18F-FDG PET/CT of Non-Small Cell Lung Carcinoma Under Neoadjuvant Chemotherapy: Background-Based Adaptive-Volume Metrics Outperform TLG and MTV in Predicting Histopathologic Response.
- Burger IA Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland Department of Radiology, University Hospital Zurich, Zurich, Switzerland irene.burger@usz.ch.
- Casanova R Department of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
- Steiger S Department of Radiology, University Hospital Zurich, Zurich, Switzerland.
- Husmann L Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
- Stolzmann P Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
- Huellner MW Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
- Curioni A Department of Medical Oncology, University Hospital Zurich, Zurich, Switzerland.
- Hillinger S Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland; and.
- Schmidtlein CR Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
- Soltermann A Department of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland.
- 2016-01-30
Published in:
- Journal of nuclear medicine : official publication, Society of Nuclear Medicine. - 2016
NSCLC
neoadjuvant therapy
quantification
tumor regression
volume segmentation
Adult
Aged
Carcinoma, Non-Small-Cell Lung
Female
Fluorodeoxyglucose F18
Glycolysis
Humans
Lung Neoplasms
Male
Middle Aged
Neoadjuvant Therapy
Positron Emission Tomography Computed Tomography
Retrospective Studies
Treatment Outcome
Tumor Burden
English
UNLABELLED
Assessment of tumor response after chemotherapy using (18)F-FDG PET metrics is gaining acceptance. Several studies have suggested that the parameters metabolically active tumor volume (MTV) and total lesion glycolysis (TLG) are superior to SUVmax for measuring tumor burden. However, the measurement of MTV and TLG is still controversial; the most common method uses an absolute threshold of 42% of SUVmax Recently, we implemented a background-adaptive method to determine the background-subtracted lesion activity (BSL) and the background-subtracted volume (BSV). In this study, we investigated the correlation between such PET metrics and histopathologic response in non-small cell lung carcinoma (NSCLC).
METHODS
Forty-four NSCLC patients were retrospectively identified. Their PET/CT data on both types of scan before and after neoadjuvant chemotherapy were analyzed regarding SUVmax, MTV, TLG, BSL, and BSV, as well as the relative changes in these parameters. The tumor regression score as an indicator of histopathologic response was scored on hematoxylin- and eosin-stained sections of the surgical specimens using a 4-tiered scale (scores 1-4). The correlation between score and the absolute and relative PET metrics after chemotherapy was analyzed using Spearman rank correlation tests.
RESULTS
Tumors that demonstrated a good response after neoadjuvant chemotherapy had significantly lower (18)F-FDG activity than nonresponding tumors (scores 3 and 4: SUVmax, 4.2 [range, 1.8-7.9] vs. scores 1 and 2: SUVmax, 8.1 [range, 1.4-40.4]; P = 0.001). The same was found for change in SUVmax and score (P = 0.001). PET volume metrics based on a 42% fixed threshold for SUVmax did not correlate with score (TLG, P = 0.505; MTV, P = 0.386). However, both of the background activity-based PET volume metrics-BSL and BSV-significantly correlated with score (P < 0.001 each).
CONCLUSION
PET volume metrics based on background-adaptive methods correlate better with histopathologic tumor regression score in NSCLC patients under neoadjuvant chemotherapy than algorithms and methods using a fixed threshold (42% SUVmax).
Assessment of tumor response after chemotherapy using (18)F-FDG PET metrics is gaining acceptance. Several studies have suggested that the parameters metabolically active tumor volume (MTV) and total lesion glycolysis (TLG) are superior to SUVmax for measuring tumor burden. However, the measurement of MTV and TLG is still controversial; the most common method uses an absolute threshold of 42% of SUVmax Recently, we implemented a background-adaptive method to determine the background-subtracted lesion activity (BSL) and the background-subtracted volume (BSV). In this study, we investigated the correlation between such PET metrics and histopathologic response in non-small cell lung carcinoma (NSCLC).
METHODS
Forty-four NSCLC patients were retrospectively identified. Their PET/CT data on both types of scan before and after neoadjuvant chemotherapy were analyzed regarding SUVmax, MTV, TLG, BSL, and BSV, as well as the relative changes in these parameters. The tumor regression score as an indicator of histopathologic response was scored on hematoxylin- and eosin-stained sections of the surgical specimens using a 4-tiered scale (scores 1-4). The correlation between score and the absolute and relative PET metrics after chemotherapy was analyzed using Spearman rank correlation tests.
RESULTS
Tumors that demonstrated a good response after neoadjuvant chemotherapy had significantly lower (18)F-FDG activity than nonresponding tumors (scores 3 and 4: SUVmax, 4.2 [range, 1.8-7.9] vs. scores 1 and 2: SUVmax, 8.1 [range, 1.4-40.4]; P = 0.001). The same was found for change in SUVmax and score (P = 0.001). PET volume metrics based on a 42% fixed threshold for SUVmax did not correlate with score (TLG, P = 0.505; MTV, P = 0.386). However, both of the background activity-based PET volume metrics-BSL and BSV-significantly correlated with score (P < 0.001 each).
CONCLUSION
PET volume metrics based on background-adaptive methods correlate better with histopathologic tumor regression score in NSCLC patients under neoadjuvant chemotherapy than algorithms and methods using a fixed threshold (42% SUVmax).
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.2967/jnumed.115.167684
- PMID 26823566
- Persistent URL
- https://sonar.ch/global/documents/298307
Statistics
Document views: 30
File downloads:
- Full-text: 0