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Kużdżał B, Moszczyński K, Żanowska K, Hauer J, Popovchenko S, Bryndza M, Warmus J, Trybalski Ł, Rudnicka L, Kocoń P. Correlation between 18-FDG standardized uptake value and tumor grade in patients with resectable non-small cell lung cancer. Transl Cancer Res 2023; 12:3530-3537. [PMID: 38192987 PMCID: PMC10774031 DOI: 10.21037/tcr-23-798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/08/2023] [Indexed: 01/10/2024]
Abstract
Background Positron-emission tomography (PET) is widely used for staging lung cancer. Although a correlation between the fluorodeoxyglucose standardized uptake value (SUV) and the histologic grade of the tumor has been shown in several studies, little is known about the impact of different clinical variables on this correlation. This study aimed to evaluate the correlation between tumor SUV and tumor grade in a large cohort of patients and to analyse the impact of clinical factors on this correlation. Methods This retrospective cohort study including patients with non-small cell lung cancer age 18-90 years, with clinical stage I-IVA, who underwent curative-intent lung resection. Results Data from 726 patients was included in this study. There was a strong correlation between SUV and primary tumor grade in the whole cohort (P<0.001), which was significant in both sexes (P<0.001) and in all selected age groups (P<0.001-0.03). There was a significant SUV-grade correlation for the right upper and left lower lobes, as well as for the central location in the right lung (P<0.001, P=0.005 and P=0.04, respectively). Moreover, a significant SUV-grade correlation was found for squamous cell cancer and adenocarcinoma (P<0.001 and P=0.01, respectively), and for T1-T3 factors (P<0.001, P=0.006, P=0.005 respectively). Conclusions In patients with resectable lung cancer, a significant correlation was observed between the SUV of the primary tumor and its grade. This correlation was maintained for both sexes, age groups, most common histological types and T factors T1-T3.
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Affiliation(s)
- Błażej Kużdżał
- Students Scientific Society Jagiellonian University Medical College, Cracow, Poland
| | - Konrad Moszczyński
- Students Scientific Society Jagiellonian University Medical College, Cracow, Poland
| | | | - Jolanta Hauer
- Department of Thoracic Surgery, John Paul II Hospital, Cracow, Poland
| | - Sofiia Popovchenko
- Students Scientific Society Jagiellonian University Medical College, Cracow, Poland
| | - Monika Bryndza
- Students Scientific Society Jagiellonian University Medical College, Cracow, Poland
| | - Janusz Warmus
- Department of Thoracic Surgery, John Paul II Hospital, Cracow, Poland
| | - Łukasz Trybalski
- Department of Thoracic Surgery, John Paul II Hospital, Cracow, Poland
| | - Lucyna Rudnicka
- Department of Pathology, John Paul II Hospital, Cracow, Poland
| | - Piotr Kocoń
- Department of Thoracic Surgery, Jagiellonian University Collegium Medicum, Cracow, Poland
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FDG-PET/CT tumor to liver SUV ratio (TLR), tumor SUVmax, and tumor size: can this help in differentiating squamous cell carcinoma from adenocarcinoma of the lung? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
PET/CT plays an essential role in the diagnosis, staging, and follow-up of lung cancer. We aimed to assess the ability of PET/CT to differentiate between adenocarcinomas (AC) and squamous cell carcinomas (SCC) of the lung using tumor size, tumor maximum standardized uptake value (SUVmax), lymph nodes SUVmax, and tumor to liver SUV ratio (TLR).
Results
A total of 60 patients pathologically proved to have non-small cell lung cancer either AC or SCC were retrospectively evaluated. The mean tumor size, SUVmax of the tumor, and TLR were significantly higher in SCC lesions compared to AC lesions. The mean SCC tumoral size was 7.96 ± 2.18 cm compared to 5.66 ± 2.57 cm in AC lesions (P = 0.008). The mean tumor SUVmax in SCC lesions was 18.95 ± 8.3 compared to 12.4 ± 7.55 in AC lesions (P = 0.04). While the mean TLR of SCC lesions was 10.32 ± 4.03 compared to 7.36 ± 4.61 in AC lesions (P = 0.028). All three parameters showed the same sensitivity (75%), while TLR showed the highest specificity (77.78%) followed by tumor size (76.47%) and then SUVmax of the tumor (72.22%).
Conclusions
SCC of the lung has a higher mean tumor size, SUVmax of the tumor, and TLR as compared to AC which can be helpful tools in differentiation between them using PET/CT.
