18F-fluorodeoxyglucose positron emission tomography for evaluation of thymic epithelial tumors: utility for World Health Organization classification and predicting recurrence-free survival

Seki, Norio; Sakamoto, Setsu; Karube, Yoko; Oyaizu, Takeshi; Ishihama, Hiromi; Chida, Masayuki

doi:10.1007/s12149-014-0804-2

Cited by 24 publications

(29 citation statements)

References 10 publications

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“…No previous study has evaluated more than 100 cases to verify the utility of PET parameters including SUVmax, T/M ratio, MTV, and TLG to diagnose anterior mediastinal tumors in a single institution. Several studies have reported that the SUVmax of FDG-PET is useful for predicting malignant and high-risk thymoma in selected thymic epithelial tumors, but the sample sizes of these previous studies were limited to only a few dozen cases (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). As anterior mediastinal tumors are relatively rare, it is difficult to collect data from sufficient numbers of patients with these tumors during short periods.…”

Section: Discussionmentioning

confidence: 99%

“…The differentiation of benign vs. malignant tumors in the anterior mediastinum is reportedly aided by analysis of the maximum standardized uptake value (SUVmax) of FDG-PET (5)(6)(7). Studies on thymic epithelial tumors have shown that SUVmax is greater in high-risk thymoma, particularly in thymic cancer, than in low-risk thymoma (8)(9)(10)(11)(12)(13)(14)(15); however, other studies report that SUVmax is similar in low-risk thymoma and high-risk thymoma (16)(17)(18)(19)(20). In addition, the tumor to mediastinal (T/M) ratio, which is a semiquantitative parameter defined as the ratio of the SUVmax of the tumor to the aorta, has been proposed for differentiating high-risk thymoma from low-risk thymoma in thymic epithelial tumors (21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

“…Although thymoma was classically classified as a pathological benign tumor based on its histological features, it is classified clinically as a malignant tumor when there is invasion into a neighboring organ, dissemination, or metastasis. Furthermore, the WHO classifies thymomas into five types (A, AB, B1, B2, and B3), and further divides these types into two groups: Low-risk thymoma (A, AB, and B1) and high-risk thymoma (B2 and B3) (15,26), as patients with low-risk thymoma rarely experience recurrence after complete resection. Therefore, in the clinical situation, we considered that anterior mediastinal tumors should be classified into four groups in accordance with their malignant potential: Benign, low-risk thymoma, high-risk thymoma, and malignant.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative analysis of metabolic parameters at 18F‑fluorodeoxyglucose positron emission tomography in predicting malignant potential of anterior mediastinal tumors

et al. 2020

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To evaluate the utility of 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) for predicting the malignancy of anterior mediastinal tumors, the present study retrospectively examined a total of 105 consecutive patients who underwent surgical resection of anterior mediastinal tumors at Gunma University Hospital after undergoing a preoperative FDG-PET scan. Patients were divided into benign and malignant groups in accordance with the following three classification systems: i) Clinical classification, benign or malignant (thymoma and carcinoma); ii) recurrence-based classification, low-risk recurrence (benign and low-risk thymoma) or high-risk recurrence (high-risk thymoma and carcinoma); and iii) pathological classification, benign (benign and thymoma) or malignant (carcinoma). The present study analyzed the differences between the benign and malignant groups in terms of FDG-PET parameters, including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The malignant group exhibited a significantly greater SUVmax than the benign group according to all classification systems. By contrast, there was only a slight difference between groups in volume-based metabolic parameters (MTV and TLG) using the clinical classification, and no intergroup differences using the recurrence-based and pathological classifications. The area under the curve in receiver-operating characteristic curve analysis for predicting malignancy was significantly greater for SUVmax than for volume-based metabolic parameters using all classification methods. The respective optimal cutoff value, sensitivity and specificity of SUVmax to predict malignancy were 1.77, 92.0 and 87.0% for the clinical classification, 2.54, 93.6 and 60.3% for the recurrence-based classification, and 5.15, 78.9 and 90.7% for the pathological classification. SUVmax was the most useful parameter for predicting the malignancy of anterior mediastinal tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative analysis of metabolic parameters at 18F‑fluorodeoxyglucose positron emission tomography in predicting malignant potential of anterior mediastinal tumors

et al. 2020

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“…A number of studies have evaluated the usefulness of FDG-PET/CT for predicting the grade of malignancy according to the WHO classification and outcomes in patients with thymic epithelial tumors [9][10][11][12][13][14][15] ; most reported that SUVmax was useful for differentiating thymomas from thymic carcinomas. 9,10,13,15,23 In contrast, controversy surrounds the ability of FDG-PET/CT to differentiate high-risk thymomas from low-risk thymomas. SUVmax has been shown to differentiate low-risk thymomas from high-risk thymomas, 11-13, 26, 27 whereas other studies reporting conflicting data 9,10,23,28 possibly because of a marked overlap in FDG uptake.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reported FDG-PET/CT values for predicting histological subtypes or tumor stages in patients with thymic epithelial tumors. [9][10][11][12][13][14][15] The maximum standardized uptake value (SUVmax) is a reproducible imaging biomarker on PET/CT. Newly suggested volumetric parameters, such as the metabolic tumor volume (MTV) and total lesion glycolytic activity (TLG), have recently been reported as additional diagnostic and prognostic biomarkers in various malignant tumors [16][17][18][19] ; however, few studies have examined the relationship between PET volumetric parameters and thymic epithelial tumors.…”

