Relationship between maximum standardized uptake values of 18F-FDG PET-CT and clinicopathological characteristics in non-small cell lung cancer
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Abstract:
Objective
To analyze the correlation of clinicopathological characteristics and maximum standardized uptake value (SUVmax) detected by 18F-FDG PET-CT in non-small cell lung cancer (NSCLC).
Methods
105 patients with NSCLC who underwent 18F-FDG PET-CT scan before surgical resection were reviewed retrospectively. Clinicopathological factors which might affect SUVmax were evaluated, including sex, age, smoking history, CEA level, tumor site, histological type, TNM stage, T factor, N factor, tumor size, lymphovascular invasion and pleural invasion features. Independent factors were identified by multiple regression analysis. The diagnostic efficiency and best cut-off point of SUVmax were calculated by the receiver operating characteristic curve.
Results
It was identified by the univariate analysis that the CEA level (P=0.002), tumor size (P<0.001), histological type (P<0.001), TNM stage (P<0.001), T factor (P<0.001), N factor (P<0.001), and lymphovascular invasion (P=0.001) were factors affecting SUVmax. While histological type (P=0.004), tumor size (P=0.036), N factor (P=0.043) were found to be significant independent factors according to multivariate regression analysis. The SUVmax of primary tumor was a predictor for lymphatic metastasis with the highest diagnostic accuracy at a cut-off value of 6.75, the sensitivity and specificity were 72.2 % and 81.6 %, respectively.
Conclusions
The SUVmax is correlated with histological type, tumor diameter, nodal status in NSCLC, and is higher in patients with non-adenocarcinoma, lager tumor and lymphatic metastasis. Furthermore, the probability of lymphatic metastasis could be predicted by SUVmax of the primary tumor.
Key words:
Carcinoma, non-small-cell lung; PET-CT; Deoxyglucose; Standardized uptake value; PathologyKeywords:
Lymphovascular invasion
Univariate analysis
Standardized uptake value
T-stage
Primary tumor
OBJECTIVE:To observe the relationship between the fluorodeoxyglucose(FDG)uptake of primary lesion and the presence of nodal or distant metastases in diagnosis of lung cancer.METHODS:Two hundred and eight newly diagnosed lung cancer patients were enrolled,who were conducted whole body fluorodeoxyglucose PET imaging before any treatment.Tumor size was quantitated as the greatest dimension and FDG uptake as the maximum standardized uptake value(SUVmax).The TNM status was established and all the cases were divided into 3 groups:no metastasis,lymph node metastasis and distant metastasis.The correlations among primary lesion SUVmax and its size,metastatic status were analyzed.RESULTS:The SUVmax and size of the primary lesion had a positive correlation,r=0.613,P=0.000.The primary lesion size did not demonstrate significant difference among the different metastatic status groups(P=0.078),but did in SUVmax(P=0.008).Significant statistic differences were found not only between the no metastasis and lymph node metastasis groups but also between the no metastasis and distant metastasis groups(P=0.041,P=0.002,respectively),but there was no difference between the lymph node metastasis and distant metastasis groups,P=0.298.The logistic regression analysis demonstrated a significant correlation between SUVmax and the presence of nodal or distant metastases.The odds of metastases increased significantly by 1.112 with SUVmax=1 in the primary tumor,P=0.032.CONCLUSION:Increased SUVmax in primary tumor evaluates the odds of nodal or distant metastases at presentation,which suggests that the FDG uptake value should be an indicator of metastases in lung caner.