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Ren C, Zhang J, Qi M, Zhang J, Zhang Y, Song S, Sun Y, Cheng J. Machine learning based on clinico-biological features integrated 18F-FDG PET/CT radiomics for distinguishing squamous cell carcinoma from adenocarcinoma of lung. Eur J Nucl Med Mol Imaging 2021; 48:1538-1549. [PMID: 33057772 PMCID: PMC8113203 DOI: 10.1007/s00259-020-05065-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To develop and validate a clinico-biological features and 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) radiomic-based nomogram via machine learning for the pretherapy prediction of discriminating between adenocarcinoma (ADC) and squamous cell carcinoma (SCC) in non-small cell lung cancer (NSCLC). METHODS A total of 315 NSCLC patients confirmed by postoperative pathology between January 2017 and June 2019 were retrospectively analyzed and randomly divided into the training (n = 220) and validation (n = 95) sets. Preoperative clinical factors, serum tumor markers, and PET, and CT radiomic features were analyzed. Prediction models were developed using the least absolute shrinkage and selection operator (LASSO) regression analysis. The performance of the models was evaluated and compared by the area under receiver-operator characteristic (ROC) curve (AUC) and DeLong test. The clinical utility of the models was determined via decision curve analysis (DCA). Then, a nomogram was developed based on the model with the best predictive efficiency and clinical utility and was validated using the calibration plots. RESULTS In total, 122 SCC and 193 ADC patients were enrolled in this study. Four independent prediction models were separately developed to differentiate SCC from ADC using clinical factors-tumor markers, PET radiomics, CT radiomics, and their combination. The DeLong test and DCA showed that the Combined Model, consisting of 2 clinical factors, 2 tumor markers, 7 PET radiomics, and 3 CT radiomic parameters, held the highest predictive efficiency and clinical utility in predicting the NSCLC subtypes compared with the use of these parameters alone in both the training and validation sets (AUCs (95% CIs) = 0.932 (0.900-0.964), 0.901 (0.840-0.957), respectively) (p < 0.05). A quantitative nomogram was subsequently constructed using the independently risk factors from the Combined Model. The calibration curves indicated a good consistency between the actual observations and nomogram predictions. CONCLUSION This study presents an integrated clinico-biologico-radiological nomogram that can be accurately and noninvasively used for the individualized differentiation SCC from ADC in NSCLC, thereby assisting in clinical decision making for precision treatment.
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Affiliation(s)
- Caiyue Ren
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Shanghai, 201315 China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jianping Zhang
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032 China
- Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, 200032 China
| | - Ming Qi
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321 China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032 China
- Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, 200032 China
| | - Jiangang Zhang
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Shanghai, 201315 China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yingjian Zhang
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321 China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032 China
- Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, 200032 China
| | - Shaoli Song
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321 China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032 China
- Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, 200032 China
| | - Yun Sun
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Shanghai, 201315 China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Research and Development, Shanghai Proton and Heavy Ion Center, Shanghai, 201321 China
| | - Jingyi Cheng
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321 China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032 China
- Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai, 200032 China
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Moon Y, Choi SY, Park JK, Lee KY. Risk Factors for Occult Lymph Node Metastasis in Peripheral Non-Small Cell Lung Cancer with Invasive Component Size 3 cm or Less. World J Surg 2021; 44:1658-1665. [PMID: 31912252 DOI: 10.1007/s00268-019-05365-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In the seventh edition TNM staging system for lung cancer, a high maximum standardized uptake value (SUVmax) on positron emission tomography was regarded as a risk factor for occult lymph node metastasis in clinical T1N0 non-small cell lung cancer (NSCLC). However, in the eighth edition TNM classification, tumors are classified according to the size of the invasive component only, and those with invasive component size ≤3 cm are diagnosed as stage T1. The aim of this study was to reassess the risk factors for occult lymph node metastasis under the eighth edition TNM classification for lung cancer. METHODS From 2010 to 2017, 553 patients with clinical N0 peripheral NSCLC with invasive component size ≤3 cm underwent anatomical lobectomy with systematic lymph node dissection. We analyzed these cases retrospectively to identify risk factors for postoperative nodal upstaging. RESULTS Among 553 study patients, 54 (9.8%) had nodal upstaging after surgery. In multivariate analysis adopting the eighth edition TNM classification for lung cancer, serum carcinoembryonic antigen (CEA) level (hazard ratio [HR] = 1.113, p = 0.002), invasive component size (HR = 2.398, p = 0.004), visceral pleural invasion (HR = 2.901, p = 0.005), and lymphatic invasion (HR = 9.336, p < 0.001) were significant risk factors for nodal upstaging, but SUVmax was not. CONCLUSION SUVmax is not a predictor of nodal upstaging in clinical N0 peripheral NSCLC with invasive component size ≤3 cm under the eighth edition TNM classification for lung cancer. Significant risk factors of occult lymph node metastasis are serum CEA level, tumor invasive component size, visceral pleural invasion, and lymphatic invasion.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
| | - Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhai X, Guo Y, Qian X. Combination of Fluorine-18 Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography (¹⁸F-FDG PET/CT) and Tumor Markers to Diagnose Lymph Node Metastasis in Non-Small Cell Lung Cancer (NSCLC): A Retrospective and Prospective Study. Med Sci Monit 2020; 26:e922675. [PMID: 32483109 PMCID: PMC7291785 DOI: 10.12659/msm.922675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The early diagnosis of lymph node (LN) metastasis is crucial for patients with non-small cell lung cancer (NSCLC). However, the diagnosis of LN metastasis mainly dependent on 18F-FDG PET/CT (fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography) which exhibited high false positive/negative rate. Material/Methods In retrospective analysis, 135 patients with NSCLC from February 2014 to March 2017 were enrolled. Based on the pathological examination, 71 patients were distributed to the LN Metastasis Group while 64 patients were distributed to the No LN Metastasis Group. Data from 18F-FDG PET/CT and tumor marker (TM) examination were collected to establish a logistic model. The receiver operating characteristic (ROC) curve analysis set the threshold of diagnostic factors. Finally, the diagnostic values of these factors were verified in a prospective analysis that included 78 patients with NSCLC from July 2017 to April 2019. Results In our retrospective analysis, compared with the No LN Metastasis Group, the maximum standardized uptake value (SUVmax)/size of primary lesion, the CT value/SUVmax/short diameter of LN, the level of TM were all significantly different than the LN Metastasis Group (All P<0.05). Our logistic model showed that SUVmax of primary lesion (odds ratio [OR]=1.491), short diameter of LN (OR=1.310) and grade of TM (OR=2.927) were significant variables. The ROC curve analysis showed the specificity and sensitivity of our logistic model was 90.6% and 90.1%, respectively. In our prospective analysis, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the logistic model were calculated as 85.7%, 90.9%, 87.2%, 96.0%, and 71.4%, respectively. Conclusions Our study found that combining 18F-FDG PET/CT data and TM to establish a logistic model performed better in the diagnosis of LN metastasis with low false positive/negative rates in patients with NSCLC.
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Affiliation(s)
- Xiaoli Zhai
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yuehong Guo
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xiaojun Qian
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
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Analysis of Segmental Lymph Node Metastasis and Clinical Features in cT1N0M0 Lung Adenocarcinoma. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2842604. [PMID: 32149096 PMCID: PMC7049444 DOI: 10.1155/2020/2842604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/30/2019] [Accepted: 12/30/2019] [Indexed: 12/24/2022]
Abstract
The progression of lung adenocarcinoma through lymph node metastasis has been well established; however, the process of segmental lymph node (LSN) metastasis in cT1N0M0 lung adenocarcinoma remains unclear. We aimed to elucidate the markers of lymph node metastasis to different segments in early-stage lung adenocarcinoma and identify new indications for segmentectomy. A total of 200 patients were enrolled in this study. These patients were diagnosed with cT1N0M0 lung adenocarcinoma after positron emission tomography/computed tomography and received lobectomy and lymph node dissection surgeries. Lymph nodes retrieved from each station were sorted. The metastatic status of the isolated (i) LSNs and several characteristics were analyzed. Patients with ground-glass nodules (GGNs) (P=0.025), AIS/MIA/lepidic adenocarcinoma (P=0.038), nodules with a maximum diameter ≤1 cm (P=0.017), maximum standardized uptake value (SUVmax) < 2.5 (P=0.029), serum carcinoembryonic antigen (CEA) levels ≤4.5 ng/ml (P=0.036), and no N1 lymph nodes metastasis (P=0.036) had significantly lower iLSN metastasis rates than those without these characteristics. Pure GGNs, CEA levels ≤4.5 ng/ml, SUVmax < 2.5, tumors with a maximum diameter of ≤1 cm, or those confirmed to be adenocarcinoma in situ, minimally invasive adenocarcinoma, or invasive lepidic-predominant adenocarcinoma by frozen section may indicate segmentectomy. However, segmentectomy is not suitable for patients with metastasis to the N1 lymph nodes.
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Park JK, Moon Y. Prognosis of upstaged N1 and N2 disease after curative resection in patients with clinical N0 non-small cell lung cancer. J Thorac Dis 2019; 11:1202-1212. [PMID: 31179062 DOI: 10.21037/jtd.2019.04.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Nodal upstaging occasionally occurs after curative resection in clinical N0 non-small cell lung cancer (NSCLC). The purpose of this study was to evaluate the prognosis of clinical N0 NSCLC (T1-2, tumor size 5 cm or smaller) after upstaging to pathologic N1 or N2. Methods From 2005 to 2015, 676 consecutive patients were diagnosed with clinical T1-2N0 NSCLC and underwent curative resection. Among these, tumors were upstaged to N1 in 46 patients and to N2 in 24 patients. We analyzed the prognosis of upstaged tumors. For comparison of prognosis between nodal upstaging groups and others in the same stage, patients with preoperative pathologically proven N1 (n=31) and N2 (n=55) NSCLC were included in the study. Results A total of 70 patients (10.4%) had nodal upstaging after curative resection of clinical N0 NSCLC. Upstaging to N1 occurred in 46 patients and upstaging to N2 occurred in 24 patients. The 5-year disease-specific survival rate was not statistically different between the upstaged and non-upstaged N1/N2 groups in N1 disease (73.3% vs. 70.5%, P=0.247) or in N2 disease (58.9% vs. 50.7%, P=0.283). Multivariate analysis showed that nodal upstaging was not a significant prognostic factor in N1 or N2 NSCLC (hazard ratio =0.385, P=0.235; hazard ratio =0.677, P=0.458). Conclusions Postoperative nodal upstaging from clinical T1-2N0 NSCLC was not a significant prognostic factor in the same stage. Therefore, surgical treatment of clinical T1-2N0 lung cancer diagnosed by imaging without preoperative pathologic lymph node staging can be a treatment option.
