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Confalonieri S, Matoskova B, Pennisi R, Martino F, De Mario A, Miloro G, Montani F, Rotta L, Ferrari ME, Gilardi L, Ceci F, Grana CM, Rizzuto R, Mammucari C, Di Fiore PP, Lanzetti L. A PET-Surrogate Signature for the Interrogation of the Metabolic Status of Breast Cancers. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308255. [PMID: 38757578 PMCID: PMC11267279 DOI: 10.1002/advs.202308255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/07/2024] [Indexed: 05/18/2024]
Abstract
Metabolic alterations in cancers can be exploited for diagnostic, prognostic, and therapeutic purposes. This is exemplified by 18F-fluorodeoxyglucose (FDG)-positron emission tomography (FDG-PET), an imaging tool that relies on enhanced glucose uptake by tumors for diagnosis and staging. By performing transcriptomic analysis of breast cancer (BC) samples from patients stratified by FDG-PET, a 54-gene signature (PETsign) is identified that recapitulates FDG uptake. PETsign is independently prognostic of clinical outcome in luminal BCs, the most common and heterogeneous BC molecular subtype, which requires improved stratification criteria to guide therapeutic decision-making. The prognostic power of PETsign is stable across independent BC cohorts and disease stages including the earliest BC stage, arguing that PETsign is an ab initio metabolic signature. Transcriptomic and metabolomic analysis of BC cells reveals that PETsign predicts enhanced glycolytic dependence and reduced reliance on fatty acid oxidation. Moreover, coamplification of PETsign genes occurs frequently in BC arguing for their causal role in pathogenesis. CXCL8 and EGFR signaling pathways feature strongly in PETsign, and their activation in BC cells causes a shift toward a glycolytic phenotype. Thus, PETsign serves as a molecular surrogate for FDG-PET that could inform clinical management strategies for BC patients.
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Affiliation(s)
| | | | - Rosa Pennisi
- Department of OncologyUniversity of Torino Medical SchoolCandioloTurin10060Italy
- Candiolo Cancer InstituteFPO‐IRCCSStr. Provinciale 142 km 3.95, CandioloTurin10060Italy
| | - Flavia Martino
- Department of OncologyUniversity of Torino Medical SchoolCandioloTurin10060Italy
- Candiolo Cancer InstituteFPO‐IRCCSStr. Provinciale 142 km 3.95, CandioloTurin10060Italy
| | - Agnese De Mario
- Department of Biomedical SciencesUniversity of PaduaVia U. Bassi 58/BPadua35131Italy
| | - Giorgia Miloro
- IEOEuropean Institute of Oncology IRCCSVia Ripamonti 435Milan20141Italy
| | - Francesca Montani
- IEOEuropean Institute of Oncology IRCCSVia Ripamonti 435Milan20141Italy
| | - Luca Rotta
- IEOEuropean Institute of Oncology IRCCSVia Ripamonti 435Milan20141Italy
| | | | - Laura Gilardi
- IEOEuropean Institute of Oncology IRCCSVia Ripamonti 435Milan20141Italy
| | - Francesco Ceci
- IEOEuropean Institute of Oncology IRCCSVia Ripamonti 435Milan20141Italy
- Department of Oncology and Haemato‐OncologyUniversity of MilanMilan20142Italy
| | | | - Rosario Rizzuto
- Department of Biomedical SciencesUniversity of PaduaVia U. Bassi 58/BPadua35131Italy
| | - Cristina Mammucari
- Department of Biomedical SciencesUniversity of PaduaVia U. Bassi 58/BPadua35131Italy
| | - Pier Paolo Di Fiore
- IEOEuropean Institute of Oncology IRCCSVia Ripamonti 435Milan20141Italy
- Department of Oncology and Haemato‐OncologyUniversity of MilanMilan20142Italy
| | - Letizia Lanzetti
- Department of OncologyUniversity of Torino Medical SchoolCandioloTurin10060Italy
- Candiolo Cancer InstituteFPO‐IRCCSStr. Provinciale 142 km 3.95, CandioloTurin10060Italy
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Cecil K, Huppert L, Mukhtar R, Dibble EH, O'Brien SR, Ulaner GA, Lawhn-Heath C. Metabolic Positron Emission Tomography in Breast Cancer. PET Clin 2023; 18:473-485. [PMID: 37369614 DOI: 10.1016/j.cpet.2023.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Metabolic PET, most commonly 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT), has had a major impact on the imaging of breast cancer and can have important clinical applications in appropriate patients. While limited for screening, FDG PET/CT outperforms conventional imaging in locally advanced breast cancer. FDG PET/CT is more sensitive than conventional imaging in assessing treatment response, accurately predicting complete response or nonresponse in early-stage cases. It also aids in determining disease extent and treatment response in the metastatic setting. Further research, including randomized controlled trials with FDG and other metabolic agents such as fluciclovine, is needed for optimal breast cancer imaging.