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confidence: 99%

Usefulness of Preoperative <sup>18</sup>F-FDG PET/CT for Patients with Thymic Epithelial Tumors

et al. 2019

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Background The purpose of this study was to investigate the relationship between preoperative FDG-PET parameters and the World Health Organization (WHO) classification or Masaoka staging system of thymic epithelial tumors. Methods We retrospectively reviewed 32 patients with histologically proven thymic epithelial tumors who underwent FDG-PET/CT before surgical resection. FDG-PET parameters, including the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolytic activity (TLG), were measured. These PET parameters were compared in the Masaoka staging system and WHO classification. A receiver operating characteristics (ROC) analysis was performed to identify the cutoff values of PET parameters for the accurate differentiation of early and advanced stages in the Masaoka staging system. Results There were 17 low-risk thymomas (1 type A, 9 type AB, and 7 type B1), 8 high-risk thymomas (4 type B2 and 4 type B3), and 7 thymic carcinomas (7 squamous cell carcinoma). Their Masaoka stages were as follows: 24 in the early stage (stages I and II) and 8 in the advanced stage (stage III). Regarding the WHO classification, only SUVmax showed a significant difference (P < 0.05). In the Masaoka stage, all PET parameters were significantly higher in the advanced stage than in the early stage (P < 0.05). In the ROC analysis to predict the early and advanced stages in thymic epithelial tumors, the area under the curve was the highest for TLG among the PET parameters examined and the cutoff value of TLG for discriminating the early from advanced stage with maximal sensitivity and specificity was 30.735. Conclusion Although volumetric PET parameters, such as MTV and TLG, did not correlate with the WHO classification, a significant correlation was observed between SUVmax and the WHO classification. In the Masaoka staging system, volumetric PET parameters may achieve more precise staging than SUVmax.

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Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival

Priola

Giraudo³

et al. 2015

Eur Radiol

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Objectives: To evaluate the usefulness of diffusion-weighted magnetic resonance for distinguishing thymomas according to WHO and Masaoka-Koga classifications and in predicting disease-free survival (DFS) by using the apparent diffusion coefficient (ADC). Methods:Forty-one patients were grouped based on WHO (low-risk vs. high-risk) and MasaokaKoga (early vs. advanced) classifications. For prognosis, seven patients with recurrence at followup were grouped separately from healthy subjects. Differences on ADC levels between groups were tested using Student-t testing. Logistic regression models and areas under the ROC curve (AUROC) were estimated. Results:Mean ADC values were different between groups of WHO (low-risk=1.58±0.20×10-3mm2/sec; high-risk=1.21±0.23×10-3mm2/sec; p<0.0001) and Masaoka-Koga (early=1.43±0.26×10-3mm2/sec; advanced=1.31±0.31×10-3mm2/sec; p=0.016) classifications.Mean ADC of type-B3 (1.05±0.17×10-3mm2/sec) was lower than type-B2 (1.32±0.20×10-3mm2/sec; p=0.023). AUROC in discriminating groups was 0.864 for WHO classification (cutpoint=1.309×10-3mm2/sec; accuracy=78.1 %) and 0.730 for Masaoka-Koga classification (cut-point=1.243×10-3mm2/sec; accuracy=73.2 %). Logistic regression models and two-way ANOVA were significant for WHOclassification (odds ratio[OR]=0.93, p=0.007; p<0.001), but not for Masaoka-Koga classification (OR=0.98, p=0.31; p=0.38). ADC levels were significantly associated with DFS recurrence rate being higher for patients with ADC≤1.299× 10-3mm2/sec (p=0.001; AUROC, 0.834; accuracy=78.0 %).Conclusions: ADC helps to differentiate high-risk from lowrisk thymomas and discriminates the more aggressive type-B3. Primary tumour ADC is a prognostic indicator of recurrence. Key Points• DW-MRI is useful in characterizing thymomas and in predicting disease-free survival.• ADC can differentiate low-risk from high-risk thymomas based on different histological composition • The cutoff-ADC-value of 1.309×10-3mm2/sec is proposed as optimal cut-point for this differentiation • The ADC ability in predicting Masaoka-Koga stage is uncertain and needs further validations• ADC has prognostic value on disease-free survival and helps in stratification of risk

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18F-fluorodeoxyglucose positron emission tomography for evaluation of thymic epithelial tumors: utility for World Health Organization classification and predicting recurrence-free survival

Abstract: The SUVmax of (18)F-FDG-PET reflects WHO classification of thymic epithelial tumors. High SUVmax predicts lower recurrence-free survival of the tumors.

Cited by 24 publications

References 10 publications

Quantitative analysis of metabolic parameters at 18F‑fluorodeoxyglucose positron emission tomography in predicting malignant potential of anterior mediastinal tumors

Quantitative analysis of metabolic parameters at 18F‑fluorodeoxyglucose positron emission tomography in predicting malignant potential of anterior mediastinal tumors

Usefulness of Preoperative <sup>18</sup>F-FDG PET/CT for Patients with Thymic Epithelial Tumors

Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival

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