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

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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.

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References

  1. 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.

    Article  Google Scholar 

  2. 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.

    Article  Google Scholar 

  3. 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.

    Article  CAS  Google Scholar 

  4. Warth A. Spread through air spaces (STAS): a comprehensive update. Transl Lung Cancer Res. 2017;6(5):501–7.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. Board WHOcote. Thoracic tumours. International Agency for Research on Cancer; 2021

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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  Google Scholar 

  13. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours, 8th edn. Hoboken: John Wiley & Sons; 2017.

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  CAS  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48(3):452–8.

    Article  CAS  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  CAS  Google Scholar 

  23. 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.

    Article  Google Scholar 

  24. 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.

    Article  CAS  Google Scholar 

  25. 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  Google Scholar 

  26. Sarikaya I, Sarikaya A. Assessing PET parameters in oncologic (18)F-FDG studies. J Nucl Med Technol. 2020;48(3):278–82.

    Article  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. 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.

    Article  CAS  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. 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.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Miki Nishimori, Hitomi Iwasa, Kana Miyatake, Noriko Nitta, Kosuke Nakaji, Tomohiro Matsumoto, Tomoaki Yamanishi, Rika Yoshimatsu & Takuji Yamagami

  2. Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Mituko Iguchi

  3. Department of Surgery, Division of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Masaya Tamura

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  1. Miki Nishimori
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  2. Hitomi Iwasa
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Correspondence to Miki Nishimori.

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Nishimori, M., Iwasa, H., Miyatake, K. et al. 18F FDG-PET/CT analysis of spread through air spaces (STAS) in clinical stage I lung adenocarcinoma. Ann Nucl Med 36, 897–903 (2022). https://doi.org/10.1007/s12149-022-01773-1

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  • DOI: https://doi.org/10.1007/s12149-022-01773-1

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