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Prediction of Pathologic Grade and Prognosis in Mucoepidermoid Carcinoma of the Lung Using ¹⁸F-FDG PET/CT.

Park B, Kim HK, Choi YS, Kim J, Zo JI, Choi JY, Shim YM - Korean J Radiol (2015)

Bottom Line: Clinicopathologic features were compared between the groups by χ(2) test and overall survival was determined by Kaplan-Meier analysis.Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031).Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

ABSTRACT

Objective: The maximum standardized uptake value (SUVmax) of pulmonary mucoepidermoid carcinoma (PMEC) in fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) was evaluated as a preoperative predictor of pathologic grade and survival rate.

Materials and methods: Twenty-three patients who underwent preoperative PET/CT and complete resection for PMEC were enrolled. The optimal cut-off SUVmax for tumor grade was calculated as 6.5 by receiver operating characteristic curve. The patients were divided into a high SUV group (n = 7) and a low SUV group (n = 16). Clinicopathologic features were compared between the groups by χ(2) test and overall survival was determined by Kaplan-Meier analysis.

Results: The mean SUVmax was 15.4 ± 11.5 in the high SUV group and 3.9 ± 1.3 in the low SUV group. All patients except one from the low SUV group had low grade tumors and all had no nodal metastasis. The sensitivity and specificity of SUVmax from PET/CT for predicting tumor grade was 85.7% and 93.8%, respectively. During the follow-up period (mean, 48.6 ± 38.7 months), four patients from the high SUV group experienced cancer recurrence, and one died of cancer. In contrast, none of the low SUV group had recurrence or mortality. Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031).

Conclusion: Pulmonary mucoepidermoid carcinoma patients with high SUVmax in PET/CT had higher tumor grade, more frequent lymph node metastasis and worse long-term outcome. Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.

No MeSH data available.


Related in: MedlinePlus

Chest CT and PET/CT results for 67-year-old male with PMEC in high SUV group.A. In CT image, 53 mm mass (arrow) in left upper lobe with possibility of chest wall invasion was visible. B. SUVmax of tumor in PET/CT was 11.9 (arrow) and pathologic result verified stage IIB high grade PMEC. CT = computed tomography, PET/CT = positron emission tomography/computed tomography, PMEC = pulmonary mucoepidermoid carcinoma, SUV = standardized uptake value, SUVmax = maximum SUV
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Figure 3: Chest CT and PET/CT results for 67-year-old male with PMEC in high SUV group.A. In CT image, 53 mm mass (arrow) in left upper lobe with possibility of chest wall invasion was visible. B. SUVmax of tumor in PET/CT was 11.9 (arrow) and pathologic result verified stage IIB high grade PMEC. CT = computed tomography, PET/CT = positron emission tomography/computed tomography, PMEC = pulmonary mucoepidermoid carcinoma, SUV = standardized uptake value, SUVmax = maximum SUV

Mentions: The mean age was significantly higher in the high SUV group than the low SUV group (57.6 ± 11.7 years vs. 39.6 ± 17.2 years respectively, p = 0.010). Notably, all three patients under age 20 were included in the low SUV group and had a low grade tumor. The majority of patients (73.9%) had symptoms before surgery. Common symptoms were coughing (43.5%) and hemoptysis (30.4%). Most of the patients (87.0%) showed an Eastern Cooperative Oncology Group performance score of 0 or 1 and only three patients had a performance score of 2 (two patients from high SUV group and one patient from low SUV group). The mean SUVmax was 15.4 ± 11.5 in the high SUV group and 3.9 ± 1.3 in the low SUV group. The high SUV group had more high grade tumors (p < 0.001) and larger tumor sizes (43.6 ± 9.0 mm vs. 21.4 ± 3.0 mm, p = 0.003). Typical enhanced CT and PET/CT images of low SUV group are presented in Figure 2 and images of high SUV group in Figure 3. The high SUV group also had more frequent T3/4 stage (72.4% vs. 6.3%, p = 0.006), more frequent lymph node metastases (57.1% vs. 0%, p = 0.001), and consequently, higher cancer stages (stage I/II vs. III, p = 0.001) than the low SUV group. Enhanced CT and PET/CT images of the patient with regional lymph node metastasis are presented in Figure 4. The low SUV group had low grade tumors, except for one patient, and no lymph node metastasis. The sensitivity and specificity of PET/CT for predicting tumor grade were 85.7% and 93.8%, respectively. Accuracy was 91.3% and the positive and negative predictive value was 85.7% and 93.8%, respectively. Clinicopathologic characteristics are summarized in Table 1.


