Skip to main content
Erschienen in: Annals of Nuclear Medicine 10/2022

12.07.2022 | Original Article

18F FDG-PET/CT analysis of spread through air spaces (STAS) in clinical stage I lung adenocarcinoma

verfasst von: Miki Nishimori, Hitomi Iwasa, Kana Miyatake, Noriko Nitta, Kosuke Nakaji, Tomohiro Matsumoto, Tomoaki Yamanishi, Rika Yoshimatsu, Mituko Iguchi, Masaya Tamura, Takuji Yamagami

Erschienen in: Annals of Nuclear Medicine | Ausgabe 10/2022

Einloggen, um Zugang zu erhalten

Abstract

Objective

The purpose of this retrospective study was to investigate the utility of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG-PET/CT) to predict spread through air spaces (STAS) in clinical stage I lung adenocarcinoma.

Methods

Between April 2020 and January 2022, 52 patients (55 lesions) who underwent surgery for clinical stage I lung adenocarcinoma were enrolled. The lesions were divided into two groups according to the presence of STAS. 18F FDG-PET/CT parameters, specifically the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), were calculated. The SUVmax, MTV, and TLG were compared between the two groups upon surgical pathological examination. Receiver operating characteristic (ROC) curve analysis was performed to identify a cut-off value.

Results

Nineteen lesions (35%) were positive for STAS and 36 lesions were negative for STAS. According to the presence of STAS, significant differences were detected in the SUVmax (5.21 [range 1.52–16.50] vs. 2.42 [range 0.74–11.80], p = 0.0040) but not MTV (3.44 [range 0.65–24.36] vs. 2.95 [0.00–20.07], p = 0.20) and TLG (7.92 [range 0.93–47.82] vs. 5.63 [0.00–58.66], p = 0.14). SUVmax had an AUC value of 0.74 (95% CI 0.61–0.87) with a sensitivity of 89.5% and specificity of 52.8% at a cut-off of 2.48.

