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Diagnostic and prognostic values of 2-[18F]FDG PET/CT in resectable thymic epithelial tumour

  • Nuclear Medicine
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Abstract

Objectives

We aimed to evaluate the diagnostic ability for the prediction of histologic grades and prognostic values on recurrence and death of pretreatment 2-[18F]FDG PET/CT in patients with resectable thymic epithelial tumours (TETs).

Methods

One hundred and fourteen patients with TETs who underwent pretreatment 2-[18F]FDG PET/CT between 2012 and 2018 were retrospectively evaluated. TETs were classified into three histologic subtypes: low-risk thymoma (LRT, WHO classification A/AB/B1), high-risk thymoma (HRT, B2/B3), and thymic carcinoma (TC). Area under the receiver operating characteristics curve (AUC) was used to assess the diagnostic performance of PET/CT variables (maximum standardised uptake value [SUVmax], metabolic tumour volume [MTV], total lesion glycolysis [TLG], maximum diameter). Cox proportional hazards models were built using PET/CT and clinical variables.

Results

The tumours included 52 LRT, 33 HRT, and 29 TC. SUVmax showed good diagnostic ability for differentiating HRT/TC from LRT (AUC 0.84, 95% confidence interval [CI] 0.76 − 0.92) and excellent ability for differentiating TC from LRT/HRT (AUC 0.94, 95% CI 0.90 − 0.98), with significantly higher values than MTV, TLG, and maximum diameter. With an optimal cut-off value of 6.4, the sensitivity, specificity, and accuracy for differentiating TC from LRT/HRT were 69%, 96%, and 89%, respectively. In the multivariable Cox proportional hazards analyses for freedom-from-recurrence, SUVmax was an independent prognostic factor (p < 0.001), whereas MTV and TLG were not. SUVmax was a significant predictor for overall survival in conjunction with clinical stage and resection margin.

Conclusion

SUVmax showed excellent diagnostic performance for prediction of TC and significant prognostic value in terms of recurrence and survival.

Key Points

• Maximum standardised uptake value (SUVmax) shows excellent performance in the differentiation of thymic carcinoma from low- and high-risk thymoma.

• SUVmax is an independent prognostic factor for freedom-from-recurrence in the multivariable Cox proportional hazard model and a significant predictor for overall survival.

• 2-[ 18 F]FDG PET/CT can provide a useful diagnostic and prognostic imaging biomarker in conjunction with histologic classification and stage and help choose appropriate management for thymic epithelial tumours.

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Abbreviations

2-[18F]FDG:

2-Deoxy-2-[18F]fluoro-D-glucose

ACR:

American College of Radiology

AIC:

Akaike information criterion

ANOVA:

One-way analysis of variance

AUC:

Area under the curve

CI:

Confidence interval

C-index:

Concordance index

CT:

Computed tomography

FFR:

Freedom-from-recurrence

HRT:

High-risk thymoma

IQR:

Interquartile range

ITMIG:

International Thymic Malignancy Interest Group

LRT:

Low-risk thymoma

MRI:

Magnetic resonance imaging

MTV:

Metabolic tumour volume

OS:

Overall survival

PET:

Positron emission tomography

ROC:

Receiver operating characteristics

SUVmax:

Maximum standardised uptake value

TC:

Thymic carcinoma

TET:

Thymic epithelial tumour

TLG:

Total lesion glycolysis

WHO:

World Health Organization

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (Ministry of Science and ICT; No. NRF-2020M2D9A1094074) and by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI18C2383).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Sangwon Han, Yong-il Kim, Jungsu S. Oh, Seung Yeon Seo & Jin-Sook Ryu

  2. Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Min-Jae Park

  3. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Geun Dong Lee, Sehoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Dong Kwan Kim & Seung-Il Park

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  1. Sangwon Han
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Corresponding author

Correspondence to Yong-il Kim.

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Guarantor

The scientific guarantor of this publication is Y.Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Three of the authors (S.Han, Y.Kim, and J.S.Oh) have significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in: Four of 114 study cohorts have been previously reported in the original scientific article conducted by coauthors of this study (Lee and Oh et al. Ann Nucl Med (2016) 30:309–319; https://doi.org/10.1007/s12149-016-1062-2).

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Han, S., Kim, Yi., Oh, J.S. et al. Diagnostic and prognostic values of 2-[18F]FDG PET/CT in resectable thymic epithelial tumour. Eur Radiol 32, 1173–1183 (2022). https://doi.org/10.1007/s00330-021-08230-z

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