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Affiliation(s)
- Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Liu Y, Kim J, Balagurunathan Y, Hawkins S, Stringfield O, Schabath MB, Li Q, Qu F, Liu S, Garcia AL, Ye Z, Gillies RJ. Prediction of pathological nodal involvement by CT-based Radiomic features of the primary tumor in patients with clinically node-negative peripheral lung adenocarcinomas. Med Phys 2018; 45:2518-2526. [PMID: 29624702 DOI: 10.1002/mp.12901] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/07/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the potential of computed tomography (CT) based radiomic features of primary tumors to predict pathological nodal involvement in clinically node-negative (N0) peripheral lung adenocarcinomas. METHODS A total of 187 patients with clinical N0 peripheral lung adenocarcinomas who underwent preoperative CT scan and subsequently received systematic lymph node dissection were retrospectively reviewed. 219 quantitative 3D radiomic features of primary lung tumor were extracted; meanwhile, nine radiological semantic features were evaluated. Univariate and multivariate logistic regression analysis were used to explore the role of these features in predicting pathological nodal involvement. The areas under the ROC curves (AUCs) were compared between multivariate logistic regression models. RESULTS A total of 153 patients had pathological N0 status and 34 had pathological lymph node metastasis. On univariate analysis, fissure attachment and 17 radiomic features were significantly associated with pathological nodal involvement. Multivariate analysis revealed that semantic features of pleural retraction (P = 0.048) and fissure attachment (P = 0.023) were significant predictors of pathological nodal involvement (AUC = 0.659); and the radiomic feature F185 (Histogram SD Layer 1) (P = 0.0001) was an independent prognostic factor of pathological nodal involvement (AUC = 0.73). A logistic regression model produced from combining radiomic feature and semantic feature showed the highest AUC of 0.758 (95% CI: 0.685-0.831), and the AUC value computed by fivefold cross-validation method was 0.737 (95% CI: 0.73-0.744). CONCLUSIONS Features derived on primary lung tumor described by semantic and radiomic could provide information of pathological nodal involvement in clinical N0 peripheral lung adenocarcinomas.
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Affiliation(s)
- Ying Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin.,Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Jongphil Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Yoganand Balagurunathan
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Samuel Hawkins
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, FL, USA
| | - Olya Stringfield
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin.,Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Fangyuan Qu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Shichang Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Alberto L Garcia
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA.,Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
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Li M, Wu N, Zhang L, Sun W, Wang J, Lv L, Ren J, Lin D. Pathologic N 0 Status in Clinical T 1N 0M 0 Lung Adenocarcinoma is Predictable by the Solid Component Proportion with Quantitative CT Number Analysis. Sci Rep 2017; 7:16810. [PMID: 29196627 PMCID: PMC5711838 DOI: 10.1038/s41598-017-16701-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/13/2017] [Indexed: 01/11/2023] Open
Abstract
Correctly predicting pathologic regional node-negative (pN0) disease in patients with lung cancer before operation may avoid unnecessary mediastinal lymph node dissection (MLND). In this study, we analyze the value of the radiographic and histopathological features of primary tumors for predicting pN0 status in cT1N0M0 lung adenocarcinoma and to establish an optimal surgical strategy for avoiding MLND in cT1N0M0 lung adenocarcinoma patients. We retrospectively investigated the histopathological and radiographic data of 348 surgically resected cT1N0M0 lung adenocarcinoma patients with systematic lymph node dissection from January 2005 to December 2012. Histopathological features and radiographic features were analyzed. Multivariable analysis was used to identify significant predictors of pN0 disease. Our results showed that pN0 disease was detected in 306 patients (87.9%) among the 348 patients with cT1N0M0 lung adenocarcinoma. A decreasing trend of the pN0 disease proportion was observed with both increasing histological grade and decreased differentiation (P < 0.001). In multivariable analysis, the solid component proportion was a significant predictor of pN0 disease. Among 110 patients with a solid component proportion of no more than 21.3%, mediastinal lymph node involvement was not observed. Patients who meet this criterion may be successfully managed with lung resection without MLND.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. .,PET-CT center, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Sun
- Department of Pathology, Beijing Cancer Hospital, Beijing, 100142, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lv Lv
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiansong Ren
- National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dongmei Lin
- Department of Pathology, Beijing Cancer Hospital, Beijing, 100142, China
