Korean J Radiol.  2013 Apr;14(2):375-383. 10.3348/kjr.2013.14.2.375.

Imaging Characteristics of Stage I Non-Small Cell Lung Cancer on CT and FDG-PET: Relationship with Epidermal Growth Factor Receptor Protein Expression Status and Survival

• Lee Y
• Lee HJ
• Kim YT
• Kang CH
• Goo JM
• Park CM
• Paeng JC
• Chung DH
• Jeon YK

• KMID: 1482802
• DOI: http://doi.org/10.3348/kjr.2013.14.2.375

Abstract

OBJECTIVE
To identify CT and FDG-PET features associated with epidermal growth factor receptor (EGFR) protein overexpression, and to evaluate whether imaging features and EGFR-overexpression can help predict clinical outcome.
MATERIALS AND METHODS
In 214 patients (M : F = 129 : 85; mean age, 63.2) who underwent curative resection of stage I non-small cell lung cancer, EGFR protein expression status was determined through immunohistochemical analysis. Imaging characteristics on CT and FDG-PET was assessed in relation to EGFR-overexpression. Imaging features and EGFR-overexpression were also evaluated for clinical outcome by using the Cox proportional hazards model.
RESULTS
EGFR-overexpression was found in 51 patients (23.8%). It was significantly more frequent in tumors with an SUVmax > 5.0 (p < 0.0001), diameter > 2.43 cm (p < 0.0001), and with ground glass opacity < or = 50% (p = 0.0073). SUVmax > 5.0 (OR, 3.113; 95% CI, 1.375-7.049; p = 0.006) and diameter > 2.43 cm (OR, 2.799; 95% CI, 1.285-6.095; p = 0.010) were independent predictors of EGFR overexpression. Multivariate analysis showed that SUVmax > 4.0 (hazard ratio, 10.660; 95% CI, 1.370-82.966; p = 0.024), and the presence of cavitation within a tumor (hazard ratio, 3.122; 95% CI, 1.143-8.532; p = 0.026) were factors associated with poor prognosis.
CONCLUSION
EGFR-overexpression is associated with high SUVmax, large tumor diameter, and small GGO proportion. CT and FDG-PET findings, which are closely related to EGFR overexpression, can be valuable in the prediction of clinical outcome.

Keyword

EGFR; EGFR protein; CT; FDG-PET; Non-small cell lung cancer

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung/metabolism/mortality/*radiography/*radionuclide imaging
Chi-Square Distribution
Female
Fluorodeoxyglucose F18/therapeutic use
Humans
Lung Neoplasms/metabolism/mortality/*radiography/*radionuclide imaging
Male
Middle Aged
Neoplasm Staging
Positron-Emission Tomography/*methods
Proportional Hazards Models
ROC Curve
Radiopharmaceuticals/diagnostic use
Receptor, Epidermal Growth Factor/*metabolism
Statistics, Nonparametric
Survival Rate
Tomography, X-Ray Computed/*methods
Radiopharmaceuticals
Fluorodeoxyglucose F18
Receptor, Epidermal Growth Factor

Figure

• 

  Fig. 1 Adenocarcinoma with EGFR overexpression found in 50-year-old man. Contrast-enhanced CT scan (A) reveals 2.77 cm solid nodule in left lower lobe. Nodule showed increased fluorodeoxyglucose uptake with maximum standardized uptake value of 8.00 (B) on FDG-PET/CT scan. Disease-free survival time of this patient was 9.7 months. EGFR = epidermal growth factor receptor

• 

  Fig. 2 Adenocarcinoma without EGFR overexpression found in 62-year-old woman. Contrast-enhanced CT scan (A) reveals 1.23 cm subsolid nodule with GGO proportion > 50% in right middle lobe. Nodule showed maximum standardized uptake value of 1.7 (B) on FDG-PET/CT scan. Patient has no recurrence during 4-year of postoperative follow-up period. EGFR = epidermal growth factor receptor, GGO = ground glass opacity

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