Conclusions

SUVmax rather than MTV and TLG were shown to be valuable indices for the prediction of STAS in clinical stage I lung adenocarcinoma.
Literatur
1.
Zurück zum Zitat Rami-Porta R, Bolejack V, Crowley J, Ball D, Kim J, Lyons G, et al. The IASLC lung cancer staging project: proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol. 2015;10(7):990–1003.CrossRef Rami-Porta R, Bolejack V, Crowley J, Ball D, Kim J, Lyons G, et al. The IASLC lung cancer staging project: proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol. 2015;10(7):990–1003.CrossRef
2.
Zurück zum Zitat Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.CrossRef Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.CrossRef
3.
Zurück zum Zitat Vansteenkiste J, Crinò L, Dooms C, Douillard JY, Faivre-Finn C, Lim E, et al. ESMO consensus conference on lung cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol. 2014;25(8):1462–74.CrossRef Vansteenkiste J, Crinò L, Dooms C, Douillard JY, Faivre-Finn C, Lim E, et al. ESMO consensus conference on lung cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol. 2014;25(8):1462–74.CrossRef
4.
Zurück zum Zitat Warth A. Spread through air spaces (STAS): a comprehensive update. Transl Lung Cancer Res. 2017;6(5):501–7.CrossRef Warth A. Spread through air spaces (STAS): a comprehensive update. Transl Lung Cancer Res. 2017;6(5):501–7.CrossRef
5.
Zurück zum Zitat Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 world health organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10(9):1243–60.CrossRef Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 world health organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10(9):1243–60.CrossRef
6.
Zurück zum Zitat Board WHOcote. Thoracic tumours. International Agency for Research on Cancer; 2021 Board WHOcote. Thoracic tumours. International Agency for Research on Cancer; 2021
7.
Zurück zum Zitat Shiono S, Yanagawa N. Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage I lung adenocarcinoma. Interact Cardiovasc Thorac Surg. 2016;23(4):567–72.CrossRef Shiono S, Yanagawa N. Spread through air spaces is a predictive factor of recurrence and a prognostic factor in stage I lung adenocarcinoma. Interact Cardiovasc Thorac Surg. 2016;23(4):567–72.CrossRef
8.
Zurück zum Zitat Toyokawa G, Yamada Y, Tagawa T, Kozuma Y, Matsubara T, Haratake N, et al. Significance of spread through air spaces in resected pathological stage I lung adenocarcinoma. Ann Thorac Surg. 2018;105(6):1655–63.CrossRef Toyokawa G, Yamada Y, Tagawa T, Kozuma Y, Matsubara T, Haratake N, et al. Significance of spread through air spaces in resected pathological stage I lung adenocarcinoma. Ann Thorac Surg. 2018;105(6):1655–63.CrossRef
9.
Zurück zum Zitat Kadota K, Kushida Y, Kagawa S, Ishikawa R, Ibuki E, Inoue K, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stage I lung adenocarcinoma with tumor spread through air spaces. Am J Surg Pathol. 2019;43(8):1033–41.CrossRef Kadota K, Kushida Y, Kagawa S, Ishikawa R, Ibuki E, Inoue K, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stage I lung adenocarcinoma with tumor spread through air spaces. Am J Surg Pathol. 2019;43(8):1033–41.CrossRef
10.
Zurück zum Zitat Shiono S, Endo M, Suzuki K, Yarimizu K, Hayasaka K, Yanagawa N. Spread through air spaces is a prognostic factor in sublobar resection of non-small cell lung cancer. Ann Thorac Surg. 2018;106(2):354–60.CrossRef Shiono S, Endo M, Suzuki K, Yarimizu K, Hayasaka K, Yanagawa N. Spread through air spaces is a prognostic factor in sublobar resection of non-small cell lung cancer. Ann Thorac Surg. 2018;106(2):354–60.CrossRef
11.
Zurück zum Zitat Masai K, Sakurai H, Sukeda A, Suzuki S, Asakura K, Nakagawa K, et al. Prognostic impact of margin distance and tumor spread through air spaces in limited resection for primary lung cancer. J Thorac Oncol. 2017;12(12):1788–97.CrossRef Masai K, Sakurai H, Sukeda A, Suzuki S, Asakura K, Nakagawa K, et al. Prognostic impact of margin distance and tumor spread through air spaces in limited resection for primary lung cancer. J Thorac Oncol. 2017;12(12):1788–97.CrossRef
12.
Zurück zum Zitat Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med. 2003;44(8):1200–9.PubMed Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med. 2003;44(8):1200–9.PubMed
