Fluorodeoxyglucose Uptake Measured by Positron Emission Tomography and Standardized Uptake Value Predicts Long-Term Survival of CT Screening Detected Lung Cancer in Heavy Smokers

Background: Fluorodeoxyglucose-positron emission tomography (FDG-PET) has proven its value in the diagnosis of undetermined pulmonary lesions, lung cancer staging, and assessment of prognosis. Purpose of this study is to clarify whether standardized uptake value (SUV) can predict clinical outcome of computed tomography (CT) screening detected lung cancer. Methods: We tested the predictive value of FDG-PET using SUV on long-term survival of 34 lung cancer patients, detected from 1035 heavy smokers ≥50 years monitored by annual low-dose CT for 5 years, with a median follow-up of 75 months from diagnosis. Findings: PET scan was performed in 34 (89%) of 38 lung cancer patients diagnosed during the 5 years of screening and was positive in 32 (94%). Complete resection was achieved in 30 cases (88%), 20 (59%) were pathologic stage I and 23 (68%) were adenocarcinoma. Median SUV was 5.0 overall, being significantly lower in stage I (2.5 vs. 10.1, p = 0.001) and in adenocarcinoma (2.5 vs. 13.0, p = 0.001). The 5-year survival of lung cancer patients was 100% for SUV levels ≤2.5, 60% for SUV more than 2.5 and less than 8, and only 20% for SUV ≥8 (p = 0.001). Conclusions: FDG-PET using SUV can predict long-term survival of screening detected lung cancer, in a noninvasive manner. Metabolic assessment of biologic behavior might improve the clinical management of CT-detected lung cancer and reduce the risk of unnecessary treatments for indolent disease.

[1]  David F Yankelevitz,et al.  Solitary and multiple resected adenocarcinomas after CT screening for lung cancer: histopathologic features and their prognostic implications. , 2009, Lung cancer.

[2]  Hermann Brenner,et al.  Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data. , 2007, The Lancet. Oncology.

[3]  J. Crowley,et al.  The IASLC Lung Cancer Staging Project: Proposals for the Revision of the TNM Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumours , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[4]  Ugo Pastorino,et al.  Computed tomography screening and lung cancer outcomes. , 2007, JAMA.

[5]  Jonathan Goldin,et al.  Accuracy of PET/CT in characterization of solitary pulmonary lesions. , 2007, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[6]  O. Miettinen,et al.  Survival of patients with stage I lung cancer detected on CT screening. , 2006, The New England journal of medicine.

[7]  E. Bergstralh,et al.  Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. , 2006, Journal of the National Cancer Institute.

[8]  N. Altorki,et al.  Positron emission tomographic scanning in the diagnosis and staging of non-small cell lung cancer 2 cm in size or less. , 2005, The Journal of thoracic and cardiovascular surgery.

[9]  Rebecca M. Lindell,et al.  Lung cancer screening experience: a retrospective review of PET in 22 non-small cell lung carcinomas detected on screening chest CT in a high-risk population. , 2005, AJR. American journal of roentgenology.

[10]  Anne-Marie Sykes,et al.  CT screening for lung cancer: five-year prospective experience. , 2005, Radiology.

[11]  C. Dooms,et al.  Positron-emission tomography in prognostic and therapeutic assessment of lung cancer: systematic review. , 2004, The Lancet. Oncology.

[12]  T. Naruke,et al.  Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. , 2004, Lung cancer.

[13]  J. Herndon,et al.  Comparison of whole-body FDG-PET to bone scan for detection of bone metastases in patients with a new diagnosis of lung cancer. , 2004, Lung cancer.

[14]  J. Vansteenkiste.  PET scan in the staging of non-small cell lung cancer. , 2003, Lung cancer.

[15]  F. Fazio,et al.  Fluorodeoxyglucose positron emission tomography improves preoperative staging of resectable lung metastasis. , 2003, The Journal of thoracic and cardiovascular surgery.

[16]  F. Fazio,et al.  Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results , 2003, The Lancet.

[17]  E. Patz,et al.  PET imaging in patients with bronchioloalveolar cell carcinoma. , 2002, Lung cancer.

[18]  Mark Muzi,et al.  In vivo validation of 3'deoxy-3'-[(18)F]fluorothymidine ([(18)F]FLT) as a proliferation imaging tracer in humans: correlation of [(18)F]FLT uptake by positron emission tomography with Ki-67 immunohistochemistry and flow cytometry in human lung tumors. , 2002, Clinical cancer research : an official journal of the American Association for Cancer Research.

[19]  A. Alavi,et al.  Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET , 2002, European Journal of Nuclear Medicine and Molecular Imaging.

[20]  M. Boers,et al.  Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial , 2002, The Lancet.

[21]  D. Hellwig,et al.  [Meta-analysis of the efficacy of positron emission tomography with F-18-fluorodeoxyglucose in lung tumors. Basis for discussion of the German Consensus Conference on PET in Oncology 2000]. , 2001, Pneumologie.

[22]  M. Bamberg,et al.  Metaanalyse zum Stellenwert der Positronen-Emissions-Tomographie mit F-18-Fluorodesoxyglukose (FDG-PET) bei Lungentumoren1 - Diskussionsbasis der deutschen Konsensus-Konferenz Onko-PET 2000 - , 2001 .

[23]  R. Coleman,et al.  The prognostic significance of fluorodeoxyglucose positron emission tomography imaging for patients with nonsmall cell lung carcinoma , 1998, Cancer.

[24]  U. Pastorino,et al.  Selective use of PET scan in the preoperative staging of NSCLC. , 1998, Lung cancer.

[25]  U. Pastorino.  Does screening for stage I lung cancer improve survival in a high-risk population? , 2007, Nature Clinical Practice Oncology.

[26]  L. Tanoue.  CT Screening for Lung Cancer: Five-year Prospective Experience , 2007 .

[27]  J. Vansteenkiste,et al.  Value of FDG-PET in the management of non-small cell lung cancer. , 2003, European journal of radiology.

[28]  W. Kuschner,et al.  Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. , 2001, JAMA.

[29]  R Doll,et al.  Mortality from smoking worldwide. , 1996, British medical bulletin.