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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) 18F-FDG PET/CT in lung cancer. The added value of quantification
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Vol. 36. Issue 6.
Pages 342-349 (November - December 2017)
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Vol. 36. Issue 6.
Pages 342-349 (November - December 2017)
Original article
18F-FDG PET/CT in lung cancer. The added value of quantification
PET/TC con 18F-FDG en el cáncer de pulmón. Valor adicional de la cuantificación
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P. Lapaa,
Corresponding author
paula.alexandra.lapa@gmail.com

Corresponding author.
, M. Marquesb,c, J. Isidoroa, F. Baratad, G. Costaa, J.P. de Limaa,e
a Nuclear Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
b Technology and Information Systems Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
c Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
d Lung Diseases Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
e Institute of Nuclear Sciences Applied to Health-ICNAS, University of Coimbra, Coimbra, Portugal
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Tables (5)
Table 1. Characteristics of the population studied.
Table 2. Estimated mean survival time based on the calculated cutoffs for Entropy and visual analysis of metabolic heterogeneity.
Table 3. Multivariate analysis of survival predictive value for entropy, visual analysis of metabolic heterogeneity, age, male gender and TNM stage. Statistically significant results highlighted.
Table 4. Estimated mean survival time based on the calculated cutoffs for entropy, SUVmax, MATV and TLG.
Table 5. Multivariate analysis of survival predictive value for entropy, SUVmax, MATV, TLG, age, male gender and TNM stage. Statistically significant results highlighted.
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Abstract
Objective

To test a software application for the quantification of metabolic heterogeneity and to evaluate its superiority in relation to visual interpretation. To investigate if a quantitative analysis adds information to the interpretation of 18F-FDG-PET/CT.

Material and methods

The study analyzed 215 patients with a 18F-FDG-PET/CT done for the initial staging of lung cancer between March 2011 and December 2015. The study included 57 (26.5%) women and 158 (73.5%) men, with ages ranging from 34 to 88 years (mean±SD: 67.23±10.04). There were 82 surgical stages (I, II, IIIA), and 133 non-surgical stages (IIIB, IV). The primary tumour was analyzed quantitatively by obtaining the following parameters: SUVmax, metabolic active tumour volume (MATV), total lesion glycolysis (TLG), and the entropy heterogeneity index (ET). Heterogeneity was assessed visually. Death dates and/or the follow-up time were registered, ranging from 0.70 to 67.60 months (mean±SD: 23.20±17.68).

Results

In multivariate analysis, ET emerged as a better predictor of survival than visual analysis of heterogeneity that was not statistically significant. The C-index determination demonstrated that all quantitative parameters were statistically-significant predictors of survival. Cut-offs were obtained in order to compare survival times. A multivariate analysis was performed. In the total population, the best predictor was the TNM stage, but MATV, ET, and male gender were statistically significant and independent predictors of survival. In stages without surgical indication, the best predictor was the TNM stage, but the MATV and male gender were statistically significant and independent predictors of survival. In the surgical stages, ET was the only statistically significant and independent predictor of survival.

Conclusions

Quantification adds prognostic information to the visual analysis of 18F-FDG-PET/CT.

Keywords:
18F-FDG PET/CT
Quantification
Non-small cell lung cancer
Resumen
Objetivo

Valorar un software para cuantificar la heterogeneidad metabólica e investigar su superioridad en relación con la interpretación visual. Analizar si el análisis cuantitativo ofrece información adicional en la interpretación de los estudios 18F-FDG-PET/TC.

Material y métodos

Se valoraron retrospectivamente 215 estudios 18F-FDG-PET/TC para estatificación inicial de cáncer de pulmón entre marzo de 2011 y diciembre de 2015; se incluyeron 57(26,5%) mujeres y 158(73,5%) hombres, con edades de 34 a 88 años (media±DE: 67,23±10,04); hubo 82 estadios quirúrgicos (I, II, IIIA) y 133 no quirúrgicos (IIIB, IV). El tumor primario fue analizado obteniendo los parámetros SUVmax, metabolic active tumour volume (MATV), total lesion glycolisys (TLG) y el índice de heterogeneidad entropía (ET). La heterogeneidad fue valorada visualmente. Se registró la fecha de fallecimiento y/o el tiempo de seguimiento, que osciló entre 0,70 y 67,60 meses (media±DE: 23,20±17,68).

Resultados

En el análisis multivariante, la ET se mostró mejor predictor de supervivencia que el análisis visual de heterogeneidad, el cual no fue estadísticamente significativo. La determinación del C-index demostró que todos los parámetros cuantitativos fueron predictores de supervivencia estadísticamente significativos. Se obtuvieron puntos de corte para comparar los tiempos de supervivencia. En el análisis multivariante, el mejor predictor fue el TNM, pero el MATV, el ET y el género masculino demostraron ser predictores de supervivencia independientes estadísticamente significativos. En los estadios no quirúrgicos, el mejor predictor fue el TNM, pero el MATV y el género masculino demostraron ser predictores de supervivencia estadísticamente significativos e independientes. En los estadios quirúrgicos, la ET fue el único predictor de supervivencia estadísticamente significativo e independiente.

Conclusiones

La cuantificación ofrece información pronóstica adicional al análisis visual del 18F-FDG-PET/TC.

Palabras clave:
PET/CT con 18F-FDG
Cuantificación
Cáncer de pulmón de células no pequeñas

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