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Affiliation(s)
- Katherine Cecil
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Laura Huppert
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Rita Mukhtar
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Sophia R O'Brien
- Divisions of Molecular Imaging and Therapy Breast Imaging, Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Irvine, CA, USA; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
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3
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Ghossein J, Gingras S, Zeng W. Differentiating primary from secondary lung cancer with FDG PET/CT and extra-pulmonary tumor grade. J Med Imaging Radiat Sci 2023; 54:451-456. [PMID: 37355362 DOI: 10.1016/j.jmir.2023.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Assess feasibility of differentiating primary from secondary lung cancer in patients with a solid solitary malignant pulmonary lesion (SMPL) and a previously resected extrapulmonary tumor. METHODS Patients with pathology proven primary or secondary lung cancer from a solitary pulmonary lesion and known histopathology of extrapulmonary tumor were included. Patients with a small pulmonary lesion size, multiple malignant pulmonary nodules or an active infectious/inflammatory process were excluded. Extrapulmonary tumor grade was categorized as low, intermediate and high and was matched to FDG uptake intensity of SMPL, with FDG uptake range (SMPL/Liver SUVmax) of <0.9 for low, 0.91-1.99 for intermediate and >2.0 for high extrapulmonary tumor grade. RESULTS Of 274 patients, 62 met the study criteria. 46 are primary and 16 are secondary lung cancer. There are 19 low, 27 intermediate and 16 high grade extrapulmonary tumors. Mean SMPL SUVmax is 8.2 ± 4.5 and SMPL/liver SUVmax is 2.4 ± 1.4. There are 37 cases (60%) with mismatched results (e.g., low FDG SMPL with intermediate or high grade extrapulmonary tumor or vice versa) and 25 matched cases (40%) that are inconclusive (e.g., low FDG with low tumor grade or high FDG with high tumor grade). Of the mismatched cases, we correctly predicted 30 cases (81%) as primary lung cancers. CONCLUSION A mismatch between the SMPL SUVmax and the extrapulmonary tumor grade could be used to differentiate a primary lung cancer from a metastasis with reasonable accuracy. Our preliminary results support the hypothesis that FDG uptake intensity of a metastatic pulmonary lesion mirrors the tumor aggressiveness of its extrapulmonary neoplasm of origin.
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Affiliation(s)
- Jason Ghossein
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sebastien Gingras
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Wanzhen Zeng
- Department of Medicine, Division of Nuclear Medicine, University of Ottawa, Ottawa, Ontario ON K1Y 4E9, Canada.
