Chae Hong Lim1, Tae Ran Ahn2, Seung Hwan Moon1, Young Seok Cho1, Joon Young Choi1, Byung-Tae Kim1, Kyung-Han Lee3. 1. Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. 2. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea. 3. Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. khnm.lee@samsung.com.
Abstract
OBJECTIVES: We investigated the capacity of fluorodeoxyglucose (FDG) PET/CT features for stratifying probability of metastasis for single-bone FDG lesions in non-small-cell lung cancer (NSCLC). METHODS: Subjects were 118 newly diagnosed NSCLC patients with a solitary bone FDG lesion and no evidence of other distant metastasis based on PET/CT, brain MRI, and contrast-enhanced chest CT. Bone lesion SUVmax and CT findings, primary tumor SUVmax, clinical T stage, and N stage were analyzed. RESULTS: The bone lesions were determined by biopsy, characteristic MRI findings and clinical follow-up to be metastatic in 33 (28.0%) and benign in 85 cases (72.0%). A cutoff bone SUVmax of 4.3 showed good diagnostic performance (81.8% sensitivity, 84.7% specificity, and 83.9% accuracy), but there was considerable overlap. Bone lesion PET/CT features of SUVmax ≤ 2, osteosclerotic rim or fracture correctly diagnosed 20/20 benign, while SUVmax > 10, soft-tissue mass or bone destruction correctly diagnosed 18/18 metastatic cases. In the remaining 80 cases, bone features of SUVmax > 4.3 and osteolytic change, and lung tumor features of SUVmax > 6.4, ≥ T2 stage (n = 70), and ≥ N1 stage (n = 43) favored metastasis. The presence of one or less of these features correctly diagnosed 38/38 benign, while the presence of four or more features correctly diagnosed 5/5 metastatic cases. The 37 cases with two or three features had either benign (n = 27) or metastatic bone disease (n = 10). CONCLUSION: Combining bone lesion and lung tumor PET/CT features can help stratify risk of bone metastasis in these patients. KEY POINTS: • In NSCLC with a single-bone FDG lesion, lesion SUVmaxis useful for differential diagnosis. • CT features of the single-bone FDG lesions provide additional diagnostic value. • High NSCLC SUVmax, greater T stage, and FDG positive nodes also favor metastasis.
OBJECTIVES: We investigated the capacity of fluorodeoxyglucose (FDG) PET/CT features for stratifying probability of metastasis for single-bone FDG lesions in non-small-cell lung cancer (NSCLC). METHODS: Subjects were 118 newly diagnosed NSCLCpatients with a solitary bone FDG lesion and no evidence of other distant metastasis based on PET/CT, brain MRI, and contrast-enhanced chest CT. Bone lesion SUVmax and CT findings, primary tumor SUVmax, clinical T stage, and N stage were analyzed. RESULTS: The bone lesions were determined by biopsy, characteristic MRI findings and clinical follow-up to be metastatic in 33 (28.0%) and benign in 85 cases (72.0%). A cutoff bone SUVmax of 4.3 showed good diagnostic performance (81.8% sensitivity, 84.7% specificity, and 83.9% accuracy), but there was considerable overlap. Bone lesion PET/CT features of SUVmax ≤ 2, osteosclerotic rim or fracture correctly diagnosed 20/20 benign, while SUVmax > 10, soft-tissue mass or bone destruction correctly diagnosed 18/18 metastatic cases. In the remaining 80 cases, bone features of SUVmax > 4.3 and osteolytic change, and lung tumor features of SUVmax > 6.4, ≥ T2 stage (n = 70), and ≥ N1 stage (n = 43) favored metastasis. The presence of one or less of these features correctly diagnosed 38/38 benign, while the presence of four or more features correctly diagnosed 5/5 metastatic cases. The 37 cases with two or three features had either benign (n = 27) or metastatic bone disease (n = 10). CONCLUSION: Combining bone lesion and lung tumor PET/CT features can help stratify risk of bone metastasis in these patients. KEY POINTS: • In NSCLC with a single-bone FDG lesion, lesion SUVmaxis useful for differential diagnosis. • CT features of the single-bone FDG lesions provide additional diagnostic value. • High NSCLC SUVmax, greater T stage, and FDG positive nodes also favor metastasis.
Entities:
Keywords:
Bone metastasis; Fluorodeoxyglucose; Lung cancer; Positron-emission tomography
Authors: Jeong Won Lee; Yong-Jin Park; Youn Soo Jeon; Ki Hong Kim; Jong Eun Lee; Sung Hoon Hong; Sang Mi Lee; Su Jin Jang Journal: Quant Imaging Med Surg Date: 2020-11