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Consistency and prognostic value of preoperative staging and postoperative pathological staging using 18 F-FDG PET/MRI in patients with non-small cell lung cancer

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Abstract

Objective

In recent years, positron emission tomography/magnetic resonance imaging (PET/MRI) has been clinically used as a method to diagnose non-small cell lung cancer (NSCLC). This study aimed to evaluate the concordance of staging and prognostic ability of NSCLC patients using thin-slice computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) PET/MRI.

Methods

This retrospective study was performed on consecutive NSCLC patients who underwent both diagnostic CT and 18F-FDG PET/MRI before surgery between November 2015 and May 2019. The cTNM staging yielded from PET/MRI was compared with CT and pathological staging, and concordance was investigated, defining pathological findings as reference. To assess the prognostic value of disease-free survival (DFS) and overall survival (OS), we dichotomized the typical prognostic factors and TNM classification staging (Stage I vs. Stage II or higher). Kaplan–Meier curves derived by the log-rank test were generated, and univariate and multivariate analyses were performed to identify the factors associated with DFS and OS.

Results

A total of 82 subjects were included; PET/MRI staging was more consistent (59 of 82) with pathological staging than with CT staging. There was a total of 21 cases of CT and 11 cases of PET/MRI that were judged as cStage I, but were actually pStage II or pStage III. CT tended to judge pN1 or pN2 as cN0 compared to PET/MRI. There was a significant difference between NSCLC patients with Stage I and Stage II or higher by PET/MRI staging as well as prognosis prediction of DFS by pathological staging (P < 0.001). In univariate analysis, PET/MRI, CT, and pathological staging (Stage I or lower vs. Stage II or higher) all showed significant differences as prognostic factors of recurrence or metastases. In multivariate analysis, pathological staging was the only independent factor for recurrence (P = 0.009), and preoperative PET/MRI staging was a predictor of patient survival (P = 0.013).

Conclusions

In NSCLC, pathologic staging was better at predicting recurrence, and preoperative PET/MRI staging was better at predicting survival. Preoperative staging by PET/MRI was superior to CT in diagnosing hilar and mediastinal lymph-node metastases, which contributed to the high concordance with pathologic staging.

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Authors and Affiliations

  1. Department of Radiology, Toho University Graduate School of Medicine, Tokyo, Japan

    Akiko Kajiyama

  2. Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Akiko Kajiyama, Kimiteru Ito, Hirokazu Watanabe & Masahiko Kusumoto

  3. Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan

    Sunao Mizumura

  4. Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan

    Shun-ichi Watanabe

  5. Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan

    Yasushi Yatabe

  6. Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan

    Tatsuya Gomi

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  1. Akiko Kajiyama
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Kajiyama, A., Ito, K., Watanabe, H. et al. Consistency and prognostic value of preoperative staging and postoperative pathological staging using 18 F-FDG PET/MRI in patients with non-small cell lung cancer . Ann Nucl Med 36, 1059–1072 (2022). https://doi.org/10.1007/s12149-022-01795-9

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