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Chen YH, Chen YC, Lue KH, Chu SC, Chang BS, Wang LY, Li MH, Lin CB. Glucose metabolic heterogeneity correlates with pathological features and improves survival stratification of resectable lung adenocarcinoma. Ann Nucl Med 2023; 37:139-150. [PMID: 36436112 DOI: 10.1007/s12149-022-01811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We investigated whether glycolytic heterogeneity correlated with histopathology, and further stratified the survival outcomes pertaining to resectable lung adenocarcinoma. METHODS We retrospectively analyzed the 18F-fluorodeoxyglucose positron emission tomography-derived entropy and histopathology from 128 patients who had undergone curative surgery for lung adenocarcinoma. Disease-free survival (DFS) and overall survival (OS) were analyzed using univariate and multivariate Cox regression models. Independent predictors were used to construct survival prediction models. RESULTS Entropy significantly correlated with histopathology, including tumor grades, lympho-vascular invasion, and visceral pleural invasion. Furthermore, entropy was an independent predictor of unfavorable DFS (p = 0.031) and OS (p = 0.004), while pathological nodal metastasis independently predicted DFS (p = 0.009). Our entropy-based models outperformed the traditional staging system (c-index = 0.694 versus 0.636, p = 0.010 for DFS; c-index = 0.704 versus 0.630, p = 0.233 for OS). The models provided further survival stratification in subgroups comprising different tumor grades (DFS: HR = 2.065, 1.315, and 1.408 for grade 1-3, p = 0.004, 0.001, and 0.039, respectively; OS: HR = 25.557, 6.484, and 2.570, for grade 1-3, p = 0.006, < 0.001, and = 0.224, respectively). CONCLUSION The glycolytic heterogeneity portrayed by entropy is associated with aggressive histopathological characteristics. The proposed entropy-based models may provide more sophisticated survival stratification in addition to histopathology and may enable personalized treatment strategies for resectable lung cancer.
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Affiliation(s)
- Yu-Hung Chen
- Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Yen-Chang Chen
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kun-Han Lue
- Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan.
| | - Sung-Chao Chu
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan. .,Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| | - Bee-Song Chang
- Department of Cardiothoracic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ling-Yi Wang
- Epidemiology and Biostatistics Consulting Center, Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien, 97002, Taiwan
| | - Ming-Hsun Li
- Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chih-Bin Lin
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97002, Taiwan
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Tissue Fraction Correction and Visual Analysis Increase Diagnostic Sensitivity in Predicting Malignancy of Ground-Glass Nodules on [ 18F]FDG PET/CT: A Bicenter Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12051292. [PMID: 35626447 PMCID: PMC9140844 DOI: 10.3390/diagnostics12051292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 01/15/2023] Open
Abstract
We investigated the role of [18F]FDG positron emission tomography/computed tomography (PET/CT) in evaluating ground-glass nodules (GGNs) by visual analysis and tissue fraction correction. A total of 40 pathologically confirmed ≥1 cm GGNs were evaluated visually and semiquantitatively. [18F]FDG uptake of GGN distinct from background lung activity was considered positive in visual analysis. In semiquantitative analysis, we performed tissue fraction correction for the maximum standardized uptake value (SUVmax) of GGN. Of the 40 GGNs, 25 (63%) were adenocarcinomas, 9 (23%) were minimally invasive adenocarcinomas (MIAs), and 6 (15%) were adenocarcinomas in situ (AIS). On visual analysis, adenocarcinoma showed the highest positivity rate among the three pathological groups (88%, 44%, and 17%, respectively). Both SUVmax and tissue-fraction−corrected SUVmax (SUVmaxTF) were in the order of adenocarcinoma > MIA > AIS (p = 0.033 and 0.018, respectively). SUVmaxTF was significantly higher than SUVmax before correction (2.4 [1.9−3.0] vs. 1.3 [0.8−1.8], p < 0.001). When using a cutoff value of 2.5, the positivity rate of GGNs was significantly higher in SUVmaxTF than in SUVmax (50% vs. 5%, p < 0.001). The diagnostic sensitivity of [18F]FDG PET/CT in predicting the malignancy of lung GGN was improved by tissue fraction correction and visual analysis.
