Preoperative 18F-Fluorodeoxyglucose Positron Emission Tomography can Predict the Tumor Malignancy of Small Peripheral Lung Cancer

Abstract

Purpose: Recent advances in image diagnostic technology have enhanced the discovery of peripheral small size lung cancers. Here, we examined the utility of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for the evaluation of grade of tumor malignant potency. Methods: Seventy-nine patients with peripheral small lung cancers (≤2 cm) who underwent surgical resections and preoperative FDG-PET were enrolled. The correlations between the maximum standardized uptake value (SUV max ) and various clinicopathological features related to tumor invasiveness, nodal metastasis, and recurrence were analyzed. Results: The median SUV max of all tumors was 2.4 (range, 0-16.1). The SUV max was significantly higher in patients with vascular invasion (5.6 ± 3.5 vs. 2.4 ± 2.4; P <0.0001), lymphatic invasion (4.9 ± 3.7 vs. 2.7 ± 2.6; P = 0.0029), lymph node metastasis (6.1 ± 4.4 vs. 3.0 ± 2.7; P = 0.0022), and recurrences (5.8 ± 3.3 vs. 3.1 ± 3.1; P = 0.0219). Patients with SUV max ≥2.5 had a significantly higher incidence rate of vascular invasion (56% vs. 7%; P <0.0001), lymphatic invasion (51% vs. 15%; P = 0.0006), lymph node metastasis (26% vs. 3%; P = 0.0033), and recurrence (18% vs. 3%; P = 0.0289). The patients with SUV max ≥1.5 also had a significantly higher incidence of vascular invasion, lymphatic invasion, lymph node metastasis, and recurrence. It is particularly worth noting that patients with SUV max <1.5 had no vascular invasion, lymph node metastasis, or recurrence. Conclusion: Preoperative SUV max of peripheral small lung cancers were significantly associated with tumor malignancy.

Preoperative identification of clinicopathological prognostic factors for relapse-free survival in clinical N1 non-small cell lung cancer: a retrospective single center-based study

“…The present study demonstrated that the prognoses of patients with cN1 NSCLC were associated with age, the CEA value, and the primary tumor’s SUVmax value. The primary tumor’s SUVmax value was also an independent prognostic factor for both OS and RFS, which is consistent with previous reports regarding the associations between FDG uptake and tumor malignancy [ 13 – 16 ]. Clinical and experimental studies have indicated that FDG accumulation during PET examination was correlated with tumor growth rate, cell density, and cell differentiation [ 17 – 19 ].…”

Preoperative identification of clinicopathological prognostic factors for relapse-free survival in clinical N1 non-small cell lung cancer: A retrospective single center-based study

“…SUVmax value was also an independent prognostic factor for both OS and RFS, which is consistent with previous reports on the associations between FDG uptake and tumor malignancy [13][14][15][16]. Clinical and experimental studies have indicated that FDG accumulation during PET examination was correlated with tumor growth rate, cell density, and cell differentiation.…”

FDG PET/CT Overcomes Discordance Between Clinical and Pathologic TNM Classification of Small-size Primary Lung Cancer: Influence on Postoperative Prognosis

“…Many studies have indicated that FDG-PET/CT is useful for determining the c-stage and therapeutic strategy for small-size lung cancer. [4][5][6][7][8] However, a recent study in the Netherlands reported that the accuracy of the c-stage for non-small-cell lung cancer (NSCLC) was low, even in the era of FDG-PET/CT. 9,10 Few studies have investigated whether the PET/CT findings can salvage the discordance between the clinical and pathologic TNM staging.…”