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Hennon M, Landreneau RJ. Role of Segmentectomy in Treatment of Early-Stage Non–Small Cell Lung Cancer. Ann Surg Oncol 2017; 25:59-63. [DOI: 10.1245/s10434-017-5787-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 11/18/2022]
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Moon Y, Sung SW, Lee KY, Park JK. Clinicopathological characteristics and prognosis of non-lepidic invasive adenocarcinoma presenting as ground glass opacity nodule. J Thorac Dis 2016; 8:2562-2570. [PMID: 27747010 DOI: 10.21037/jtd.2016.08.46] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Ground glass opacity (GGO) generally associated with the lepidic component of lung adenocarcinoma. However, in some cases, GGO nodules have been associated with invasive adenocarcinomas, where a lepidic component is minimal or absent. The purpose of this study is to evaluate the clinicopathological characteristics and prognosis of non-lepidic invasive adenocarcinoma presenting as GGO nodules. METHODS We reviewed computed tomography (CT) images from 168 patients diagnosed with non-lepidic invasive adenocarcinoma classified as stage T1N0M0 (≤3 cm) who underwent curative anatomical resection. Tumors were classified according to radiologic features: 31 were GGO predominant (Group A) and 137 were solid predominant (Group B). The clinicopathological findings and recurrence free survival were used as outcome measures. RESULTS The mean percentages of micropapillary and solid component in tumor was higher in Group B than Group A (P<0.001) Pleural invasion and lymphatic invasion were more frequently seen in Group B. The presence of tumors with a micropapillary component was higher in Group B (P=0.040). The 3-year recurrence-free survival was lower in Group B than Group A (80.4% vs. 100%, P=0.019). Risk factors for recurrence such as presence of a micropapillary component and lymphatic invasion were more frequently seen in Group B. CONCLUSIONS Non-lepidic invasive adenocarcinoma presenting as GGO has fewer risk factors and better prognosis when compared with those presenting as solid tumors. Therefore, the presence of GGO on chest CT is a good prognostic indicator for lung cancer irrespective of histomorphologic classification.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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12
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Moon Y, Kim KS, Lee KY, Sung SW, Kim YK, Park JK. Clinicopathologic Factors Associated With Occult Lymph Node Metastasis in Patients With Clinically Diagnosed N0 Lung Adenocarcinoma. Ann Thorac Surg 2016; 101:1928-35. [PMID: 26952299 DOI: 10.1016/j.athoracsur.2015.11.056] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/15/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In some patients, clinical N0 (cN0) lung adenocarcinoma diagnosed by preoperative computed tomography scanning and positron emission tomography scanning was staged as pathologic N1 (pN1) or N2 (pN2) postoperatively. The aim of this study was to determine the preoperative and postoperative clinicopathologic factors related to nodal upstaging after a surgical operation. METHODS We conducted a retrospective chart review of 350 patients treated for cN0 lung adenocarcinoma by curative resection. We analyzed clinicopathologic findings, comparing pN0 patients with the nodal upstaging group. RESULTS Of 350 patients treated for cN0 tumors, 305 (87.1%) were confirmed postoperatively as having pN0 tumors, and 45 (12.9%) were confirmed as having pN1 or pN2 tumors. The mean maximum standardized uptake value (SUVmax) was higher in the nodal upstaging group than in the pN0 group (6.9 versus 3.8, p = 0.004); the upstaging group also included more cases in which SUVmax was greater than 5 (70.5% versus 24.8%, p < 0.001). Pleural invasion, lymphatic invasion, and vascular invasion were all more frequently seen in the nodal upstaging group than in the pN0 group (all p < 0.001). The presence of tumors with a micropapillary component was higher in the nodal upstaging group (p < 0.001). Multivariate logistic regression analysis identified SUVmax greater than 5, lymphatic invasion, vascular invasion, and a micropapillary component as significant risk factors for nodal upstaging. CONCLUSIONS In lung adenocarcinoma diagnosed as clinical N0 by chest computed tomography and positron emission tomography scanning, the possibility of occult lymph node metastasis increases with SUVmax greater than 5 and when lymphatic invasion, vascular invasion, and a micropapillary component are present.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Sook Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Young Kyoon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
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13
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Geng JQ, Wang XC, Li LF, Zhao J, Wu S, Yu GP, Zhu KJ. MicroRNA-related single-nucleotide polymorphism of XPO5 is strongly correlated with the prognosis and chemotherapy response in advanced non-small-cell lung cancer patients. Tumour Biol 2015; 37:2257-65. [PMID: 26358254 DOI: 10.1007/s13277-015-3980-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/24/2015] [Indexed: 01/04/2023] Open
Abstract
