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. 2024 Nov 26;24(1):162.
doi: 10.1186/s40644-024-00807-3.

Challenging the significance of SUV-based parameters in a large-scale retrospective study on lung lesions

Cristiano Pini  1   2 , Margarita Kirienko  3 , Fabrizia Gelardi  4   5 , Paola Bossi  6 , Daoud Rahal  6 , Luca Toschi  7 , Gaia Ninatti  1   2 , Marcello Rodari  8 , Giuseppe Marulli  9   10 , Lidija Antunovic  1 , Arturo Chiti  1   11 , Emanuele Voulaz #  9   10 , Martina Sollini #  1   11
Affiliations

Challenging the significance of SUV-based parameters in a large-scale retrospective study on lung lesions

Cristiano Pini et al. Cancer Imaging. .

Abstract

Background: Although many well-known factors affect the maximum standardized uptake value (SUVmax), it remains the most requested and used parameter, especially among clinicians, despite other parameters, such as the standardized uptake value corrected for lean body mass and the metabolic tumor volume, being proven to be less sensitive to the same factors, more robust, and eventually more informative. This study intends to provide robust evidence regarding the diagnostic and prognostic value of SUVmax in a large cohort of subjects with suspected malignant lung nodules imaged by [18F]FDG PET/CT.

Materials and methods: We performed a retrospective analysis of patients with suspected/confirmed primary lung tumours undergoing [18F]FDG PET/CT. The sample size was 567 patients. Demographics, imaging, surgical, histological, and follow-up data were collected. SUVmax was analysed according to histology, stage, scanner, and outcome. The impact on measured values of different reconstruction protocols was assessed. All potential predictors of patients' outcome were assessed.

Results: 91% cases were primary lung tumours. Lung benign nodules or metastases accounted for 5% and 4% of cases. Most patients presented with adenocarcinoma (70%) and stage I disease (51%); 144 patients relapsed and 55 died. SUVmax failed to effectively differentiate benign lesions from primary tumours or metastases. Stage I patients presented lower SUVmax. SUVmax significantly correlated with patient weight, injected [18F]FDG activity, and lesion size and differed between reconstructions' protocols. Survival analyses revealed no independent prognostic significance for SUVmax in progression-free after adjusting for other variables. SUVmax correlated with overall survival, disease stage and tumour histotype.

Conclusion: Our study confirms that SUVmax, though widely employed, present relevant limitations in discriminating between benign lesion and lung cancer, in classifying cancer histotypes, and in predicting patient outcomes independently. Known influencing factors significantly impact on numerical values, thus SUV values should be regarded with caution in clinical practice.

Keywords: Biomarker; Lung lesions; Positron emission tomography; Prognosis; Standardised uptake value; [18F]FDG.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Ethics Committee of IRCCS Humanitas Research Hospital approved the study (approval number 3/18, on 17 April 2018, protocol ADVIMAG-Thorax). Consent to participate: A specific informed consent was waived because of the observational and retrospective study design. Competing interests: AC is editor-in-chief of EJNMMI. MK, LA and MS are in the editorial board of EJNMMI. MK and MS are section editors of the Artificial intelligence, machine learning and radiomics section of Cancer Imaging. AC reports personal fees from AmGen, General Electric Healthcare, Novartis, Sirtex, and Telix, all outside the submitted work. All other authors did not report competing interest.

Figures

Fig. 1
Fig. 1
Clinical examples of different pattern of [.18F]FDG uptake in patients with suspected lung nodules. MIP and axial fused PET/CT of four different patients diagnosed with a benign intraparenchymal lymph node (a, b), primary lung adenocarcinoma (c, d), primary lung squamous cell carcinoma (e, f), and a lung metastasis from melanoma (g, h)
Fig. 2
Fig. 2
distribution of SUVmax according to histology (only significant correlation are reported). The light red line coincides with the threshold of 2.5
See this image and copyright information in PMC

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