13.
Zurück zum Zitat Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours, 8th edn. Hoboken: John Wiley & Sons; 2017. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours, 8th edn. Hoboken: John Wiley & Sons; 2017.
14.
Zurück zum Zitat Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC lung cancer staging project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2016;11(8):1204–23.CrossRef Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC lung cancer staging project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2016;11(8):1204–23.CrossRef
15.
Zurück zum Zitat Walker MD, Morgan AJ, Bradley KM, McGowan DR. Data-driven respiratory gating outperforms device-based gating for clinical (18)F-FDG PET/CT. J Nucl Med. 2020;61(11):1678–83.CrossRef Walker MD, Morgan AJ, Bradley KM, McGowan DR. Data-driven respiratory gating outperforms device-based gating for clinical (18)F-FDG PET/CT. J Nucl Med. 2020;61(11):1678–83.CrossRef
16.
Zurück zum Zitat Iwano S, Ito S, Kamiya S, Ito R, Kato K, Naganawa S. Utility of metabolic parameters on FDG PET/CT in the classification of early-stage lung adenocarcinoma: prediction of pathological invasive size. Clin Nucl Med. 2019;44(7):560–5.CrossRef Iwano S, Ito S, Kamiya S, Ito R, Kato K, Naganawa S. Utility of metabolic parameters on FDG PET/CT in the classification of early-stage lung adenocarcinoma: prediction of pathological invasive size. Clin Nucl Med. 2019;44(7):560–5.CrossRef
17.
Zurück zum Zitat Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48(3):452–8.CrossRef Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48(3):452–8.CrossRef
18.
Zurück zum Zitat Wang XY, Zhao YF, Yang L, Liu Y, Yang YK, Wu N. Correlation analysis between metabolic tumor burden measured by positron emission tomography/computed tomography and the 2015 world health organization classification of lung adenocarcinoma, with a risk prediction model of tumor spread through air spaces. Transl Cancer Res. 2020;9(10):6412–22.CrossRef Wang XY, Zhao YF, Yang L, Liu Y, Yang YK, Wu N. Correlation analysis between metabolic tumor burden measured by positron emission tomography/computed tomography and the 2015 world health organization classification of lung adenocarcinoma, with a risk prediction model of tumor spread through air spaces. Transl Cancer Res. 2020;9(10):6412–22.CrossRef
19.
Zurück zum Zitat Suh JW, Jeong YH, Cho A, Kim DJ, Chung KY, Shim HS, et al. Stepwise flowchart for decision making on sublobar resection through the estimation of spread through air space in early stage lung cancer(1). Lung Cancer. 2020;142:28–33.CrossRef Suh JW, Jeong YH, Cho A, Kim DJ, Chung KY, Shim HS, et al. Stepwise flowchart for decision making on sublobar resection through the estimation of spread through air space in early stage lung cancer(1). Lung Cancer. 2020;142:28–33.CrossRef
20.
Zurück zum Zitat Yang L, Wang S, Zhou Y, Lai S, Xiao G, Gazdar A, et al. Evaluation of the 7(th) and 8(th) editions of the AJCC/UICC TNM staging systems for lung cancer in a large North American cohort. Oncotarget. 2017;8(40):66784–95.CrossRef Yang L, Wang S, Zhou Y, Lai S, Xiao G, Gazdar A, et al. Evaluation of the 7(th) and 8(th) editions of the AJCC/UICC TNM staging systems for lung cancer in a large North American cohort. Oncotarget. 2017;8(40):66784–95.CrossRef
21.
Zurück zum Zitat Kadota K, Colovos C, Suzuki K, Rizk NP, Dunphy MP, Zabor EC, et al. FDG-PET SUVmax combined with IASLC/ATS/ERS histologic classification improves the prognostic stratification of patients with stage I lung adenocarcinoma. Ann Surg Oncol. 2012;19(11):3598–605.CrossRef Kadota K, Colovos C, Suzuki K, Rizk NP, Dunphy MP, Zabor EC, et al. FDG-PET SUVmax combined with IASLC/ATS/ERS histologic classification improves the prognostic stratification of patients with stage I lung adenocarcinoma. Ann Surg Oncol. 2012;19(11):3598–605.CrossRef
22.
Zurück zum Zitat Yoshizawa A, Motoi N, Riely GJ, Sima CS, Gerald WL, Kris MG, et al. Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases. Mod Pathol. 2011;24(5):653–64.CrossRef Yoshizawa A, Motoi N, Riely GJ, Sima CS, Gerald WL, Kris MG, et al. Impact of proposed IASLC/ATS/ERS classification of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases. Mod Pathol. 2011;24(5):653–64.CrossRef