This study was performed to investigate if the microRNA-related single-nucleotide polymorphisms (miR-SNPs) of XPO5 gene predicted the prognosis and pathological features of advanced non-small-cell lung cancer patients receiving chemotherapy. A total of 131 advanced non-small-cell lung cancer (NSCLC) patients were recruited. MicroRNA (miRNA) binding site prediction software was adopted for the prediction and screening of SNPs in XPO5 and miRNA binding regions. Polymerase chain reaction (PCR) amplification was further performed. Time-dependent survival-free curves were constructed using the Kaplan-Meier technique. Univariate and the multivariate survival analyses were conducted for confirmation of prognostic factor for advanced NSCLC patients receiving chemotherapy. There were no significant differences of SNP distribution frequencies between groups, without statistical significance (P > 0.05). Included clinical pathological features and chemotherapy regimens showed no apparent statistical significance in influencing the curative effect of chemotherapy in advanced NSCLC patients (all P > 0.05). While the objective response rate (ORR) in patients who carried AA and AC genotype was 35.48 and 51.22 %, respectively, with statistically significant difference (P < 0.05). Univariate survival analysis indicated that patients who carried AA genotype showed a significantly lower 5-year survival rate to those who carried AC genotype (P < 0.05). And, considering pathological features, statistical significance was found in patients with different pathological types, lymph node metastasis, differentiation degree, T staging, and pathological staging (all P < 0.05). Multivariate analysis results indicated that the SNP sites of rs11077 might be an independent prognostic factor of advanced NSCLC patients receiving chemotherapy (risk ratio [RR] = 0.346; 95 % confidence interval [95 % CI] = 0.174-0.685, P = 0.002). Other clinical features were all considered to have no apparent effect in influencing the prognostic outcomes of advanced NSCLC patients receiving chemotherapy except lymph node metastasis (P < 0.05). miR-SNP rs11077 of XPO5 may be independently connected with the prognosis and chemotherapy response of advanced NSCLC patients, and patients with AC genotype have relatively improved prognostic outcomes and better curative effect of chemotherapy than those with AA allele of XPO5. Further, lymph node metastasis may be also involved in influencing the prognosis of advanced NSCLC patients.
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Affiliation(s)
- Ji-Qun Geng
- Department of Thoracic and Cardiac Surgery, The Fourth People's Hospital of Wuxi City, Jiangnan University, No. 200, Huihe Road, Wuxi, 214062, People's Republic of China
| | - Xiao-Chen Wang
- Department of Thoracic and Cardiac Surgery, The Affiliated Jiangyin Hospital of Southwest University Medical College, Jiangyin, 214400, People's Republic of China.,Department of Thoracic and Cardiac Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Long-Fei Li
- Department of Thoracic and Cardiac Surgery, The Affiliated Xuzhou Hospital of Jiangsu University, Xuzhou, 221000, People's Republic of China
| | - Jun Zhao
- Department of Thoracic and Cardiac Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Song Wu
- Department of Thoracic and Cardiac Surgery, The Affiliated Jiangyin Hospital of Southwest University Medical College, Jiangyin, 214400, People's Republic of China
| | - Gui-Ping Yu
- Department of Thoracic and Cardiac Surgery, The Affiliated Jiangyin Hospital of Southwest University Medical College, Jiangyin, 214400, People's Republic of China
| | - Kou-Jun Zhu
- Department of Thoracic and Cardiac Surgery, The Fourth People's Hospital of Wuxi City, Jiangnan University, No. 200, Huihe Road, Wuxi, 214062, People's Republic of China.
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14
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Lee DS, Kim SJ, Jang HS, Yoo IR, Park KR, Na SJ, Lee KY, Hong SH, Kang JH, Kim YK, Kim YS. Clinical Correlation Between Tumor Maximal Standardized Uptake Value in Metabolic Imaging and Metastatic Tumor Characteristics in Advanced Non-small Cell Lung Cancer. Medicine (Baltimore) 2015; 94:e1304. [PMID: 26266371 PMCID: PMC4616678 DOI: 10.1097/md.0000000000001304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study aimed to elucidate whether the maximal standardized uptake value (SUVmax) of primary tumors in metabolic imaging correlated with pathological or metastatic characteristics and whether it was prognostic in stage IV nonsmall cell lung cancer (NSCLC).We retrospectively reviewed the medical records of 412 eligible patients between June 2007 and January 2013. All enrolled patients fulfilled the following criteria: they were newly diagnosed with stage IV NSCLC without any previous treatment and had undergone a systemic evaluation, including 18(F)-Fluoro-2-deoxyglucose positron emission tomography/computed tomography, to assess synchronous metastatic sites. Patient and tumor characteristics were analyzed, and clinical correlations between SUVmax and metastatic features were investigated.The median age of the study population was 65 years (range, 30-94), and 259 (62.9%) patients were male. The median SUVmax was statistically higher in males, in tumors with squamous cell histology, and in poorly differentiated tumors. Multivariate logistic regression analysis revealed that SUVmax ≥ 11.4 (top 30 percentiles) were significantly correlated with positive lymph node status (odds ratio [OR] 3.473), abdomen/pelvis metastasis (OR 1.949), and the absence of bone metastasis (OR 0.399) in the subgroup of nonsquamous NSCLC (n = 343). In Kaplan-Meier survival analysis, overall survival was significantly lower among cohorts with high SUVmax (≥11.4) than with low SUVmax (<11.4) (P < 0.001, median 7.4 months vs 12.1 months).The tumors with different SUVmax have distinctive metastatic and biological features in stage IV NSCLC. The underlying mechanisms of this unique metabolic biology need to be resolved in future studies.
