Predictive value of 18F-FDG PET/CT for acute exacerbation of interstitial lung disease in patients with lung cancer and interstitial lung disease treated with chemotherapy
We examined whether fluorine-18 2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) performed before chemotherapy could predict the onset of acute exacerbation of interstitial lung disease (AE-ILD) in patients with lung cancer and ILD treated with chemotherapy.
Thirty-three patients with lung cancer and ILD who underwent 18F-FDG PET/CT and were treated with chemotherapy at Kumamoto University Hospital between April 2006 and March 2018 were retrospectively analyzed. The maximum standardized uptake value (SUVmax) of interstitial lesions was measured to quantify the background ILD activity. A prediction model of AE-ILD was developed using logistic regression analyses for the SUVmax, and receiver operating characteristic (ROC) curve analyses were conducted.
Among the 33 patients, 7 experienced AE-ILD. The SUVmax of contralateral interstitial lesions was significantly higher in patients with vs. without AE-ILD (median SUVmax: 2.220 vs. 1.795, P = 0.025). Univariable logistic regression analyses showed that the SUVmax of contralateral interstitial lesions trended towards being significantly associated with the onset of AE-ILD [odds ratio: 8.683, 95% confidence interval (CI) 0.88–85.83, P = 0.064]. The area under the ROC curve of the SUVmax for predicting AE-ILD was 0.780 (95% CI 0.579–0.982, P = 0.025). The optimal cut-off value for SUVmax was 2.005, with sensitivity and specificity values of 0.857 and 0.769, respectively.
The SUVmax of contralateral interstitial lesions in 18F-FDG PET/CT images might be useful for predicting the onset of AE-ILD in patients with lung cancer and ILD treated with chemotherapy.
KeywordsAcute exacerbation Fluorine-18 2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography Interstitial lung disease Lung cancer Chemotherapy
We are grateful to Ms. Tamura and Ms. Tashiro, who are secretaries at department of respiratory medicine at Kumamoto University Hospital, for their support. The authors declare that they have no support by NIH Grants.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 7.Enomoto Y, Inui N, Kato T et al (2016) Low forced vital capacity predicts cytotoxic chemotherapy-associated acute exacerbation of interstitial lung disease in patients with lung cancer. Lung Cancer (Amsterdam, Netherlands) 96:63–67. https://doi.org/10.1016/j.lungcan.2016.03.017 CrossRefGoogle Scholar
- 14.van Baardwijk A, Dooms C, van Suylen RJ et al (2007) The maximum uptake of (18)F-deoxyglucose on positron emission tomography scan correlates with survival, hypoxia inducible factor-1alpha and GLUT-1 in non-small cell lung cancer. Eur J Cancer (Oxford, England 1990) 43(9):1392–1398. https://doi.org/10.1016/j.ejca.2007.03.027 CrossRefGoogle Scholar
- 15.El-Chemaly S, Malide D, Yao J et al (2013) Glucose transporter-1 distribution in fibrotic lung disease: association with [(1)(8)F]-2-fluoro-2-deoxyglucose-PET scan uptake, inflammation, and neovascularization. Chest 143(6):1685–1691. https://doi.org/10.1378/chest.12-1359 CrossRefPubMedGoogle Scholar
- 16.Andrianifahanana M, Hernandez DM, Yin X et al (2016) Profibrotic up-regulation of glucose transporter 1 by TGF-beta involves activation of MEK and mammalian target of rapamycin complex 2 pathways. FASEB J 30(11):3733–3744. https://doi.org/10.1096/fj.201600428R CrossRefPubMedPubMedCentralGoogle Scholar