Volume-based assessment by 18F-FDG PET/CT predicts survival in patients with stage III non-small-cell lung cancer

Hyun, Seung Hyup; Ahn, Hee Kyung; Kim, Hojoong; Ahn, Myung‐Ju; Park, Keunchil; Ahn, Yong Chan; Kim, Young Tae; Shim, Young Mog; Choi, Joon Young

doi:10.1007/s00259-013-2530-8

Cited by 118 publications

(86 citation statements)

References 28 publications

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“…However, which of these provides the lowest variability among observers is still controversial. The semiquantitative parameter of 18 F-FDG uptake that is currently most widely used for the assessment of therapeutic response in tumors is SUV max (13,14). The most important concern with SUV max is that a mildly active tumor may have a single hot pixel that may arise from random error rather than actual abnormal uptake in the body.…”

Section: Discussionmentioning

confidence: 99%

Value of Metabolic Tumor Volume on Repeated ¹⁸F-FDG PET/CT for Early Prediction of Survival in Locally Advanced Non–Small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

et al. 2014

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The aim of this study was to investigate the value of standardized uptake values (SUVs) and metabolic tumor volume (MTV) in 18 F-FDG PET/CT to predict the survival of patients with locally advanced nonsmall cell lung cancer during the early stage of concurrent chemoradiotherapy. Methods: A total of 53 patients were included in the prospective study. All patients were evaluated by 18 F-FDG PET before and after 40 Gy of radiotherapy with a concurrent cisplatinbased chemotherapy regimen. Semiquantitative assessment was used to determine the maximum and mean SUVs (SUV max and SUV mean , respectively) and MTV of the primary tumor. The cutoffs for changes in SUV max , SUV mean , and MTV (37.2%, 41.7%, and 29.7%, respectively) determined in a previous study were used with Kaplan-Meier curves to separate the groups. The prognostic significance of PET/CT parameters and other clinical variables was assessed using Cox regression analysis. Results: Overall survival (OS) at 1 and 2 y was 83.0% (46/53) and 52.8% (28/53), respectively. Survival curves for SUV mean and MTV were significantly different using the cutoffs. However, Cox regression analysis showed that the only prognostic factor for OS was a decrease in MTV. Conclusion: The use of repeated 18 F-FDG PET to assess survival early during concurrent chemoradiotherapy is possible in patients with locally advanced non-small cell lung cancer. A decrease in MTV according to 18 F-FDG uptake by the primary tumor correlates with higher long-term OS.

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Section: Discussionmentioning

confidence: 99%

Value of Metabolic Tumor Volume on Repeated ¹⁸F-FDG PET/CT for Early Prediction of Survival in Locally Advanced Non–Small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

et al. 2014

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“…Despite its popularity and practical application, however, SUV max is derived only from a single pixel, thus it may not represent the whole tumor entity and does not provide any information regarding tumor biology (29,30). Furthermore, SUV max is highly sensitive to noise and affected by the partial-volume effect (30,31). These phenomena appear particularly in inflammatory lesions; therefore, the evaluation of biologic and anatomic tumor data based only on SUV max is highly susceptible to bias (30).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, new 18 F-FDG PET parameters (MTV and TLG) have been introduced and showed their potential as an alternative to SUV max by offering more relevant tumor information while combining both metabolic activity and 3-dimensional tumor volume (15,16). In lung cancer, recently these parameters served as significant prognostic factors for survival and provided better prognostic imaging biomarkers than SUV max (31). In OSCC, TLG was suspected to be also reliable as an independent prognostic factor for recurrence and metastasis.…”