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Affiliation(s)
- Dong Soo Lee
- From the Department of Radiation Oncology (DSL, HSJ, YSK), College of Medicine, The Catholic University of Korea; Division of Pulmonology (SJK, YKK), Department of Internal Medicine, College of Medicine, The Catholic University of Korea; Department of Radiation Oncology (KRP), School of Medicine, Ewha Womans University; Department of Nuclear Medicine (IRY, SJN), College of Medicine, The Catholic University of Korea; Department of Hospital Pathology (KYL), College of Medicine, The Catholic University of Korea; and Department of Medical Oncology (SHH, JHK), College of Medicine, The Catholic University of Korea, Seoul, South Korea
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15
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Wang Y, Ma S, Dong M, Yao Y, Liu K, Zhou J. Evaluation of the factors affecting the maximum standardized uptake value of metastatic lymph nodes in different histological types of non-small cell lung cancer on PET-CT. BMC Pulm Med 2015; 15:20. [PMID: 25880540 PMCID: PMC4372315 DOI: 10.1186/s12890-015-0014-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the factors affecting the maximum standardized uptake value (SUVmax) of metastatic lymph nodes in different histological types of non-small cell lung cancer (NSCLC) on integrated positron emission tomography and computed tomography (PET-CT). Methods This was a retrospective, single-institution review of 122 patients with pathologically proven NSCLC who had PET-CT scanning at the same center. Lymph node metastases were pathologically confirmed in tissue specimens from surgical patients. Statistical evaluation of PET-CT results was performed on a per-nodal-station basis. Results The tumor SUVmax of squamous cell carcinoma (SCC) (11.0 ± 4.1) was higher than that of adenocarcinoma (AC) (7.4 ± 4.4) (P < 0.01), however, the SUVmax of the metastatic lymph nodes did not differ between the SCC (4.6 ± 3.1) and AC groups(3.6 ± 2.5) (P = 0.221). The SUVmax of metastatic lymph nodes was positively correlated with lymph node size but not with the primary tumor SUVmax, primary tumor size, tumor location and tumor differentiation. The frequency of a SUVmax of lymph nodes ≥2.5 was 44%, 80%,100% in SCC group and 39%, 59%, 90% in AC group when the short-axis diameter of metastatic lymph node was <10 mm, 10–15 mm, and > 15 mm, respectively. The low sensitivity for metastatic lymph nodes on PET-CT was increased when the SUVmax cut-off for malignancy was considered to be above the normal background compared with that when the SUVmax cut-off was above 2.5. Conclusions There was no difference in the SUVmax of metastatic lymph nodes in the SCC and AC groups. The SUVmax of metastatic lymph nodes was positively correlated with metastatic lymph node size. There was a high false negative rate if lymph nodes with a short-axis diameter less than 10 mm and a extremely low false negative rate if lymph nodes with a short-axis diameter higher than 15 mm. Although an increased sensitivity may be achieved by decreasing the SUVmax cut-off, invasive staging may still be required for negative lymph nodes due to the lower sensitivity of PET-CT in both SCC and AC.