Primary tumor
Standardized uptake value
Fluorodeoxyglucose
Distant metastasis
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1035 Objectives: Our study intended to explore the association combining 18F-FDG PET/CT metabolic parameters and clinical features and lymphovascular invasion status in non-small-cell lung cancer (NSCLC). Methods: This retrospective study included 161 patients (median age, 63 years; interquartile range, 55.5 - 67.0 years) from January 2018 to November 2020 with NSCLC who underwent 18F-FDG PET/CT scan within one month before surgery in our hospital. The PET/CT metabolic parameters including maximum and mean standard uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of primary lesion were measured. The associations between PET/CT parameters and clinical characteristics (age, sex, smoking, serum tumor marker, histological type, T-stage, N-stage, TNM stage, pleural invasion) and lymphovascular invasion status were analyzed. Multivariate logistic regression analysis was performed to explore independent predictive factors for lymphovascular invasion. Results: A total of 161 eligible patients with NSCLC enrolled in this study, including 111 males and 50 females, were divided into two groups, lymphovascular invasion-positive group (n=38, 23.6%) and lymphovascular invasion-negative group (n=123, 76.4%). Histopathological findings included adenocarcinoma (n=119), squamous cell carcinoma (n=38), undefined NSCLC (n=1) and adenosquamous carcinoma (n=3). The average of SUVmax and SUVmean of primary lesion were 15.43 ± 5.91 vs. 11.73 ± 7.53 (p = 0.006) and 6.02 ± 1.58 vs. 5.07 ± 2.03 (p = 0.009), in the lymphovascular invasion-positive group and lymphovascular group-negative group, respectively. The median MTV and TLG were 15.80 (8.22, 31.07) vs. 5.47 (1.47, 20.17) (p
Lymphovascular invasion
Interquartile range
Adenosquamous carcinoma
T-stage
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Higher intensity of FDG uptake on PET/CT in primary tumor is seen in patients with IDC compared to ILC, also in high grade tumours, tumours with negative ER and higher Ki67 values, while data are inconsistent in case of relation between primary tumor's PgR and HER2 expression with its metabolic activity levels.On account of the lack of studies that include research of breast cancer metastatic lesion metabolism level and its relation to tumor histology and biology, our goal was to investigate the association of metastatic lesions' glucose metabolism level on PET/CT with different histological and biological characteristics of primary tumor.In a total number of N=100 patients, highest SUVmax values for each patient were used in testing difference between metastatic metabolic activity in patients with different tumor histology, grade, ER, PgR and HER2 status, subtype, as well in testing relation of Ki67 index to metastasis' metabolism level.In testing difference between histological types of breast cancer, SUVmax values were also compared separately for each specific anatomical site (regional and distant lymph nodes, bones and liver).No difference was found regarding metastatic SUVmax values in patients with primary IDC (n=55, median SUVmax 9.70) and ILC (n=34, median SUVmax 7.20) independently of anatomic site, and for each of analysed sites separately.No difference was found as well between SUVmax detected in metastasis in patients with different grade (grade II: n=58, median SUVmax 7.70; grade III: n=12, median SUVmax 10.20), ER (59 positive, median SUVmax 8.50; 22 negative, median SUVmax 8.05), PgR (55 positive, median SUVmax 8.50; 23 negative, median SUVmax 7.80), and HER2 (14 positive, median SUVmax 6.84; 51 negative, median SUVmax 8.63) expression in primary tumor, and between patients with different tumor subtype.Ki67 was also not associated with tumor metastatic SUVmax values (n=11, r s = -0.21,p=0.53).We conclude that there is no association of primary breast cancer histological type, grade, ER, PgR, HER2 and Ki67 expression with metabolic activity in metastasis detected on PET/CT.
Standardized uptake value
Primary tumor
Histology
PET-CT
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To explore the relationships between primary tumor 18F-FDG uptake measured as the SUVmax and local extension, and nodal or distant organ metastasis in patients with NSCLC on pretreatment PET-CT.93 patients with NSCLC who underwent 18F-FDG PET-CT scans before the treatment were included in the study. Primary tumor SUVmax was calculated; clinical stages, presence of local extension, nodal and distant organ metastases were recorded. The patients with SUVmax ≥ 2.5 were divided into low and high SUVmax groups by using the median SUVmax. The low SUVmax group consisted of 45 patients with SUVmax<10.5, the high SUVmax group consisted of 46 patients with SUVmax ≥ 10.5. Their data were compared statistically.91 cases with SUVmax≥2.5 were included for analysis. The mean SUVmax in patients without any metastasis was 7.42 ± 2.91 and this was significantly lower than that (12.18 ± 4.94) in patients with nodal and/or distant organ metastasis (P=0.000). In the low SUV group, 19 patients had local extension, 22 had nodal metastasis, and 9 had distant organ metastasis. In the high SUV group, 31 patients had local extension, 37 had nodal metastasis, and 18 had distant organ metastases. There was a significant difference in local extension (P =0.016), distant organ metastasis (P =0.046), and most significant difference in nodal metastasis rate (P =0.002) between the two groups. In addition, there was a moderate correlation between SUVmax and tumor size (r = 0.642, P<0.001), tumor stage (r = 0.546, P<0.001), node stage (r = 0.388, P<0.001), and overall stage (r = 0.445, P= 0.000).Higher primary tumor SUVmax predicts higher extensional or metastatic potential in patients with NSCLC. Patients with higher SUVmax may need a close follow-up and more reasonable individual treatment because of their higher extensional and metastatic potential.
