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

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.

Flor 18F-FDG PET/BT’nin Akciğer Kanseri Tanı, Evreleme ve Tedavi Planlamasına Katkısı

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-fluorodeoksiglukozpozitron 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.

Kaynakça

Dela Cruz CS, Tanoue LT, Matthay RA. Lung Cancer: Epidemiology, Etiology, and Prevention. Clin Chest Med 2011;32:605-644.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-249.

Purandere NC, Rangarajan V. Imaging of lung cancer: Implications on staging and management. Indian J Radiol Imaging 2015;25:109-120.

Gupta NC, Maloof J, Gunel E. Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET. J Nucl Med 1996;137:943-949.

Feng M, Yang X, Ma Q, He Y. Retrospective analysis for the false positive diagnosis of PET-CT scan in lung cancer patients. Medicine (Baltimore) 2017;96:e7415.

Herder GJ, Van Tinteren H, Comans EF, Hoekstra OS, Teule GJ, Postmus PE, Joshi U, Smit EF. Prospective use of serial questionnaires to evaluate the therapeutic efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in suspected lung cancer. Thorax 2003;58:47-51.

Chang JM, Lee HJ, Goo JM, Lee HY, Lee JJ, Chung JK, Im JG. False Positive and False Negative FDG-PET Scans in Various Thoracic Diseases. Korean J Radiol 2006;7:57-69.

Long NM, Smith CS. Causes and imaging features of false positives and false negatives on 18F-PET/CT in oncologic imaging. Insights Imaging. 2011;2:679-698.

. Bunyaviroch T, Coleman RE. PET Evaluation of Lung Cancer. J Nucl Med 2006;47:451-469.

Liu Y. Lung Neoplasms with Low F18-Fluorodeoxyglucose Avidity. PET Clin 2018;13:11-18.

Meirelles GS, Capobianco J, de Oliveira MA. Pitfalls and artifacts in the interpretation of oncologic PET/CT of the chest. Radiol Bras 2017;50:55-59.

Vesselle H, Salskov A, Turcotte E, Wiens L, Schmidt R, Jordan CD, Vallières E, Wood DE. Relationship between non-small cell lung cancer FDG uptake at PET, tumor histology, and Ki-67 proliferation index. J Thorac Oncol 2008;3:971-978.

Wang Y, Ma S, Dong, Yao Y, Liu K, Zhou J. Evaluation of the factors affecting the maximum standardized uptake value of metastatic lymph nodes in different histological types of non-small cell lung cancer on PET-CT. BMC Pulm Med 2015;15:20.

Lu P, Yu L, Li Y, Sun Y. A correlation study between maximum standardized uptake values and pathology and clinical staging in nonsmall cell lung cancer. Nucl Med Commun 2010;31:646-651.

Mery CM, Pappas AN, Burt BM, Bueno R, Linden PA, Sugarbaker DJ, Jaklitsch MT. Diameter of non-small cell lung cancer correlates with long-term survival: implications for T stage. Chest 2005;128:32553260.

Liu Y, Wu N, Bi GC, Zhang DS, Zheng R, Liang Y, Zhang WJ, Li XM, Fang Y. Correlation analysis between 18F-FDG uptake features and the prognosis in patients with pathologic stageⅠlung adenocarcinoma. Zhonghua Zhong Liu Za Zhi 2016;38:263-269.

Sunnetcioglu A, Arısoy A, Demir Y, Ekin S, Dogan E. Associations between the standardized uptake value of (18)F-FDG PET/CT and demographic, clinical, pathological, radiological factors in lung cancer. Int J Clin Exp Med 2015;8:15794-15800.

Zhu SH, Zhang Y, Yu YH, Fu Z, Kong L, Han DL, Fu L, Yu JM, Li J. FDG PET-CT in non-small cell lung cancer: relationship between primary tumor FDG uptake and extensional or metastatic potential. Asian Pac J Cancer Prev 2013;14:2925-2929.

Al-Sarraf N, Gately K, Lucey J, Wilson L, McGovern E, Young V. Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes; Analysis of 1145 lymph nodes. Lung cancer 2008;60:62-68.

Detterbeck F, Falen S, Rivera PM, Halle JS, Socinski MA. Seeking a home for a PET, part 2: Defining the appropriate place for positron emission tomography imaging in the staging of patients with suspected lung cancer. Chest 2004;125:2300-2308.

Van Tinteren H, Hoekstra OS, Smit EF, Van Den Bergh JH, Schreurs AJ, Stallaert RA, Van Velthoven PC, Comans EF, Diepenhorst FW, Verboom P, Van Mourik JC, Postmus PE, Boers M, Teule GJ. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small cell lung cancer: the PLUS multicentre randomised trial. Lancet 2002;359:13881393.

Gregory DL, Hicks RJ, Hogg A, Binns DS, Shum PL, Milner A, Link E, Ball DL, Mac Manus MP. Effect of PET/CT on Management of Patients with Non–Small Cell Lung Cancer: Results of a Prospective Study with 5-Year Survival Data. J Nucl Med 2012;53:1007-1015.

Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Clinical Significance of Positron Emission Tomography in Subcentimeter NonSmall Cell Lung Cancer. Ann Thorac Surg 2017;103:1614-1620.

Liu J, Dong M, Sun X, Li W, Xing L, Yu J. Prognostic Value of 18F-FDG PET/CT in Surgical Non-Small Cell Lung Cancer: A Meta-Analysis. PLoS One 2016;11:e0146195.

Ahuja V, Coleman RE, Herndon J, Patz EF Jr. The prognostic significance of fluorodeoxyglucose positron emission tomography imaging for patients with nonsmall cell lung carcinoma. Cancer 1998;83:918-924.

Hoang JK, Hoagland LF, Coleman RE, Coan AD, Herndon JE, Patz EF Jr. Prognostic Value of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography Imaging in Patients With Advanced-Stage Non Small-Cell Lung Carcinoma. J Clin Oncol 2008;26:1459-1464.

Berghmans T, Dusart M, Paesmans M, Hossein-Foucher C, Buvat I, Castaigne C, Scherpereel A, Mascaux C, Moreau M, Roelandts M, Alard S, Meert AP, Patz EF Jr, Lafitte JJ, Sculier JP; European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. J Thorac Oncol 2008;3:6-12.

Kaynak Göster

Molecular Imaging and Radionuclide Therapy
  • ISSN: 2146-1414
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 1992

1.1b341

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