Predictive accuracy of lepidic growth subtypes in early-stage adenocarcinoma of the lung by quantitative CT histogram and FDG-PET. (November 2018)

• Record Type: Journal Article
• Authors: Eriguchi, Daisuke; Shimada, Yoshihisa; Imai, Kentaro; Furumoto, Hideyuki; Okano, Tetsuya; Masuno, Ryuhei; Matsubayashi, Jun; Kajiwara, Naohiro; Ohira, Tatsuo; Ikeda, Norihiko
• Is Part Of: Lung cancer. Volume 125(2018)
• Page Start: 14
• Page End: 21
• Publication Date: 2018-11
• Subjects: AAH atypical adenomatous hyperplasia -- AIS adenocarcinoma in situ -- ATS American Thoracic Society -- CI confidence interval -- CT computed tomography -- CTR consolidation to tumor ratio -- DFS disease-free survival -- ERS European Respiratory Society -- FDG-PET F-18 fluorodeoxyglucose-positron emission tomography -- GGO ground-glass opacities -- HRCT high-resolution CT -- IASLC International Association for the Study of Lung Cancer -- LGA lepidic growth adenocarcinoma -- MIA minimally invasive adenocarcinoma -- ROC receiver operating characteristic -- SUV standardized uptake values -- 3D three-dimensional; Histogram -- Three-dimensional CT -- PET/CT -- Stage I -- Adenocarcinoma; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2018.08.027
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: 75 th percentile CT attenuation value is predictive of lepidic-predominant adenocarcinoma. Maximum CT attenuation value is associated with lepidic-predominant adenocarcinoma. SUVmax is also useful in distinguishing lepidic adenocarcinoma from non-lepidic ones. CT histogram analysis is highly beneficial for understanding lung cancer biology. Abstract: Objectives: The aim of this study was to analyze the accuracy of computed tomography (CT) and F-18 fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) to distinguish lepidic growth adenocarcinoma (LGA), including adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and lepidic-predominant adenocarcinoma, all of which have favorable survival outcomes, from the more aggressive and invasive non-LGA subtypes. Materials and Methods: We identified 225 patients with c-0/I adenocarcinoma of the lung who underwent PET/CT and 3DCT followed by complete resection. Maximum standardized uptake values (SUVmax) of FDG and several histogram parameters were analyzed. Histological grades were classified according to the predominant subtype (G1: lepidic; G3: micropapillary or solid; and G2: subtypes other than G1/G3). Results: The proportion of pathological invasive factors (lymphatic vessel involvement/blood vessel invasion/pleural invasion/lymph node metastasis) of patients with preinvasive adenocarcinoma, G1, G2, and G3 tumors were 0%, 3.6%, 48.0%, and 100%, respectively; p < 0.001). Multivariate analysis with CT-related parameters demonstrated that 75 th percentile CT attenuation value (75 th %, p < 0.001) and maximum CT attenuation value (maxCT, p = 0.009) were associated with incidence of non-LGA, whereas the value of SUVmax demonstrated a significant correlation ( p < 0.001). When all patients were dichotomized according to ground-glass opacities (GGO)/solid-dominancy for CT maximum diameter, a significant correlation with non-LGA was shown in patients with solid-dominant tumor on SUVmax ( p < 0.001) and with GGO-dominant tumor on 75 th % ( p = 0.006) and maxCT ( p = 0.007). The combination of one of the two significant histogram parameters and SUVmax revealed higher predictive performance for pathological high malignant features (positive pathological invasive factors, non-LGA, and the highly malignant subtype covering G2 with moderately or poorly-differentiated carcinoma and G3) than the individual use of either factor. Conclusion: The 75 th %, maxCT, and SUVmax were highly useful in distinguishing LGA from non-LGA in c-0/I adenocarcinoma.