesion area of greater biological representativeness. The objective is to evaluate the histopathological results based on findings on ADC and SUV levels in lung lesions suspected for primary cancer. METHODS Tissue samples were evaluated after undergoing biopsies guided by either DWI-MR or PET-CT findings. In each patient, sample collection from two lesion areas was guided by local ADC and SUV. Values were used to define areas of low vs. high suspicion for cancer. RESULTS Patients who underwent DWI-MR had median lesion size of 78.0 mm. Areas of higher suspicion (HSA) had a median ADC of 1.1 × 10-3 mm2/s, while areas of lower suspicion (LSA) had median ADC of 1.8 × 10-3 mm2/s (p = 0.0001). All HSA samples and 71.43% of LSA samples were positive for cancer (p = 0.0184). Patients who performed PET-CT had median lesion size of 61.0 mm. Median SUV was 7.1 for HSA and 3.9 for LSA (p = 0.0002). Positivity for cancer was observed in 76.9% of samples for both HSA and LSA (p = 0.0522). CONCLUSION Use of DWI-MR and PET-CT showed that tumors are functional and metabolically heterogeneous and that this heterogeneity has implications for histopathological diagnosis. KEY POINTS • Lung cancer is heterogeneous regarding functional and metabolic imaging. • Tumor heterogeneity may have implications in histopathological diagnosis. • Intralesional lower levels of ADC target highly suspected areas with a significant improvement in lung cancer diagnosis.

中文翻译：

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计算机断层扫描引导的经胸活检的功能和代谢成像。

目的 CT 引导的不确定肺部病变活检有时会因肿瘤坏死而提供不充分的组织学结果。功能和代谢方法（如 DWI-MR 和 PET-CT）可能有助于将样本收集到具有更大生物学代表性的病变区域。目的是根据疑似原发癌的肺部病变中 ADC 和 SUV 水平的发现来评估组织病理学结果。方法 在 DWI-MR 或 PET-CT 结果指导下进行活检后，对组织样本进行评估。在每位患者中，两个病变区域的样本采集均由当地 ADC 和 SUV 指导。值用于定义癌症低度和高度怀疑区域。结果 接受 DWI-MR 的患者的中位病变大小为 78.0 mm。高度怀疑区域 (HSA) 的平均 ADC 为 1.1 × 10-3 mm2/s，而较低怀疑区域 (LSA) 的 ADC 中值为 1.8 × 10-3 mm2/s (p = 0.0001)。所有 HSA 样本和 71.43% 的 LSA 样本均呈癌症阳性 (p = 0.0184)。进行 PET-CT 的患者的中位病变大小为 61.0 mm。HSA 的 SUV 中位数为 7.1，LSA 为 3.9 (p = 0.0002)。在 76.9% 的样本中观察到 HSA 和 LSA 的癌症阳性 (p = 0.0522)。结论 使用 DWI-MR 和 PET-CT 显示肿瘤在功能和代谢上存在异质性，并且这种异质性对组织病理学诊断有影响。要点 • 肺癌在功能和代谢成像方面存在异质性。• 肿瘤异质性可能对组织病理学诊断有影响。• 病灶内较低水平的ADC 针对高度怀疑的区域，显着改善肺癌诊断。