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Aydos U, Ünal ER, Özçelik M, Akdemir D, Ekinci Ö, Taştepe Aİ, Memiş L, Atay LÖ, Akdemir ÜÖ. Texture features of primary tumor on 18F-FDG PET images in non-small cell lung cancer: The relationship between imaging and histopathological parameters. Rev Esp Med Nucl Imagen Mol 2021; 40:343-350. [PMID: 34752367 DOI: 10.1016/j.remnie.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aims of this study were to evaluate the relationships between textural features of the primary tumor on FDG PET images and clinical-histopathological parameters which are useful in predicting prognosis in newly diagnosed non-small cell lung cancer (NSCLC) patients. METHODS PET/CT images of ninety (90) patients with NSCLC prior to surgery were analyzed retrospectively. All patients had resectable tumors. From the images we acquired data related to metabolism (SUVmax, MTV, TLG) and texture features of primary tumors. Histopathological tumor types and subgroups, degree of Ki-67 expression and necrosis rates of the primary tumor, mediastinal lymph node (MLN) status and nodal stages were recorded. RESULTS Among the two histologic tumor types (adenocarcinoma and squamous cell carcinoma) significant differences were present regarding metabolic parameters, Ki-67 index with higher values and kurtosis with lower values in the latter group. Textural heterogeneity was found to be higher in poorly differentiated tumors compared to moderately differentiated tumors in patients with adenocarcinoma. While Ki-67 index had significant correlations with metabolic parameters and kurtosis, tumor necrosis rate was only significantly correlated with textural features. By univariate and multivariate analyses of the imaging and histopathological factors examined, only gradient variance was significant predictive factor for the presence of MLN metastasis. CONCLUSIONS Textural features had significant associations with histologic tumor types, degree of pathological differentiation, tumor proliferation and necrosis rates. Texture analysis has potential to differentiate tumor types and subtypes and to predict MLN metastasis in patients with NSCLC.
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Affiliation(s)
- Uğuray Aydos
- Gazi University, Faculty of Medicine, Department of Nuclear Medicine, Beşevler/Ankara, Turkey.
| | - Emel Rodoplu Ünal
- Gazi University, Faculty of Medicine, Department of Pathology, Beşevler/Ankara, Turkey
| | - Mahsun Özçelik
- Yüzüncü Yıl University, Faculty of Medicine, Department of Nuclear Medicine, Van, Turkey
| | - Deniz Akdemir
- Michigan State University, Department of Epidemiology and Biostatistics, East Lansing, MI, USA
| | - Özgür Ekinci
- Gazi University, Faculty of Medicine, Department of Pathology, Beşevler/Ankara, Turkey
| | - Abdullah İrfan Taştepe
- Gazi University, Faculty of Medicine, Department of Thoracic Surgery, Beşevler/Ankara, Turkey
| | - Leyla Memiş
- Gazi University, Faculty of Medicine, Department of Pathology, Beşevler/Ankara, Turkey
| | - Lütfiye Özlem Atay
- Gazi University, Faculty of Medicine, Department of Nuclear Medicine, Beşevler/Ankara, Turkey
| | - Ümit Özgür Akdemir
- Gazi University, Faculty of Medicine, Department of Nuclear Medicine, Beşevler/Ankara, Turkey
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Liu H, Zheng L, Shi G, Xu Q, Wang Q, Zhu H, Feng H, Wang L, Zhang N, Xue M, Dai Y. Pulmonary Functional Imaging for Lung Adenocarcinoma: Combined MRI Assessment Based on IVIM-DWI and OE-UTE-MRI. Front Oncol 2021; 11:677942. [PMID: 34307146 PMCID: PMC8292137 DOI: 10.3389/fonc.2021.677942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/11/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose The goal of current study was to introduce noninvasive and reproducible MRI methods for in vivo functional assessment of lung adenocarcinoma (LUAD). Methods Forty-four patients with pathologically confirmed LUAD were included in this study. All the lesions were classified as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IA). The IA lesions were further divided into five subtype patterns, including acinar, lepidic, papillary, micropapillary and solid. Tumors were grouped depending on predominant subtype: low grade (AIS, MIA or lepidic predominant), intermediate grade (papillary or acinar predominant) and high grade (micropapillary, or solid predominant). Spirometry was performed according to American Thoracic Society guidelines. For each patient, Intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) analysis and oxygen-enhanced MRI (OE-MRI) analysis were performed. Spearman's test was used to assess the relationship between a) whole lung mean percent signal enhancement (PSE) and pulmonary function tests (PFTs) parameters; b) IVIM-derived parameters and PFTs parameters; c) tumor mean PSE and IVIM-derived parameters. Kruskal -Wallis tests were applied to test the difference of tumor mean PSE and IVIM-derived parameters between different histological tumor grades. Receiver operating characteristics (ROC) analysis was used to evaluate the diagnostic performance. Results Whole lung mean PSE was significantly positively correlated with PFTs parameters (r = 0.40 ~ 0.44, P < 0.05). f value derived from IVIM-DWI was significantly negatively correlated with PFTs parameters (r = -0.38 ~ -0.47, P < 0.05). Both tumor mean PSE (P = 0.030 < 0.05) and f (P = 0.022 < 0.05) could differentiate different histological grades. f was negatively correlated with tumor mean PSE (r = -0.61, P < 0.001). For the diagnostic performance, the combination of tumor mean PSE and f outperformed than using tumor mean PSE or f alone in both sensitivity and area under the ROC curve. Conclusions The combined measurement of OE-MRI and IVIM-DWI may serve as a promising method for the noninvasive and non-radiation evaluation of pulmonary function. Quantitative analyses achieved by OE-MRI and IVIM-DWI offer an approach of the classification of LUAD subtypes.
