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One Versus Up-to-5 Lesion Measurements for Response Assessment by PERCIST in Patients with Lung Cancer

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Abstract

Purpose

The optimal number of lesions to measure for response assessment from fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) is not validated for lung cancer. We compared 1 lesion and up-to-5 lesion measurements for response assessment in lung cancer per PET Response Criteria in Solid Tumors (PERCIST).

Methods

Patients with lung cancer with pre- and post-treatment PET/CT images were included. The standard uptake value corrected for lean body mass (SULpeak) of up-to-5 hottest target lesions was measured at each time point. The percent changes of SULpeak of the single hottest lesion and the sum of up-to-5 hottest lesions were computed. Pearson correlation coefficient evaluated the strength of association between the percent changes of SULpeak values from the 1 lesion and up-to-5 lesion analyses. Response categories were complete metabolic response (CMR) with no perceptible lesion; partial metabolic response (PMR), stable metabolic disease (SMD), or progressive metabolic disease (PMD) using the threshold of 30% and 0.8 unit change in SULpeak; and unequivocal new lesion meant PMD. The concordance for response categorization was assessed by kappa statistics.

Results

A total of 40 patients (25 non-small cell lung cancer; 15 small cell lung cancer) were analyzed, all with 18F-FDG-avid lung cancer. Average of 3 target lesions were measured for up-to-5 lesion analysis. Pearson’s r was 0.74 (P < 0.001) and increased to 0.96 (P < 0.001) when two outliers were excluded. Response categorization with 1 lesion and up-to-5 lesion analyses was concordant in 37 patients (92.5%, weighted kappa = 0.89).

Conclusion

Analyzing 1 lesion and up-to-5 lesions for response assessment by PERCIST showed high concordance in patients with lung cancer.

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Acknowledgements

This article is the expansion of a previous abstract presented at the SNMMI 2020 annual meeting (https://jnm.snmjournals.org/content/61/supplement_1/1357).

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Soo Jin Kwon, Joo Hyun O & Ie Ryung Yoo

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  1. Soo Jin Kwon
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Correspondence to Joo Hyun O.

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Conflict of Interest

Soo Jin Kwon, Joo Hyun O, and Ie Ryung Yoo declare no conflict of interest.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration as revised in 2013 and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The institutional review board of our institute approved this retrospective study (KC20RASI0078), and the requirement to obtain informed consent was waved.

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Kwon, S.J., O, J.H. & Yoo, I.R. One Versus Up-to-5 Lesion Measurements for Response Assessment by PERCIST in Patients with Lung Cancer. Nucl Med Mol Imaging 55, 123–129 (2021). https://doi.org/10.1007/s13139-021-00697-4

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  • DOI: https://doi.org/10.1007/s13139-021-00697-4

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