Section: Discussionmentioning

confidence: 99%

Effects of Intratumoral Inflammatory Process on ¹⁸F-FDG Uptake: Pathologic and Comparative Study with ¹⁸F-Fluoro-α-Methyltyrosine PET/CT in Oral Squamous Cell Carcinoma

et al. 2014

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The accurate depiction of both biologic and anatomic profiles of tumors has long been a challenge in PET imaging. An inflammation, which is innate in the carcinogenesis of oral squamous cell carcinoma (OSCC), frequently complicates the image analysis because of the limitations of 18 F-FDG and maximum standardized uptake values (SUV max ). New PET parameters, metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as well as 18 Ffluoro-α-methyltyrosine ( 18 F-FAMT), a malignancy-specific amino acid-based PET radiotracer, are considered more comprehensive in tumor image analysis. Here, we showed the substantial effects of the intratumoral inflammatory process on 18 F-FDG uptake and further study the possibility of MTV and TLG to predict both tumor biology (proliferation activity) and anatomy (pathologic tumor volume). Methods: 18 F-FDG and 18 F-FAMT PET images from 25 OSCC patients were analyzed. SUV max on the tumor site was obtained. PET volume computerized-assisted reporting was used to generate a volume of interest to obtain MTV and TLG for 18 F-FDG and total lesion retention (TLR) for 18 F-FAMT. The whole tumor dissected from surgery was measured and sectioned for pathologic analysis of tumor inflammation grade and Ki-67 labeling index. Results: The high SUV max of 18 F-FDG was related to the high inflammation grade. The SUV max ratio of 18 F-FDG to 18 F-FAMT was higher in inflammatory tumors (P , 0.05) whereas the corresponding value in tumors with a low inflammation grade was kept low. All 18 F-FAMT parameters were correlated with Ki-67 labeling index (P , 0.01). Pathologic tumor volume predicted from MTV of 18 F-FAMT was more accurate (R 5 0.90, bias 5 3.4 ± 6.42 cm 3 , 95% confidence interval 5 0.77-6.09 cm 3 ) than that of 18 F-FDG (R 5 0.77, bias 5 8.1 ± 11.17 cm 3 , 95% confidence interval 5 3.45-12.67 cm 3 ). Conclusion: 18 F-FDG uptake was overestimated by additional uptake related to the intratumoral inflammatory process, whereas 18 F-FAMT simply accumulated in tumors according to tumor activity as evaluated by Ki-67 labeling index in OSCC.

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“…For non-small cell lung cancer (NSCLC), 18 F-FDG PET/CT image quantification has been shown to provide prognostic information. PET image-derived features, including metabolically active tumor volume (MATV), mean standardized uptake value (SUV mean ), and total lesion glycolysis (TLG, defined as MATV · SUV mean ), have been shown to provide an accurate assessment of tumor burden with potentially higher prognostic value than standard maximum SUV (SUV max ), for both surgical and nonsurgical patients (5)(6)(7)(8)(9).…”

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confidence: 99%

Visual Versus Quantitative Assessment of Intratumor ¹⁸F-FDG PET Uptake Heterogeneity: Prognostic Value in Non–Small Cell Lung Cancer

et al. 2014

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The goal of this study was to compare visual assessment of intratumor 18 F-FDG PET uptake distribution with a textural-features (TF) automated quantification and to establish their respective prognostic value in non-small cell lung cancer (NSCLC). Methods: The study retrospectively included 102 consecutive patients. Only primary tumors were considered. Intratumor heterogeneity was visually scored (3-level scale [H visu ]) by 2 nuclear medicine physicians. Tumor volumes were automatically delineated, and heterogeneity was quantified with TF. Mean and maximum standardized uptake value were also included. Visual interobserver agreement and correlations with quantitative assessment were evaluated using the κ test and Spearman rank (ρ) coefficient, respectively. Association with overall survival and recurrencefree survival was investigated using the Kaplan-Meier method and Cox regression models. Results: Moderate correlations (0.4 , ρ , 0.6) between TF parameters and H visu were observed. Interobserver agreement for H visu was moderate (κ 5 0.64, discrepancies in 27% of the cases). High standardized uptake value, large metabolic volumes, and high heterogeneity according to TF were associated with poorer overall survival and recurrence-free survival and remained an independent prognostic factor of overall survival with respect to clinical variables. Conclusion: Quantification of 18 F-FDG uptake heterogeneity in NSCLC through TF was correlated with visual assessment by experts. However, TF also constitutes an objective heterogeneity quantification, with reduced interobserver variability, and independent prognostic value potentially useful for patient stratification and management. PET/ CT imaging with 18 F-FDG is today a well-established tool for diagnostic oncology applications (1). Its exploitation for tumor delineation in the planning of radiotherapy treatment (2) or monitoring of response to therapy (3,4) is increasing. For non-small cell lung cancer (NSCLC), 18 F-FDG PET/CT image quantification has been shown to provide prognostic information. PET image-derived features, including metabolically active tumor volume (MATV), mean standardized uptake value (SUV mean ), and total lesion glycolysis (TLG, defined as MATV · SUV mean ), have been shown to provide an accurate assessment of tumor burden with potentially higher prognostic value than standard maximum SUV (SUV max ), for both surgical and nonsurgical patients (5-9).Intratumor 18 F-FDG uptake heterogeneity has been associated with treatment failure (10), and its quantification has recently generated interest (11-14), including in lung cancer (15). Several methodologies have been proposed to assess intratumor heterogeneity, including visual evaluation (16), SUV coefficient of variation (SUV COV ) (17), area under the curve of the cumulative histogram (CH AUC ) (18), and textural-features (TF) analysis (17,19).TF analysis can generate many features quantifying heterogeneity within a delineated MATV. Recent studies have identified a few of these features that are ...