Primary tumor
Distant metastasis
Standardized uptake value
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Standardized uptake value
Fluorodeoxyglucose
PET-CT
Adjuvant Therapy
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Fluorodeoxyglucose
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Adenosquamous carcinoma
Standardized uptake value
Lymphovascular invasion
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18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) for lung cancer may be a biomarker for malignancy as well as a useful tool for detection of nodal involvement and distant metastasis. The goal of this study was to clarify a relationship between clinicopathological findings and maximum standardized uptake value( SUVmax) obtained by preoperative PET in patients with non-small cell lung cancer in diameter of 2 cm or less. Between January 2008 and April 2011, 124 patients( 54 men and 70 women) with non-small cell lung cancer in diameter of 2 cm or less undergoing lobectomy or segmentectomy were enrolled. The relationship between SUVmax and clinicopathological findings as tumor diameter, histological type, pleural invasion, vascular invasion, lymphatic permeation and nodal involvement were analyzed. Correlation between SUVmax and findings such as vascular invasion and lymphatic permeation showed relatively strong in the patients with adenocarcinoma, on the contrary to the correlation in the patients with non-adenocarcinoma. No tumor showing SUVmax of 2 or less showed vascular invasion and/or lymphatic permeation as well as nodal involvement in any patients with adenocarcinoma. SUVmax of the primary tumor in diameter of 2 cm or less, can be a useful biomarker which indicates a surgical candidate for sublobar pulmonary resection as well as mediastinal nodal dissection, especially in patients with adenocarcinoma.
Standardized uptake value
Fluorodeoxyglucose
Lymphovascular invasion
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We assessed the clinical value of 2-fluoro-2-deoxyglucose (18F-FDG) PET/CT imaging for predicting occult nodal metastasis in non-small cell lung cancer (NSCLC) patients. This retrospective study included 54 patients with T1-2N0M0 NSCLC who had undergone 18F-FDG PET/CT before surgery. Occult nodal metastasis was detected in 25.9% (14/54) of the patients. Immunohistochemical analysis revealed that increased glucose transporter 1 expression was associated with occult nodal metastasis, but hexokinase 2 expression was not. Compared to the negative nodal metastasis group, the positive nodal metastasis group was associated with increased maximum standardized uptake value (SUVmax) and tumor size. Multivariate analysis indicated that SUVmax and tumor size were associated with nodal metastasis. Nodal metastasis could be predicted with a sensitivity of 92.9% and a specificity of 55.0% when the SUVmax cutoff was 4.35. When patients were divided into low-risk (tumor size ≤ 2.5 cm and SUVmax ≤ 4.35), moderate-risk (tumor size ≤ 2.5 cm and SUVmax > 4.35 or tumor size > 2.5 cm and SUVmax ≤ 4.35) and high-risk (tumor size > 2.5 cm and SUVmax > 4.35) groups, the lymph node metastasis rates were 4.3%, 22.7%, and 88.9%, respectively. These results indicate that the combination of SUVmax and tumor size has potential clinical value for predicting occult nodal metastasis in NSCLC patients.
Standardized uptake value
Occult
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Purpose Considerable discrepancies are observed between clinical staging and pathological staging after surgical resection in patients with esophageal squamous cell carcinoma (ESCC). In this study, we examined the relationships between tumor SUVs on FDG PET/CT and aggressive pathological features in resected ESCC patients. Methods A total of 220 patients with surgically resected clinical stage I–II ESCC without neoadjuvant treatment were retrospectively analyzed. SUVmax of the primary tumor was measured on pretreatment FDG PET/CT. Pathological features included depth of tumor invasion, lymph node metastasis, tumor differentiation, lymphatic vessel tumor embolus, perineural invasion, Ki-67 index, and p53 protein expression. Receiver operating characteristic curve analysis was used to determine an optimal cutoff of SUVmax to predict pathologically advanced disease. Differences in pathological features associated with SUVmax were examined by t test or χ 2 test. Results The number of patients upstaged from clinical stage I–II to pathological stage III–IV was 43 (19.5%). Receiver operating characteristic curve analysis showed that the optimal cutoff SUVmax of 4.0 had good performance for predicting locally advanced disease (area under the receiver operating characteristic curve = 0.844, P < 0.001). Higher tumor SUVmax was significantly associated with advanced depth of tumor invasion (deeper than submucosa, P < 0.001), positive lymph node metastasis ( P < 0.001), presence of lymphatic vessel tumor embolus ( P < 0.001), presence of perineural invasion ( P < 0.001), higher Ki-67 index ( P = 0.025), and poor tumor differentiation ( P = 0.039). Conclusions SUVmax measured on pretreatment FDG PET/CT is significantly associated with aggressive pathological features and may help clinicians identify patients at risk of advanced disease.
Perineural invasion
Primary tumor
T-stage
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