18F-FDG PET/CT of Non-Small Cell Lung Carcinoma Under Neoadjuvant Chemotherapy: Background-Based Adaptive-Volume Metrics Outperform TLG and MTV in Predicting Histopathologic Response.
18F-FDG PET/CT of Non-Small Cell Lung Carcinoma Under Neoadjuvant Chemotherapy: Background-Based Adaptive-Volume Metrics Outperform TLG and MTV in Predicting Histopathologic Response.
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DOI：
10.2967/jnumed.115.167684
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发表时间：
2016-06
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影响因子：
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通讯作者：
Soltermann A
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文献类型：
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作者：
Burger IA;Casanova R;Steiger S;Husmann L;Stolzmann P;Huellner MW;Curioni A;Hillinger S;Schmidtlein CR;Soltermann A
使用18F-FDG PET指标评估化疗后的肿瘤反应正在获得认可。多项研究表明，代谢活性肿瘤体积（MTV）和总病变糖酵解（TLG）参数在测量肿瘤负荷方面优于SUVmax，且具有上级作用。然而，MTV和TLG的测量仍然存在争议;最常见的方法使用SUVmax的42%的绝对阈值。最近，我们实施了一种背景自适应的方法来确定减去背景的病变活动（BSL）和减去背景的体积（BSV）。在这项研究中，我们研究了非小细胞肺癌（NSCLC）的PET指标和组织病理学反应之间的相关性。回顾性确定了44例NSCLC患者。分析新辅助化疗前后两种类型扫描的PET/CT数据，包括SUVmax、MTV、TLG、BSL和BSV，以及这些参数的相对变化。使用4层量表（评分1-4）对手术标本的苏木精和伊红染色切片进行肿瘤消退评分，作为组织病理学缓解的指标。使用斯皮尔曼等级相关检验分析评分与化疗后绝对和相对PET指标之间的相关性。新辅助化疗后表现出良好反应的肿瘤的18F-FDG活性显著低于无反应肿瘤（评分3和4：SUVmax，4.2 [范围，1.8-7.9] vs.评分1和2：SUVmax，8.1 [范围，1.4-40.4]; P = 0.001）。SUVmax和评分的变化也是如此（P = 0.001）。基于SUVmax 42%固定阈值的PET体积指标与评分无关（TLG，P = 0.505; MTV，P = 0.386）。然而，基于背景活性的PET体积度量-BSL和BSV-与评分显著相关（均P < 0.001）。与使用固定阈值（42%SUVmax）的算法和方法相比，基于背景自适应方法的PET体积指标与接受新辅助化疗的非小细胞肺癌患者的组织病理学评分相关性更好。
Assessment of tumor response after chemotherapy using 18F-FDG PET metrics is gaining acceptance. Several studies have suggested that the parameters metabolically active tumor volume (MTV) and total lesion glycolysis (TLG) are superior to SUVmax for measuring tumor burden. However, the measurement of MTV and TLG is still controversial; the most common 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 histopathologic response in non–small cell lung carcinoma (NSCLC). Forty-four NSCLC patients were retrospectively identified. Their PET/CT data on both types of scan before and after neoadjuvant chemotherapy were analyzed regarding SUVmax, MTV, TLG, BSL, and BSV, as well as the relative changes in these parameters. The tumor regression score as an indicator of histopathologic response was scored on hematoxylin- and eosin-stained sections of the surgical specimens using a 4-tiered scale (scores 1–4). The correlation between score and the absolute and relative PET metrics after chemotherapy was analyzed using Spearman rank correlation tests. Tumors that demonstrated a good response after neoadjuvant chemotherapy had significantly lower 18F-FDG activity than non-responding tumors (scores 3 and 4: SUVmax, 4.2 [range, 1.8–7.9] vs. scores 1 and 2: SUVmax, 8.1 [range, 1.4–40.4]; P = 0.001). The same was found for change in SUVmax and score (P = 0.001). PET volume metrics based on a 42% fixed threshold for SUVmax did not correlate with score (TLG, P = 0.505; MTV, P = 0.386). However, both background activity–based PET volume metrics—BSL and BSV—significantly correlated with score (P < 0.001 each). PET volume metrics based on background-adaptive methods correlate better with histopathologic score in NSCLC patients under neoadjuvant chemotherapy than algorithms and methods using a fixed threshold (42% SUVmax).