Development of lung cancer risk prediction models based on F-18 FDG PET images

Abstract

Background: We aimed to evaluate whether the degree of F-18 fluorodeoxyglucose (FDG) uptake in the lungs is associated with an increased risk of lung cancer and develop lung cancer risk prediction models using metabolic parameters on F-18 FDG positron emission tomography (PET). Methods: We retrospectively included 585 healthy individuals who underwent F-18 FDG PET/CT scans for a health check-up. Individuals who developed lung cancer within 5 years of the PET/CT scan were classified into the lung cancer group (n=100); those who did not were classified into the control group (n=485). Clinical factors including age, sex, body mass index (BMI), and smoking history were collected. The standardized uptake value ratio (SUVR) and metabolic heterogeneity (MH) index were obtained in the bilateral lungs. Logistic regression models with clinical factors, SUVR and MH index were generated to quantify the probability of lung cancer development. The prediction models were validated using internal data set (n=210). Results: The lung SUVR and lung MH index in the lung cancer group were significantly higher than those in the control group (p<0.001 and p<0.001, respectively). In the combined prediction model 1, age, sex, BMI, smoking history, and lung SUVR were significantly associated with lung cancer development (age: OR 1.07, p <0.001; male: OR 2.08, p=0.015; BMI: OR 0.93, p =0.057; current or past smoker: OR 5.60, p <0.001; lung SUVR: OR 1.13, p <0.001). In the combined prediction model 2, age, sex, BMI, smoking history, and lung MH index showed a significant association with lung cancer development (age: OR 1.06, p<0.001; male: OR 1.87, p=0.045; BMI: OR 0.93, p =0.010; current or past smoker: OR 4.78, p<0.001; lung MH index: OR 1.33, p<0.001). In the validation data, combined prediction model 1 and 2 exhibited very good discrimination (area under the receiver operator curve [AUC]: 0.867 and 0.901, respectively). Conclusion: The metabolic parameters on F-18 FDG PET are related to an increased risk of lung cancer. Metabolic parameters can be used as biomarkers that provide information independent of clinical parameters related to lung cancer risk.