The Role of Histogram-Based Textural Analysis of ¹⁸F-FDG PET/CT in Evaluating Tumor Heterogeneity and Predicting the Prognosis of Invasive Lung Adenocarcinoma

Abstract

Objectives: This study aimed to investigate the contributory role of histogram-based textural features (HBTFs) extracted from 18 fluorinefluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) in tumoral heterogeneity (TH) evaluation and invasive lung adenocarcinoma (ILA) prognosis prediction. Methods: This retrospective study analyzed the data of 72 patients with ILA who underwent 18 F-FDG PET/CT followed by surgical resection. The maximum standardized uptake value (SUV max ), metabolic tumor volume, and total lesion glycolysis values were calculated for each tumor. Additionally, HBTFs were extracted from 18 F-FDG PET/CT images using the software program. ILA was classified into the following five histopathological subtypes according to the predominant pattern: Lepidic adenocarcinoma (LA), acinar adenocarcinoma, papillary adenocarcinoma, solid adenocarcinoma (SA), and micropapillary adenocarcinoma (MA). Differences between 18 F-FDG PET/CT parameters and histopathological subtypes were evaluated using non-parametric tests. The study endpoints include overall survival (OS) and progression-free survival (PFS). The prognostic values of clinicopathological factors and 18 F-FDG PET/CT parameters were evaluated using the Cox regression analyses. Results: The median SUV max and entropy values were significantly higher in SA-MA, whereas lower in LA. The median energy-uniformity value of the LA was significantly higher than the others. Among all parameters, only skewness and kurtosis were significantly associated with lymph node involvement status. The median values for follow-up time, PFS, and OS were 31.26, 16.07, and 20.87 months, respectively. The univariate Cox regression analysis showed that lymph node involvement was the only significant predictor for PFS. The multivariate Cox regression analysis revealed that higher SUV max (≥11.69) and advanced stage (IIB-IIIA) were significantly associated with poorer OS [hazard ratio (HR): 3.580, p=0.024 and HR: 7.608, p=0.007, respectively]. Conclusion: HBTFs were tightly associated with clinicopathological factors causing TH. Among the 18 F-FDG PET/CT parameters, only skewness and kurtosis were associated with lymph node involvement, whereas SUV max was the only independent predictor of OS. TH measurement with HBTFs may contribute to conventional metabolic parameters in guiding precision medicine for ILA.

Prognostic Value of Axillary Lymph Node Texture Parameters Measured by Pretreatment 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Locally Advanced Breast Cancer with Neoadjuvant Chemotherapy

“…SUV skewness shows the asymmetry of the distribution of lesion intensity about its mean value, and a higher SUV skewness reflects the statistical heterogeneity of images [ 16 ]. In previous studies, tumor SUV skewness was a useful predictor for LN metastasis in the uterine cervix, lung, pancreas, brain, and nasopharyngeal cancers [ 17 , 18 , 19 , 20 ]. Another study reported that tumor SUV skewness was associated with PFS and OS in lymphoma [ 21 , 22 ].…”

18F-FDG PET/CT characteristics of IASLC grade 3 invasive adenocarcinoma and the value of 18F-FDG PET/CT for preoperative prediction: a new prognostication model

“…18 F-fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (CT) is an important modality for tumor imaging, which can not only provide the detailed morphologic changes to represent the pathological process of the lesions through CT component, but also can provide the tumor’s metabolic activity through PET component. The tumor’s metabolic activity was always reported to be closely related to tumor aggressiveness and the prognosis of the patients [19–21]. Currently, PET/CT has gained a great application on the diagnosis, pretherapeutic staging and efficacy evaluation of lung cancer [22–24], however, few studies were reported concerning its use in evaluating the tumor grade based on the new IASLC grading system 2020.…”

18F-FDG PET/CT characteristics of IASLC grade 3 invasive adenocarcinoma and the value of18F-FDG PET/CT for preoperative prediction

“…17,18 Due to the high aggressiveness of this tumor, it is of great clinical value to predict it noninvasively before the surgery, which is useful to guide surgeon to make a more suitable treatment plan. [19][20][21] Currently, PET/CT has gained a great application on the diagnosis, pretherapeutic staging and efficacy evaluation of lung cancer, [22][23][24] however, few studies were reported concerning its use in evaluating the tumor grade based on the new IASLC grading system 2020. In the present study, we retrospectively analyzed the 18 F-FDG PET/CT findings in 227 patients to uncover the imaging characteristics of IASLC grade 3 tumor and investigate the value of 18 F-FDG PET/CT for noninvasively predicting IASLC grade 3 tumors before surgery.…”