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. 2018 Jun 7;27(2):73-80.
doi: 10.4274/mirt.53315.

The Contribution of Fluorine 18F-FDG PET/CT to Lung Cancer Diagnosis, Staging and Treatment Planning

Emine Budak  1 , Gürsel Çok  2 , Ayşegül Akgün  3
Affiliations

The Contribution of Fluorine 18F-FDG PET/CT to Lung Cancer Diagnosis, Staging and Treatment Planning

Emine Budak et al. Mol Imaging Radionucl Ther. .

Abstract
in English, Turkish

Objective: Lung cancer is the most common cause of cancer-related death throughout the world, and the correct choice of treatment based on early diagnosis and staging increases the chance of survival. The present study aims to investigate the contribution of fluorine 18-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) to the management of lung cancer.

Methods: In this study, 50 patients who underwent 18F-FDG PET/CT for lung cancer diagnosis and staging between February 2012 and February 2014 were included. The maximum standardized uptake value (SUVmax) of the primary lung lesion along with other findings of 18F-FDG PET/CT and the results of histopathologic and conventional examinations were evaluated retrospectively. The mean survival time of patients was determined, and the findings were compared by using statistical methods.

Results: Histopathologic examinations revealed 51 lung cancers in 50 patients. The sensitivity, accuracy and positive predictive value of 18F-FDG PET/CT in detecting primary malignancy were 94%, 94%, 100%, respectively. Adenocarcinoma (n=23, 16.8±13.5) and squamous cell carcinoma (n=15, 17.9±5.6) did not differ significantly regarding their mean SUVmax values (p=0.2). A statistically significant positive correlation (r=0.4) was identified between tumor size and SUVmax value for 51 tumors (p=0.002). The 18F-FDG PET/CT result was true negative in nine, false positive in six, true positive in two, and false negative in four patients who underwent histopathologic evaluation of their lymph nodes. The 18F-FDG PET/CT changed treatment planning in 34% of the patients. No significant relationship was identified between SUVmax value of the tumor and patient survival in patients (p=0.118).

Conclusion: The present study concluded that PET/CT was an efficient method in the diagnosis and staging of lung cancer since it provided useful information in addition to conventional methods. It was also observed that PET/CT scanning resulted in a change in therapeutic plans in the majority of patients. However, there was no statistically significant relationship between survival and the SUVmax of the primary mass.

Amaç: Akciğer kanseri, tüm dünyada kansere bağlı ölümlerin en sık nedenidir. Erken tanı ve evrelemeye bağlı doğru tedavi seçimi akciğer kanserinde sağkalımı artıran bir faktördür. Amacımız akciğer kanseri yönetimine flor 18-fluorodeoksiglukoz-pozitron emisyon tomografisi/bilgisayarlı tomografinin (18F-FDG PET/BT) katkısını araştırmaktır. Yöntem: Çalışmamıza Şubat 2012-Şubat 2014 tarihleri arasında akciğer kanseri tanı ve evrelemesi amacıyla 18F-FDG PET/BT yapılan 50 hasta dahil edildi. 18F-FDG PET/BT’de akciğerde saptanan primer lezyonun maksimum standart tutulum değeri (SUVmaks) ve diğer bulguları ile histopatolojik ve konvansiyonel yöntem sonuçları retrospektif olarak değerlendirildi. Hastaların ortalama sağkalım süresi belirlendi. İstatistiksel yöntemler kullanılarak bulgular karşılaştırıldı. Bulgular: Elli hastada histopatolojik olarak toplam 51 akciğer kanseri saptandı. 18F-FDG PET/BT’nin primer maligniteyi saptamada duyarlılık, doğruluk ve pozitif prediktif değeri sırasıyla %94, %94, %100 saptandı. Adenokarsinom (n=23, 16,8±13,5) ve skuamöz hücreli karsinom (n=15, 17,9±5,6) ortalama SUVmaks değeri açısından anlamlı bir farklılık göstermedi (p=0,2). Elli bir tümör için tümör boyutu ile SUVmaks değeri arasında istatistiksel olarak anlamlı pozitif korelasyon (r=0,4) mevcuttu (p=0,002). 18F-FDG PET/BT, histopatolojik olarak lenf nodu değerlendirilen hastaların; dokuzunda gerçek negatif, altısında yanlış pozitif, ikisinde gerçek pozitif ve dördünde yanlış negatifti. 18F-FDG PET/BT, hastaların %34’ünde tedavi planını değiştirdi. Tümörün SUVmaks değeri ile hasta sağkalımı arasında anlamlı bir ilişki yoktu (p=0,118). Sonuç: Çalışmamızda PET/BT’nin konvansiyonel yöntemlere ek önemli bilgiler sağlayarak akciğer kanseri tanı ve evrelemesinde etkin bir yöntem olduğu sonucuna varıldı. Ayrıca PET/BT’nin evrelemeye katkısıyla hastaların önemli bir kısmında tedavi planında değişikliğe neden olduğu görüldü. Ancak primer kitlenin SUVmaks değeri ile hastaların sağkalımı arasında istatistiksel olarak anlamlı ilişki saptanmadı.

Keywords: Lung cancer; positron emission tomography survival analysis..

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1. Axial, coronal, and sagittal CT images (A), fused PET/CT images (B) and PET images (C) of the patient with small cell lung carcinoma. The tumor size could not clearly be assessed on CT images. The fused PET/CT images enables differentiation of tumor and atelectasis areas due to intense FDG uptake of the tumor area [tumor maximum standardized uptake value (SUVmax): 10, atelectasis SUVmax: 3.7], thus, the tumor size has been correctly calculated
Figure 2
Figure 2. A and B demonstrate axial sections of CT and fused PET/CT images in the patient with lung adenocarcinoma. Right hilar [black arrow in A, maximum standardized uptake value (SUVmax): 4.1], subcarinal (red arrow in A, SUVmax: 4.2) and left interlobar hypermetabolic lymph nodes (in B, SUVmax: 3.8) seen on fused PET/CT were evaluated as anthracosis using histopathologic sampling. The hypermetabolic subaortic lymph node (blue arrowhead in A, SUVmax: 4.1) was histopathologically reactive
Figure 3
Figure 3. Survival curves of patients according to their maximum standardized uptake value (SUVmax) values; there was no significant difference in terms of mean survival time between SUVmax values below 15.6 (10.3±2.2 months) and those above 15.6 (15.9±1.6 months) (p=0.118)
See this image and copyright information in PMC

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