Prediction of Pathologic Grade and Prognosis in Mucoepidermoid Carcinoma of the Lung Using ¹⁸F-FDG PET/CT.

Park B, Kim HK, Choi YS, Kim J, Zo JI, Choi JY, Shim YM - Korean J Radiol (2015)

Chest CT and PET/CT results for 67-year-old male with PMEC in high SUV group.A. In CT image, 53 mm mass (arrow) in left upper lobe with possibility of chest wall invasion was visible. B. SUVmax of tumor in PET/CT was 11.9 (arrow) and pathologic result verified stage IIB high grade PMEC. CT = computed tomography, PET/CT = positron emission tomography/computed tomography, PMEC = pulmonary mucoepidermoid carcinoma, SUV = standardized uptake value, SUVmax = maximum SUV
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499560&req=5

Figure 3: Chest CT and PET/CT results for 67-year-old male with PMEC in high SUV group.A. In CT image, 53 mm mass (arrow) in left upper lobe with possibility of chest wall invasion was visible. B. SUVmax of tumor in PET/CT was 11.9 (arrow) and pathologic result verified stage IIB high grade PMEC. CT = computed tomography, PET/CT = positron emission tomography/computed tomography, PMEC = pulmonary mucoepidermoid carcinoma, SUV = standardized uptake value, SUVmax = maximum SUV
Mentions: The mean age was significantly higher in the high SUV group than the low SUV group (57.6 ± 11.7 years vs. 39.6 ± 17.2 years respectively, p = 0.010). Notably, all three patients under age 20 were included in the low SUV group and had a low grade tumor. The majority of patients (73.9%) had symptoms before surgery. Common symptoms were coughing (43.5%) and hemoptysis (30.4%). Most of the patients (87.0%) showed an Eastern Cooperative Oncology Group performance score of 0 or 1 and only three patients had a performance score of 2 (two patients from high SUV group and one patient from low SUV group). The mean SUVmax was 15.4 ± 11.5 in the high SUV group and 3.9 ± 1.3 in the low SUV group. The high SUV group had more high grade tumors (p < 0.001) and larger tumor sizes (43.6 ± 9.0 mm vs. 21.4 ± 3.0 mm, p = 0.003). Typical enhanced CT and PET/CT images of low SUV group are presented in Figure 2 and images of high SUV group in Figure 3. The high SUV group also had more frequent T3/4 stage (72.4% vs. 6.3%, p = 0.006), more frequent lymph node metastases (57.1% vs. 0%, p = 0.001), and consequently, higher cancer stages (stage I/II vs. III, p = 0.001) than the low SUV group. Enhanced CT and PET/CT images of the patient with regional lymph node metastasis are presented in Figure 4. The low SUV group had low grade tumors, except for one patient, and no lymph node metastasis. The sensitivity and specificity of PET/CT for predicting tumor grade were 85.7% and 93.8%, respectively. Accuracy was 91.3% and the positive and negative predictive value was 85.7% and 93.8%, respectively. Clinicopathologic characteristics are summarized in Table 1.

Bottom Line: Clinicopathologic features were compared between the groups by χ(2) test and overall survival was determined by Kaplan-Meier analysis.Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031).Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

ABSTRACT

Objective: The maximum standardized uptake value (SUVmax) of pulmonary mucoepidermoid carcinoma (PMEC) in fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) was evaluated as a preoperative predictor of pathologic grade and survival rate.

Materials and methods: Twenty-three patients who underwent preoperative PET/CT and complete resection for PMEC were enrolled. The optimal cut-off SUVmax for tumor grade was calculated as 6.5 by receiver operating characteristic curve. The patients were divided into a high SUV group (n = 7) and a low SUV group (n = 16). Clinicopathologic features were compared between the groups by χ(2) test and overall survival was determined by Kaplan-Meier analysis.

Results: The mean SUVmax was 15.4 ± 11.5 in the high SUV group and 3.9 ± 1.3 in the low SUV group. All patients except one from the low SUV group had low grade tumors and all had no nodal metastasis. The sensitivity and specificity of SUVmax from PET/CT for predicting tumor grade was 85.7% and 93.8%, respectively. During the follow-up period (mean, 48.6 ± 38.7 months), four patients from the high SUV group experienced cancer recurrence, and one died of cancer. In contrast, none of the low SUV group had recurrence or mortality. Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031).

Conclusion: Pulmonary mucoepidermoid carcinoma patients with high SUVmax in PET/CT had higher tumor grade, more frequent lymph node metastasis and worse long-term outcome. Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.

No MeSH data available.


Related in: MedlinePlus