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FDG-PET/CT of non-small cell lung carcinoma under neo-adjuvant chemotherapy: background based adaptive volume metrics outperform TLG and MTV in predicting histopathological response - Zurich Open Repository and Archive


Burger, Irene A; Casanova, Ruben; Steiger, Seraina; Husmann, Lars; Stolzmann, Paul; Huellner, Martin W; Curioni, Alessandra; Hillinger, Sven; Schmidtlein, Charles Ross; Soltermann, Alex (2016). FDG-PET/CT of non-small cell lung carcinoma under neo-adjuvant chemotherapy: background based adaptive volume metrics outperform TLG and MTV in predicting histopathological response. Journal of Nuclear Medicine, 57(6):849-854.

Abstract

Assessment of tumor response after chemotherapy using FDG PET metrics is gaining acceptance. Several studies have suggested that the parameters metabolically active tumor volume (MTV) or total lesion glycolysis (TLG) are superior for measuring the tumor burden compared to the maximum standardized uptake value (SUVmax). However, the measurement of MTV and TLG is still controversial; the most commonly 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 histopathological response in non-small cell lung carcinoma (NSCLC). PATIENTS AND METHODS Forty-four NSCLC patients were retrospectively identified. Their PET/CT data before and after neo-adjuvant chemotherapy was analyzed regarding SUVmax, MTV, TLG, BSL, and BSV on both scans and the relative changes (delta = d) were calculated (dSUVmax, dMTV, dTLG, dBSL, and dBSV). The tumor regression grade (TRG) as an indicator of histopathological response was assessed on H&E stained sections of the surgical specimens using a 4-tiered scale (TRG1-TRG4). The TRG was correlated with the absolute PET metrics after chemotherapy and their relative changes, respectively, using Spearman's rank correlation tests. RESULTS Tumors that demonstrated a good response after neo-adjuvant chemotherapy had significantly lower FDG activity than non-responders (TRG3-4: SUVmax 4.2 (1.8-7.9) versus TRG1-2: SUVmax 8.1 (1.4-40.4), P = 0.001). The same was found for dSUVmax and TRG (P = 0.001). PET volume metrics based on a 42% fixed threshold of SUVmax did not correlate with TRG (TLG: P = 0.505 and MTV: P = 0.386). However, both background activity-based PET volume metrics BSL and BSV significantly correlated with TRG (p<0.001 each). CONCLUSION PET volume metrics based on background adaptive methods correlate better with histopathological TRG in NSCLC patients under neo-adjuvant chemotherapy than algorithms/methods using a fixed threshold (42% SUVmax).

Abstract

Assessment of tumor response after chemotherapy using FDG PET metrics is gaining acceptance. Several studies have suggested that the parameters metabolically active tumor volume (MTV) or total lesion glycolysis (TLG) are superior for measuring the tumor burden compared to the maximum standardized uptake value (SUVmax). However, the measurement of MTV and TLG is still controversial; the most commonly 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 histopathological response in non-small cell lung carcinoma (NSCLC). PATIENTS AND METHODS Forty-four NSCLC patients were retrospectively identified. Their PET/CT data before and after neo-adjuvant chemotherapy was analyzed regarding SUVmax, MTV, TLG, BSL, and BSV on both scans and the relative changes (delta = d) were calculated (dSUVmax, dMTV, dTLG, dBSL, and dBSV). The tumor regression grade (TRG) as an indicator of histopathological response was assessed on H&E stained sections of the surgical specimens using a 4-tiered scale (TRG1-TRG4). The TRG was correlated with the absolute PET metrics after chemotherapy and their relative changes, respectively, using Spearman's rank correlation tests. RESULTS Tumors that demonstrated a good response after neo-adjuvant chemotherapy had significantly lower FDG activity than non-responders (TRG3-4: SUVmax 4.2 (1.8-7.9) versus TRG1-2: SUVmax 8.1 (1.4-40.4), P = 0.001). The same was found for dSUVmax and TRG (P = 0.001). PET volume metrics based on a 42% fixed threshold of SUVmax did not correlate with TRG (TLG: P = 0.505 and MTV: P = 0.386). However, both background activity-based PET volume metrics BSL and BSV significantly correlated with TRG (p<0.001 each). CONCLUSION PET volume metrics based on background adaptive methods correlate better with histopathological TRG in NSCLC patients under neo-adjuvant chemotherapy than algorithms/methods using a fixed threshold (42% SUVmax).

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2 citations in Web of Science®
2 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Pathology and Molecular Pathology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > University Hospital Zurich > Clinic for Oncology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Thoracic Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:28 January 2016
Deposited On:23 Feb 2016 13:27
Last Modified:26 Feb 2017 08:21
Publisher:Society of Nuclear Medicine
ISSN:0161-5505
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.2967/jnumed.115.167684
PubMed ID:26823566

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