Korean J Radiol.  2015 Aug;16(4):929-935. 10.3348/kjr.2015.16.4.929.

Prediction of Pathologic Grade and Prognosis in Mucoepidermoid Carcinoma of the Lung Using 18F-FDG PET/CT

• Park B
• Kim HK
• Choi YS
• Kim J
• Zo JI
• Choi JY
• Shim YM

• KMID: 2155569
• DOI: http://doi.org/10.3348/kjr.2015.16.4.929

Abstract

OBJECTIVE
The maximum standardized uptake value (SUVmax) of pulmonary mucoepidermoid carcinoma (PMEC) in fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was evaluated as a preoperative predictor of pathologic grade and survival rate.
MATERIALS AND METHODS
Twenty-three patients who underwent preoperative PET/CT and complete resection for PMEC were enrolled. The optimal cut-off SUVmax for tumor grade was calculated as 6.5 by receiver operating characteristic curve. The patients were divided into a high SUV group (n = 7) and a low SUV group (n = 16). Clinicopathologic features were compared between the groups by chi2 test and overall survival was determined by Kaplan-Meier analysis.
RESULTS
The mean SUVmax was 15.4 +/- 11.5 in the high SUV group and 3.9 +/- 1.3 in the low SUV group. All patients except one from the low SUV group had low grade tumors and all had no nodal metastasis. The sensitivity and specificity of SUVmax from PET/CT for predicting tumor grade was 85.7% and 93.8%, respectively. During the follow-up period (mean, 48.6 +/- 38.7 months), four patients from the high SUV group experienced cancer recurrence, and one died of cancer. In contrast, none of the low SUV group had recurrence or mortality. Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031).
CONCLUSION
Pulmonary mucoepidermoid carcinoma patients with high SUVmax in PET/CT had higher tumor grade, more frequent lymph node metastasis and worse long-term outcome. Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.

Keyword

Mucoepidermoid carcinoma; Lung cancer; 18F-FDG PET/CT

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Mucoepidermoid/*pathology/radiography
Female
Fluorodeoxyglucose F18/metabolism
Humans
Kaplan-Meier Estimate
Lung Neoplasms/*pathology/radiography
Lymph Nodes/pathology/radiography
Lymphatic Metastasis
Male
Mediastinum/radiography
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local/pathology/radiography
Positron-Emission Tomography/*methods
Prognosis
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Survival Rate
Tomography, X-Ray Computed/*methods
Young Adult
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Receiver operating characteristics (ROCs) curve for maximum standardized uptake value (SUVmax) for prediction of tumor grade of pulmonary mucoepidermoid carcinoma. Optimal cut-off value of SUVmax from PET/CT was calculated as 6.5 by ROCs curve. Area under curve for SUVmax was 0.92 and sensitivity and specificity for predicting tumor grade were 85.7% and 93.8%, respectively. PET/CT = positron emission tomography/computed tomography

• 

  Fig. 2 Chest CT and PET/CT results for 17-year-old female with PMEC in low SUV group. A. In CT image, 14 mm intraluminal nodule (arrow) obliterated lumen of right middle lobar bronchus and protruded into lumen of intermediate bronchus. B. SUVmax of tumor in PET/CT was 4.2 (arrow) and pathologic result verified stage IA low grade PMEC. CT = computed tomography, PET/CT = positron emission tomography/computed tomography, PMEC = pulmonary mucoepidermoid carcinoma, SUV = standardized uptake value, SUVmax = maximum SUV

• 

  Fig. 3 Chest CT and PET/CT results for 67-year-old male with PMEC in high SUV group. A. In CT image, 53 mm mass (arrow) in left upper lobe with possibility of chest wall invasion was visible. B. SUVmax of tumor in PET/CT was 11.9 (arrow) and pathologic result verified stage IIB high grade PMEC. CT = computed tomography, PET/CT = positron emission tomography/computed tomography, PMEC = pulmonary mucoepidermoid carcinoma, SUV = standardized uptake value, SUVmax = maximum SUV

• 

  Fig. 4 Nodal metastasis of PMEC on chest CT and PET/CT in 68-year-old female. A. In CT image, 10 cm large mass (arrow) was evident in right upper lobe and mediastinal lymph nodes in para-tracheal area (arrowhead) were enlarged, representing possible nodal metastases. B. In PET/CT, SUVmax of mass was 13.1 (arrow) and slightly increased uptake in right para-tracheal lymph nodes (SUVmax = 2.9, arrowhead) were seen. Pathologic results revealed high grade PMEC with single metastasis in right lower para-tracheal lymph node representing stage IIIA. CT = computed tomography, PET/CT = positron emission tomography/computed tomography, PMEC = pulmonary mucoepidermoid carcinoma, SUVmax = maximum standardized uptake value

• 

  Fig. 5 Kaplan-Meier overall and disease-free survival of 23 patients after complete resection for PMEC according to SUV group. Overall survival (A) was significantly higher in low SUV group than high SUV group (5-year survival rates of 100% vs. 71.4%, p = 0.031). Disease-free survival (B) was also significantly higher in low SUV group (3-year survival rates of 100% vs. 17.9%, p < 0.001). PMEC = pulmonary mucoepidermoid carcinoma, SUV = standardized uptake value

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