Accuracy of 18F-FDG in Detecting Stage I Lung Adenocarcinomas According to IASLC/ATS/ERS Classification.

Abstract

BACKGROUND:

Only a small number of studies have explored the clinicopathological features of pulmonary adenocarcinoma (PA) associated with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) false-negative (FN) results. Herein, we investigated the FDG-PET diagnostic performance by stratifying PAs according to International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification.

METHODS:

From January 2002 to December 2016, all consecutive patients who underwent pulmonary resection for stage I PA at six thoracic surgery institutions were retrospectively reviewed. The diagnostic performance of FDG-PET was analysed according to IASLC/ATS/ERS classification and two validated subclassifications. Univariable and multivariable logistic analysis were used to identify predictors of FDG-PET FN results.

RESULTS:

Five hundred and fifty (550) patients with stage I PA were included in the analyses. Most of the patients were male (n=354 [64.4%]) and smokers (n=369 [67.1%]). Ninety-seven (n=97 [17.6%]) FN cases were observed at FDG-PET imaging. On multivariable analysis, a lepidic pattern was found to be independently associated with FDG-PET FN results (odds ratio [OR], 3.20; p<0.001), while a solid pattern more commonly presented with a positive finding (OR, 0.40; p=0.066). According to Nakamura's classification, we observed an independent association between lepidic pattern and FDG-PET FN results (OR, 3.17; p<0.001), while solid/micropapillary patterns were independently related with increased FDG uptake (OR, 0.35; p=0.021). According to Yoshizawa's classification, Intermediate-grade tumours were independently correlated with FN FDG-PET results (OR, 2.78; p=0.005).

CONCLUSIONS:

In our cohort, histopathological features were significantly associated with FDG uptake. In particular, some adenocarcinoma subtypes (mostly Lepidic pattern) have a tendency towards FN FDG-PET findings. The correlation between computed tomography findings, clinical characteristics, and FDG uptake is mandatory, in order to tailor the precise diagnostic and therapeutic pathway for each patient.

• Authors: Filippo Lococo, Francesco Guerrera, Ottavio Rena, Luca Ampollini, Jacopo Vannucci, Pietro Bertoglio, Luigi Ventura, Paraskevas Lyberis, Valentina Marchese, Vincenzo Arena, Pier Luigi Filosso, Adriana Lesca, Caterina Casadio, Andrea Viti, Massimiliano Paci, Francesco Puma, Enrico Ruffini
• Journal: Heart, lung & circulation (Heart Lung Circ) Vol. 31 Issue 5 Pg. 726-732 (May 2022) ISSN: 1444-2892 [Electronic] Australia
• PMID: 34753661 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Chemical References

• Fluorodeoxyglucose F18

Topics

• Adenocarcinoma (diagnostic imaging, surgery)
• Adenocarcinoma of Lung (diagnostic imaging, surgery)
• Female
• Fluorodeoxyglucose F18
• Humans
• Lung Neoplasms (diagnostic imaging, surgery)
• Male
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• United States