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Value of 18F-FDG uptake on PET/CT and CEA level to predict epidermal growth factor receptor mutations in pulmonary adenocarcinoma

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

An Erratum to this article was published on 08 July 2014

Abstract

Purpose

The identification of the mutation status of the epidermal growth factor receptor (EGFR) is important for the optimization of treatment in patients with pulmonary adenocarcinoma. The acquisition of adequate tissues for EGFR mutational analysis is sometimes not feasible, especially in advanced-stage patients. The aim of this study was to predict EGFR mutation status in patients with pulmonary adenocarcinoma based on 18F-fluorodeoxyglucose (FDG) uptake and imaging features in positron emission tomography/computed tomography (PET/CT), as well as on the serum carcinoembryonic antigen (CEA) level.

Methods

We retrospectively reviewed 132 pulmonary adenocarcinoma patients who underwent EGFR mutation testing, pretreatment FDG PET/CT and serum CEA analysis. The associations between EGFR mutations and patient characteristics, maximal standard uptake value (SUVmax) of primary tumors, serum CEA level and CT imaging features were analyzed. Receiver-operating characteristic (ROC) curve analysis was performed to quantify the predictive value of these factors.

Results

EGFR mutations were identified in 69 patients (52.2 %). Patients with SUVmax ≥6 (p = 0.002) and CEA level ≥5 (p = 0.013) were more likely to have EGFR mutations. The CT characteristics of larger tumors (≥3 cm) (p = 0.023) and tumors with a nonspiculated margin (p = 0.026) were also associated with EGFR mutations. Multivariate analysis showed that higher SUVmax and CEA level, never smoking and a nonspiculated tumor margin were the most significant predictors of EGFR mutation. The combined use of these four criteria yielded a higher area under the ROC curve (0.82), suggesting a good discrimination.

Conclusion

The combined evaluation of FDG uptake, CEA level, smoking status and tumor margins may be helpful in predicting EGFR mutation status in patients with pulmonary adenocarcinoma, especially when the tumor sample is inadequate for genetic analysis or genetic testing is not available. Further large-scale prospective studies are needed to validate these results.

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Acknowledgments

The authors thank the Cancer Registry Group of Tri-Service General Hospital for the clinical data support.

Conflict of interest

There was no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, 325, Section 2, Cheng-Gong Road, Nei-Hu, Taipei 114, Taiwan, Republic of China

    Kai-Hsiung Ko, Hsian-He Hsu, Wei-Chou Chang, Yi-Chih Hsu & Tsun-Hou Chang

  2. Department of Thoracic Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China

    Tsai-Wang Huang & Hung Chang

  3. Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China

    Hong-Wei Gao

  4. Department of Nuclear medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China

    Daniel H. Y. Shen

  5. Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University, Taipei, Taiwan, Republic of China

    Chi-Ming Chu

  6. Division of Hematology-Oncology, Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China

    Ching-Liang Ho

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  1. Kai-Hsiung Ko
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Correspondence to Hsian-He Hsu.

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Ko, KH., Hsu, HH., Huang, TW. et al. Value of 18F-FDG uptake on PET/CT and CEA level to predict epidermal growth factor receptor mutations in pulmonary adenocarcinoma. Eur J Nucl Med Mol Imaging 41, 1889–1897 (2014). https://doi.org/10.1007/s00259-014-2802-y

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  • DOI: https://doi.org/10.1007/s00259-014-2802-y

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