Preoperative 18F-fluorodeoxyglucose positron emission tomography can predict the tumor malignancy of small peripheral lung cancer

Abstract

Purpose: Recent advances in image diagnostic technology have enhanced the discovery ofperipheral small size lung cancers. Here, we examined the utility of 18F-fluorodeoxyglucosepositron emission tomography (FDG-PET) for the evaluation of grade of tumor malignantpotency. Methods: Seventy-nine patients with peripheral small lung cancers (≤2 cm) who underwentsurgical resections and preoperative FDG-PET were enrolled. The correlations betweenthe maximum standardized uptake value (SUVmax) and various clinicopathological featuresrelated to tumor invasiveness, nodal metastasis, and recurrence were analyzed. Results: The median SUVmax of all tumors was 2.4 (range, 0–16.1). The SUVmax was significantlyhigher in patients with vascular invasion (5.6 ± 3.5 vs. 2.4 ± 2.4; P <0.0001), lymphaticinvasion (4.9 ± 3.7 vs. 2.7 ± 2.6; P = 0.0029), lymph node metastasis (6.1 ± 4.4 vs. 3.0 ± 2.7;P = 0.0022), and recurrences (5.8 ± 3.3 vs. 3.1 ± 3.1; P = 0.0219). Patients with SUVmax ≥2.5 had a significantly higher incidence rate of vascular invasion (56% vs. 7%; P <0.0001),lymphatic invasion (51% vs. 15%; P = 0.0006), lymph node metastasis (26% vs. 3%;P = 0.0033), and recurrence (18% vs. 3%; P = 0.0289). The patients with SUVmax ≥1.5 alsohad a significantly higher incidence of vascular invasion, lymphatic invasion, lymph nodemetastasis, and recurrence. It is particularly worth noting that patients with SUVmax <1.5had no vascular invasion, lymph node metastasis, or recurrence. Conclusion: Preoperative SUVmax of peripheral small lung cancers were significantlyassociated with tumor malignancy.