2-[18F]FDG PET/CT as a Predictor of Microvascular Invasion and High Histological Grade in Patients with Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) generally presents a low avidity for 2-deoxy-2-[18F]fluoro-d-glucose (FDG) in PET/CT although an increased FDG uptake seems to relate to more aggressive biological factors. To define the prognostic value of PET/CT with FDG in patients with an HCC scheduled for a tumor resection, forty-one patients were prospectively studied. The histological factors of a poor prognosis were determined and FDG uptake in the HCC lesions was analyzed semi-quantitatively (lean body mass-corrected standardized uptake value (SUL) and tumor-to-liver ratio (TLR) at different time points). The PET metabolic parameters were related to the histological characteristics of the resected tumors and to the evolution of patients. Microvascular invasion (MVI) and a poor grade of differentiation were significantly related to a worse prognosis. The SULpeak of the lesion 60 min post-FDG injection was the best parameter to predict MVI while the SULpeak of the TLR at 60 min was better for a poor differentiation. Moreover, the latter parameter was also the best preoperative variable available to predict any of these two histological factors. Patients with an increased TLRpeak60 presented a significantly higher incidence of poor prognostic factors than the rest (75% vs. 28.6%, p = 0.005) and a significantly higher incidence of recurrence at 12 months (38% vs. 0%, p = 0.014). Therefore, a semi-quantitative analysis of certain metabolic parameters on PET/CT can help identify, preoperatively, patients with histological factors of a poor prognosis, allowing an adjustment of the therapeutic strategy for those patients with a higher risk of an early recurrence.

18F-FDG /18F-Choline Dual-Tracer PET Behavior and Tumor Differentiation in HepatoCellular Carcinoma. A Systematic Review

“…been reported in 29% of HCCs with a size ranging from 2 to 5 cm (34). Sabaté-Llobera et al reported that the ratios of well-to less differentiated tumors ranged from 1.3 in the 18F-FDG-positive group to 5.7 in the 18F-FDG-negative group (31). However, nearly 50% of 18F-FDG-positive cases in the present study were well-differentiated HCC.…”

“…Although an extensive review by Gouw et al showed that high-grade tumors but also tumor size and number of nodules to be predictive of MVI ( 33 ), MVI has also been reported in 29% of HCCs with a size ranging from 2 to 5 cm ( 34 ). Sabaté-Llobera et al reported that the ratios of well- to less differentiated tumors ranged from 1.3 in the 18F-FDG-positive group to 5.7 in the 18F-FDG-negative group ( 31 ). However, nearly 50% of 18F-FDG-positive cases in the present study were well-differentiated HCC.…”

“…As 61% of the biopsy-proven reported HCC cases were potentially a blinded case mix of ES/WHO definitions, any generalizability of 18F-FDG/18F-Choline dual PET tracer behavior according to HCC grading would be ambiguous. Second, a significant association between glucose metabolism assessed by FDG PET and microvascular invasion (MVI), another strong prognostic factor in HCC (28,29), has been widely reported (23,(30)(31)(32). Surprisingly, Kornberg et al reported that 14 of the 16 HCC patients who were positive for 18F-FDG PET had MVI (87.5%), of whom only 1/3 were poorly differentiated (5 patients) (30).…”

Surgical resection versus radiofrequency ablation for early recurrent hepatocellular carcinoma

“…suggested that the size and number of tumors were important markers for predicting vascular invasion [32]. It has been recognized that poor differentiation of tumor is closely related to metastasis and invasiveness of tumor [33]. Therefore, early rHCC is more likely to recur than late rHCC [9,29], and it is accompanied by multiple hospitalizations.…”

Tumor metabolism derived from 18F-FDG PET/CT in predicting the macrotrabecular-massive subtype of hepatocellular carcinoma

“…Currently, β-2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography with computed tomography ( 18 F-FDG PET/CT) has shown to be a valuable molecular imaging tool when evaluating the biological behavior of tumors (11)(12)(13). The FDG uptake in HCC lesions is reportedly associated with more aggressive characteristics, such as a higher histological grade, the presence of microvascular invasion (MVI), early recurrence, and poor overall survival (14)(15)(16). Thus, we aimed to evaluate the potential to use tumor FDG metabolism as an imaging indicator to preoperatively predict the MTM subtype in HCC patients.…”