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The asphericity of the metabolic tumour volume in NSCLC: correlation with histopathology and molecular markers

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Asphericity (ASP) is a tumour shape descriptor based on the PET image. It quantitates the deviation from spherical of the shape of the metabolic tumour volume (MTV). In order to identify its biological correlates, we investigated the relationship between ASP and clinically relevant histopathological and molecular signatures in non-small-cell lung cancer (NSCLC).

Methods

The study included 83 consecutive patients (18 women, aged 66.4 ± 8.9 years) with newly diagnosed NSCLC in whom PET/CT with 18F-FDG had been performed prior to therapy. Primary tumour resection specimens and core biopsies were used for basic histopathology and determination of the Ki-67 proliferation index. EGFR status, VEGF, p53 and ALK expression were obtained in a subgroup of 44 patients. The FDG PET images of the primary tumours were delineated using an automatic algorithm based on adaptive thresholding taking into account local background. In addition to ASP, SUVmax, MTV and some further descriptors of shape and intratumour heterogeneity were assessed as semiquantitative PET measures.

Results

SUVmax, MTV and ASP were associated with pathological T stage (Kruskal-Wallis, p = 0.001, p < 0.0005 and p < 0.0005, respectively) and N stage (p = 0.017, p = 0.003 and p = 0.002, respectively). Only ASP was associated with M stage (p = 0.026). SUVmax, MTV and ASP were correlated with Ki-67 index (Spearman’s rho = 0.326/p = 0.003, rho = 0.302/p = 0.006 and rho = 0.271/p = 0.015, respectively). The latter correlations were considerably stronger in adenocarcinomas than in squamous cell carcinomas. ASP, but not SUVmax or MTV, showed a tendency for a significant association with the extent of VEGF expression (p = 0.058). In multivariate Cox regression analysis, ASP (p < 0.0005) and the presence of distant metastases (p = 0.023) were significantly associated with progression-free survival. ASP (p = 0.006), the presence of distant metastases (p = 0.010), and Ki-67 index (p = 0.062) were significantly associated with overall survival.

Conclusion

The ASP of primary NSCLCs on FDG PET images is associated with tumour dimensions and molecular markers of proliferation and angiogenesis.

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Authors and Affiliations

  1. Clinic of Radiology and Nuclear Medicine, University Hospital, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Ivayla Apostolova, Kilian Ego, Ingo G. Steffen, Christian Furth & Holger Amthauer

  2. Clinic of Nuclear Medicine, University Medicine Charité, Berlin, Germany

    Ralph Buchert, Christian Furth & Holger Amthauer

  3. Lung Clinic Lostau GmbH, Lostau, Germany

    Heinz Wertzel & H. Jost Achenbach

  4. Clinic of Pneumology, University Hospital, Otto-von-Guericke University Magdeburg, Magdeburg, Germany

    Sandra Riedel & Jens Schreiber

  5. Institute of Pathology Stendal, Straße der Demokratie 1, Stendal, Germany

    Meinald Schultz

  6. Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany

    Thorsten Derlin

  7. Helmholtz-Center Dresden-Rossendorf, Dresden, Germany

    Frank Hofheinz

  8. Institute for Pathology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany

    Thomas Kalinski

  9. Institute for Pathology Lademannbogen, Hamburg, Germany

    Thomas Kalinski

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  1. Ivayla Apostolova
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  2. Kilian Ego
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  3. Ingo G. Steffen
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Correspondence to Ivayla Apostolova.

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Ethical approval

All procedures performed in this study were approved by the Institutional Ethics Committee (reference number, 159/13; RAD233) and were in accordance with ethical standards and with the principles of the 1964 Declaration of Helsinki and its later amendments. This article does not describe any studies with animals performed by any of the authors.

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Informed consent for retrospective data evaluation was obtained from all participants included in the study.

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Apostolova, I., Ego, K., Steffen, I.G. et al. The asphericity of the metabolic tumour volume in NSCLC: correlation with histopathology and molecular markers. Eur J Nucl Med Mol Imaging 43, 2360–2373 (2016). https://doi.org/10.1007/s00259-016-3452-z

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