23.
Zurück zum Zitat de Geus-Oei LF, van Krieken JH, Aliredjo RP, Krabbe PF, Frielink C, Verhagen AF, et al. Biological correlates of FDG uptake in non-small cell lung cancer. Lung Cancer. 2007;55(1):79–87.CrossRef de Geus-Oei LF, van Krieken JH, Aliredjo RP, Krabbe PF, Frielink C, Verhagen AF, et al. Biological correlates of FDG uptake in non-small cell lung cancer. Lung Cancer. 2007;55(1):79–87.CrossRef
24.
Zurück zum Zitat Kadota K, Nitadori JI, Sima CS, Ujiie H, Rizk NP, Jones DR, et al. Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage I lung adenocarcinomas. J Thorac Oncol. 2015;10(5):806–14.CrossRef Kadota K, Nitadori JI, Sima CS, Ujiie H, Rizk NP, Jones DR, et al. Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage I lung adenocarcinomas. J Thorac Oncol. 2015;10(5):806–14.CrossRef
25.
Zurück zum Zitat Yoo Ie R, Chung SK, Park HL, Choi WH, Kim YK, Lee KY, et al. Prognostic value of SUVmax and metabolic tumor volume on 18F-FDG PET/CT in early stage non-small cell lung cancer patients without LN metastasis. Biomed Mater Eng. 2014;24(6):3091–103.PubMed Yoo Ie R, Chung SK, Park HL, Choi WH, Kim YK, Lee KY, et al. Prognostic value of SUVmax and metabolic tumor volume on 18F-FDG PET/CT in early stage non-small cell lung cancer patients without LN metastasis. Biomed Mater Eng. 2014;24(6):3091–103.PubMed
26.
Zurück zum Zitat Sarikaya I, Sarikaya A. Assessing PET parameters in oncologic (18)F-FDG studies. J Nucl Med Technol. 2020;48(3):278–82.CrossRef Sarikaya I, Sarikaya A. Assessing PET parameters in oncologic (18)F-FDG studies. J Nucl Med Technol. 2020;48(3):278–82.CrossRef
27.
Zurück zum Zitat Hyun SH, Choi JY, Kim K, Kim J, Shim YM, Um SW, et al. Volume-based parameters of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography improve outcome prediction in early-stage non-small cell lung cancer after surgical resection. Ann Surg. 2013;257(2):364–70.CrossRef Hyun SH, Choi JY, Kim K, Kim J, Shim YM, Um SW, et al. Volume-based parameters of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography improve outcome prediction in early-stage non-small cell lung cancer after surgical resection. Ann Surg. 2013;257(2):364–70.CrossRef
28.
Zurück zum Zitat Chae M, Jeon JH, Chung JH, Lee SY, Hwang WJ, Jung W, et al. Prognostic significance of tumor spread through air spaces in patients with stage IA part-solid lung adenocarcinoma after sublobar resection. Lung Cancer. 2021;152:21–6.CrossRef Chae M, Jeon JH, Chung JH, Lee SY, Hwang WJ, Jung W, et al. Prognostic significance of tumor spread through air spaces in patients with stage IA part-solid lung adenocarcinoma after sublobar resection. Lung Cancer. 2021;152:21–6.CrossRef
29.
Zurück zum Zitat Kim SK, Kim TJ, Chung MJ, Kim TS, Lee KS, Zo JI, et al. Lung adenocarcinoma: CT features associated with spread through air spaces. Radiology. 2018;289(3):831–40.CrossRef Kim SK, Kim TJ, Chung MJ, Kim TS, Lee KS, Zo JI, et al. Lung adenocarcinoma: CT features associated with spread through air spaces. Radiology. 2018;289(3):831–40.CrossRef
30.
Zurück zum Zitat Blaauwgeers H, Russell PA, Jones KD, Radonic T, Thunnissen E. Pulmonary loose tumor tissue fragments and spread through air spaces (STAS): invasive pattern or artifact? A critical review. Lung Cancer. 2018;123:107–11.CrossRef Blaauwgeers H, Russell PA, Jones KD, Radonic T, Thunnissen E. Pulmonary loose tumor tissue fragments and spread through air spaces (STAS): invasive pattern or artifact? A critical review. Lung Cancer. 2018;123:107–11.CrossRef
Metadaten
Titel
18F FDG-PET/CT analysis of spread through air spaces (STAS) in clinical stage I lung adenocarcinoma
verfasst von
Miki Nishimori
Hitomi Iwasa
Kana Miyatake
Noriko Nitta
Kosuke Nakaji
Tomohiro Matsumoto
Tomoaki Yamanishi
Rika Yoshimatsu
Mituko Iguchi
Masaya Tamura
Takuji Yamagami
Publikationsdatum
12.07.2022
Verlag
Springer Nature Singapore
Erschienen in
Annals of Nuclear Medicine / Ausgabe 10/2022
Print ISSN: 0914-7187
Elektronische ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-022-01773-1

Weitere Artikel der Ausgabe 10/2022

Annals of Nuclear Medicine 10/2022 Zur Ausgabe