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Affiliation(s)
- Yuehong Wang
- Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Shanni Ma
- Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Mengjie Dong
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Yake Yao
- Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Kanfeng Liu
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Jianying Zhou
- Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
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Nguyen XC, Nguyen VK, Tran MT, Maurea S, Salvatore M. Prognostic Value of Fluoro-D-glucose Uptake of Primary Tumor and Metastatic Lesions in Advanced Nonsmall Cell Lung Cancer. World J Nucl Med 2014; 13:112-9. [PMID: 25191126 PMCID: PMC4150153 DOI: 10.4103/1450-1147.139142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To assess the prognostic value of maximum standardized uptake value (maxSUV) of the primary tumor (maxSUVpt), maxSUV of whole-body tumors (maxSUVwb) and sum of maximum standardized uptake value (sumaxSUV) measured by the sum of maxSUVs of the primary tumor, metastatic lymph nodes, and metastatic lesions per each organ on fluoro-D-glucose-positron emission tomography/computed tomography in advanced non-small cell lung cancer (NSCLC). Eighty-three patients (49 male, 34 female) with advanced NSCLC were enrolled. Seventeen patients had Stage IIIA, 21 Stage IIIB, and 45 Stage IV. maxSUVpt, maxSUVwb, sumaxSUV, age, gender, tumor-cell type, T stage, N stage, overall stage, primary tumor size, and specific treatment were analyzed for correlation with overall survival. Median follow-up duration was 13 months. Fifty patients were dead during a median follow-up time of 11 months and 33 patients were alive with a median time of 15 months. Univariate analysis revealed that overall survival was significantly correlated with sumaxSUV (≥35 vs. <35, P = 0.004), T stage (T4 vs. T1-T3, P = 0.025), overall stage (IV vs. III, P = 0.002), gender (male vs. female, P = 0.029) and specific treatment (no vs. yes, P = 0.011). maxSUVpt and maxSUVwb were not correlated with overall survival with P value of 0.139 and 0.168, respectively. Multivariate analysis identified sumaxSUV, T stage, gender, and specific treatment as independent prognostic indicators. Patients with a sumaxSUV of ≥35 were 1.921 times more likely to die than those with a sumaxSUV of < 35 (P = 0.047). Median survival time was 14 months for patients with sumaxSUV ≥ 35 compared with 20 months for those with sumaxSUV < 35. In patients with metastatic NSCLC, sumaxSUV with cut-off of 35 was much more significant for survival prognosis (P = 0.021). sumaxSUV is a new prognostic measure, independent of tumor stage, gender, and specific treatment in advanced NSCLC. sumaxSUV may be better than maxSUVpt and maxSUVwb in prediction of survival. A large prospective cohort study is necessary to validate these results.
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Affiliation(s)
- Xuan Canh Nguyen
- Unit of PET/CT and Cyclotron, Choray Hospital, Ho Chi Minh City, Vietnam
| | - Van Khoi Nguyen
- Center of Oncology, Choray Hospital, Ho Chi Minh City, Vietnam
| | - Minh Thong Tran
- Department of Pathology, Choray Hospital, Ho Chi Minh City, Vietnam
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, School of Medicine and Surgery, University Federico II of Napoli, Naples, Italy
| | - Marco Salvatore
- Department of Advanced Biomedical Sciences, School of Medicine and Surgery, University Federico II of Napoli, Naples, Italy
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Huellner MW, Collen TD, Gut P, Winterhalder R, Pauli C, Diebold J, Seifert B, Strobel K, Veit-Haibach P. Multiparametric PET/CT-perfusion does not add significant additional information for initial staging in lung cancer compared with standard PET/CT. EJNMMI Res 2014; 4:6. [PMID: 24450990 PMCID: PMC3901766 DOI: 10.1186/2191-219x-4-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/17/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the relationship of CT-perfusion (CTP), 18F-FDG-PET/CT and histological parameters, and the possible added value of CTP to FDG-PET/CT in the initial staging of lung cancer. METHODS Fifty-four consecutive patients (median age 65 years, 15 females, 39 males) with suspected lung cancer were evaluated prospectively by CT-perfusion scan and 18F-FDG-PET/CT scan. Overall, 46 tumors were identified. CTP parameters blood flow (BF), blood volume (BV), and mean transit time (MTT) of the tumor tissue were calculated. Intratumoral microvessel density (MVD) was assessed quantitatively. Differences in CTP parameters concerning tumor type, location, PET positivity of lymph nodes, TNM status, and UICC stage were analyzed. Spearman correlation analyses between CTP and 18F-FDG-PET/CT parameters (SUVmax, SUVmean, PETvol, and TLG), MVD, tumor size, and tumor stage were performed. RESULTS The mean BF (mL/100 mL min-1), BV (mL/100 mL), and MTT (s) was 35.5, 8.4, and 14.2, respectively. The BF and BV were lower in tumors with PET-positive lymph nodes (p = 0.02). However, the CTP values were not significantly different among the N stages. The CTP values were not different, depending on tumor size and location. No significant correlation was found between CTP parameters and MVD. CONCLUSIONS Overall, the CTP information showed only little additional information for the initial staging compared with standard FDG-PET/CT. Low perfusion in lung tumors might possibly be associated with metabolically active regional lymph nodes. Apart from that, both CTP and 18F-FDG-PET/CT parameter sets may reflect different pathophysiological mechanisms in lung cancer.
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Affiliation(s)
- Martin W Huellner
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Spitalstrasse 1, Lucerne CH-6004, Switzerland.
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Tong AN, Han SR, Yan P, Gong H, Zhao H, Yao H, Wang YM. Prognostic value of FDG uptake in primary inoperable non-small cell lung cancer. Med Oncol 2013; 31:780. [DOI: 10.1007/s12032-013-0780-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/20/2013] [Indexed: 12/22/2022]
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