Maximum Standardized Uptake Value on Positron Emission Tomography is Associated With More Advanced Disease and High-risk Features in Lung Adenocarcinoma

      18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) has been widely used for preoperative staging of lung adenocarcinomas. The aim of this study was to determine whether a high maximum standardized uptake value (SUVmax) could correlate with pathological characteristics in those patients. We retrospectively reviewed patients with clinical stage 0–IA lung adenocarcinoma who underwent preoperative 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography followed by curative anatomical resection. To identify more advanced disease and high-risk features, representing visceral pleural involvement, pulmonary metastasis, lymph node involvement, and lymphovascular involvement in resected surgical specimens, univariate and multivariate logistic regression analyses were performed. The optimal cutoff point for the SUVmax was determined by receiver operating characteristic analysis. In 2 groups divided according to the cutoff point, the disease-free survivals were calculated and compared using the Kaplan-Meier method and the log-rank test. More advanced disease and high-risk features were identified in 55 (18.9%) of the 291 patients. SUVmax was significantly correlated with more advanced disease and high-risk features, as did the consolidation/tumor ratio on computed tomography. Only 2 (1.2%) of the 169 patients with a SUVmax <3.20 showed more advanced disease and high-risk features, compared with 43.4% of patients with a SUVmax ≥3.20. The disease-free survival was significantly higher in patients with a SUVmax <3.20 than in those with a SUVmax ≥3.20 (P = 0.002). A high SUVmax correlates with more advanced disease and high-risk features in patients with clinical stage 0–IA lung adenocarcinoma. The SUVmax should be considered when deciding treatment strategy in early-stage lung adenocarcinoma.

      Graphical Abstract



      CEA (carcinoembryonic antigen), CI (confidence interval), Cons/Tumor ratio (consolidation/tumor ratio), CT (computed tomography), DFS (disease-free survival), FDG (18F-fluoro-2-deoxy-D-glucose), IQR (interquartile range), MRI (magnetic resonance imaging), NSCLC (non-small cell lung cancer), PET (positron emission tomography), ROC (receiver operating characteristic), SCC (squamous cell carcinoma antigen), SLX (sialyl Lewis-x antigen), SUVmax (maximum standardized uptake value)
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      Linked Article

      • Commentary: Should Standard Uptake Value Decide Who Gets Surgery?
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
        • Preview
          We read the article by Koike et al. regarding the role of positron emission tomography–computed tomography (PET-CT) in the management of lung cancer with great interest.1 Management of patients with early stage lung cancer remains a clinical challenge, as many patients are ultimately upstaged on pathologic analysis after surgery. Evolving our understanding of this disease is essential to our patients. We applaud the authors’ thorough review of current literature regarding the clinical use of the maximum standard uptake value (SUVmax).
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      • Commentary: A Guiding Light in the Night?: Maximum Standardized Uptake Value Associated With High-Risk Features in Lung Adenocarcinoma
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
        • Preview
          Positron emission tomography scans have become a key part of the staging work up for non-small cell lung carcinoma. In the current issue, Koike et al. performed a retrospective study of 297 patients who underwent resection for stage 0-IA lung adenocarcinoma and found that the maximum standardized uptake value (SUVmax) was associated with high-risk features including visceral pleural involvement, pulmonary metastasis, nodal disease, and lymphovascular invasion.1 While this is a potentially important finding since many patients, even those with early stage lung cancer, will develop recurrent disease, there are some weaknesses in the study design.
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