Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Relationship between 18F-FDG PET/CT Semi-Quantitative Parameters and International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society Classification in Lung Adenocarcinomas

  • Lihong Bu (PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University) ;
  • NingTu (PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University) ;
  • Ke Wang (PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University) ;
  • Ying Zhou (PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University) ;
  • Xinli Xie (Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University) ;
  • Xingmin Han (Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University) ;
  • Huiqin Lin (Department of Thoracic Surgery, Renmin Hospital of Wuhan University) ;
  • Hongyan Feng (PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University)
  • Received : 2021.02.22
  • Accepted : 2021.09.26
  • Published : 2022.01.01
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Abstract

Objective: To investigate the relationship between 18F-FDG PET/CT semi-quantitative parameters and the International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histopathologic classification, including histological subtypes, proliferation activity, and somatic mutations. Materials and Methods: This retrospective study included 419 patients (150 males, 269 females; median age, 59.0 years; age range, 23.0-84.0 years) who had undergone surgical removal of stage IA-IIIA lung adenocarcinoma and had preoperative PET/CT data of lung tumors. The maximum standardized uptake values (SUVmax), background-subtracted volume (BSV), and background-subtracted lesion activity (BSL) derived from PET/CT were measured. The IASLC/ATS/ERS subtypes, Ki67 score, and epidermal growth factor/anaplastic lymphoma kinase (EGFR/ALK) mutation status were evaluated. The PET/CT semi-quantitative parameters were compared between the tumor subtypes using the Mann-Whitney U test or the Kruskal-Wallis test. The optimum cutoff values of the PET/CT semi-quantitative parameters for distinguishing the IASLC/ATS/ERS subtypes were calculated using receiver operating characteristic curve analysis. The correlation between the PET/CT semi-quantitative parameters and pathological parameters was analyzed using Spearman's correlation. Statistical significance was set at p < 0.05. Results: SUVmax, BSV, and BSL values were significantly higher in invasive adenocarcinoma (IA) than in minimally IA (MIA), and the values were higher in MIA than in adenocarcinoma in situ (AIS) (all p < 0.05). Remarkably, an SUVmax of 0.90 and a BSL of 3.62 were shown to be the optimal cutoff values for differentiating MIA from AIS, manifesting as pure ground-glass nodules with 100% sensitivity and specificity. Metabolic-volumetric parameters (BSV and BSL) were better potential independent factors than metabolic parameters (SUVmax) in differentiating growth patterns. SUVmax and BSL, rather than BSV, were strongly or moderately correlated with Ki67 in most subtypes, except for the micropapillary and solid predominant groups. PET/CT parameters were not correlated with EGFR/ALK mutation status. Conclusion: As noninvasive surrogates, preoperative PET/CT semi-quantitative parameters could imply IASLC/ATS/ERS subtypes and Ki67 index and thus may contribute to improved management of precise surgery and postoperative adjuvant therapy.

Keywords

Acknowledgement

This work was supported in part, by the National Science Foundation of China (81871419 to Dr. Bu, 81701735 to Dr. Feng), Seed project in Sino foreign joint research platform of Wuhan University (2309-413100006 to Dr. Bu), Hubei Provincial Natural Science Foundation of China (2017CFB781 to Dr. Bu), Chinese Society of Clinical Oncology Foundation (Y-HR2016-44 to Dr. Bu), Hubei Provincial Health Department (WJ2017M012 to Dr. Bu) and Young Teachers' Independent Research Funding of Wuhan University (2042019kf0054 to Dr. Tu). This was not an industry supported study.

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