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Volume-based assessment by 18F-FDG PET/CT predicts survival in patients with stage III non-small-cell lung cancer

Abstract: The volume-based PET parameters (MTV and TLG) are significant prognostic factors for survival independent of tumour stage and better prognostic imaging biomarkers than SUVmax in patients with stage IIIA NSCLC after surgical resection.

Cited by 118 publications

References 28 publications

Value of Metabolic Tumor Volume on Repeated ¹⁸F-FDG PET/CT for Early Prediction of Survival in Locally Advanced Non–Small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

Value of Metabolic Tumor Volume on Repeated ¹⁸F-FDG PET/CT for Early Prediction of Survival in Locally Advanced Non–Small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

Effects of Intratumoral Inflammatory Process on ¹⁸F-FDG Uptake: Pathologic and Comparative Study with ¹⁸F-Fluoro-α-Methyltyrosine PET/CT in Oral Squamous Cell Carcinoma

Visual Versus Quantitative Assessment of Intratumor ¹⁸F-FDG PET Uptake Heterogeneity: Prognostic Value in Non–Small Cell Lung Cancer

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Volume-based assessment by 18F-FDG PET/CT predicts survival in patients with stage III non-small-cell lung cancer

Abstract: The volume-based PET parameters (MTV and TLG) are significant prognostic factors for survival independent of tumour stage and better prognostic imaging biomarkers than SUVmax in patients with stage IIIA NSCLC after surgical resection.

Cited by 118 publications

References 28 publications

Value of Metabolic Tumor Volume on Repeated 18F-FDG PET/CT for Early Prediction of Survival in Locally Advanced Non–Small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

Value of Metabolic Tumor Volume on Repeated 18F-FDG PET/CT for Early Prediction of Survival in Locally Advanced Non–Small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

Effects of Intratumoral Inflammatory Process on 18F-FDG Uptake: Pathologic and Comparative Study with 18F-Fluoro-α-Methyltyrosine PET/CT in Oral Squamous Cell Carcinoma

Visual Versus Quantitative Assessment of Intratumor 18F-FDG PET Uptake Heterogeneity: Prognostic Value in Non–Small Cell Lung Cancer

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Value of Metabolic Tumor Volume on Repeated ¹⁸F-FDG PET/CT for Early Prediction of Survival in Locally Advanced Non–Small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

Value of Metabolic Tumor Volume on Repeated ¹⁸F-FDG PET/CT for Early Prediction of Survival in Locally Advanced Non–Small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

Effects of Intratumoral Inflammatory Process on ¹⁸F-FDG Uptake: Pathologic and Comparative Study with ¹⁸F-Fluoro-α-Methyltyrosine PET/CT in Oral Squamous Cell Carcinoma

Visual Versus Quantitative Assessment of Intratumor ¹⁸F-FDG PET Uptake Heterogeneity: Prognostic Value in Non–Small Cell Lung Cancer