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Affiliation(s)
- Hui Liu
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liyun Zheng
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Gaofeng Shi
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Xu
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qi Wang
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongshan Zhu
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Feng
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lijia Wang
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Zhang
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Meng Xue
- Department of Radiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongming Dai
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
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Aydos U, Ünal ER, Özçelik M, Akdemir D, Ekinci Ö, Taştepe AI, Memiş L, Atay LÖ, Akdemir ÜÖ. Texture features of primary tumor on 18F-FDG PET images in non-small cell lung cancer: The relationship between imaging and histopathological parameters. Rev Esp Med Nucl Imagen Mol 2021; 40:S2253-654X(20)30134-7. [PMID: 33785321 DOI: 10.1016/j.remn.2020.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the relationships between textural features of the primary tumor on FDG PET images and clinical-histopathological parameters which are useful in predicting prognosis in newly diagnosed non-small cell lung cancer (NSCLC) patients. MATERIAL AND METHODS PET/CT images of ninety (90) patients with NSCLC prior to surgery were analyzed retrospectively. All patients had resectable tumors. From the images we acquired data related to metabolism (SUVmax, metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) and texture features of primary tumors. Histopathological tumor types and subgroups, degree of Ki-67 expression and necrosis rates of the primary tumor, mediastinal lymph node (MLN) status and nodal stages were recorded. RESULTS Among the 2histologic tumor types (adenocarcinoma and squamous cell carcinoma) significant differences were present regarding metabolic parameters, Ki-67 index with higher values and kurtosis with lower values in the latter group. Textural heterogeneity was found to be higher in poorly differentiated tumors compared to moderately differentiated tumors in patients with adenocarcinoma. While Ki-67 index had significant correlations with metabolic parameters and kurtosis, tumor necrosis rate was only significantly correlated with textural features. By univariate and multivariate analyses of the imaging and histopathological factors examined, only gradient variance was significant predictive factor for the presence of MLN metastasis. CONCLUSIONS Textural features had significant associations with histologic tumor types, degree of pathological differentiation, tumor proliferation and necrosis rates. Texture analysis has potential to differentiate tumor types and subtypes and to predict MLN metastasis in patients with NSCLC.
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Affiliation(s)
- U Aydos
- Gazi University, Faculty of Medicine, Department of Nuclear Medicine, Beşevler/Ankara, Turquía.
| | - E R Ünal
- Gazi University, Faculty of Medicine, Department of Pathology, Beşevler/Ankara, Turquía
| | - M Özçelik
- Yüzüncü Yıl University, Faculty of Medicine, Department of Nuclear Medicine, Van, Turquía
| | - D Akdemir
- Michigan State University, Department of Epidemiology and Biostatistics, East Lansing, MI, Estados Unidos
| | - Ö Ekinci
- Gazi University, Faculty of Medicine, Department of Pathology, Beşevler/Ankara, Turquía
| | - A I Taştepe
- Gazi University, Faculty of Medicine, Department of Thoracic Surgery, Beşevler/Ankara, Turquía
| | - L Memiş
- Gazi University, Faculty of Medicine, Department of Pathology, Beşevler/Ankara, Turquía
| | - L Ö Atay
- Gazi University, Faculty of Medicine, Department of Nuclear Medicine, Beşevler/Ankara, Turquía
| | - Ü Ö Akdemir
- Gazi University, Faculty of Medicine, Department of Nuclear Medicine, Beşevler/Ankara, Turquía
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