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

Abstract

ObjectiveTo 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 MethodsIn 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.ResultsEGFR-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 ≤ 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.ConclusionEGFR-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.

Large cell neuroendocrine carcinoma of the lung: CT and FDG PET findings

“…Spiculated or lobulated margins are findings of malignant pulmonary nodule [16]. Lobulated margin was found in 76.6% and 62.5% of the tumours in a study of stage I non-small cell lung cancer (NSCLC) [13] and a study of peripheral adenocarcinoma no greater than 2 cm in diameter [17], respectively. In these studies, lobulated margin was not related to survival.…”

“…FDG PET (Allegro, Philips Medical Systems, Cleveland, OH, USA) was performed in 11 patients, and integrated FDG PET/CT was performed in 19 patients using 3 different PET/CT cameras: Discovery BGO (GE Medical Systems) in 1 patient, Gemini (Philips Medical Systems, Cleveland, OH, USA) in 12 and Biograph 40 (Siemens Medical Systems) in 6. The details of the FDG PET or FDG PET/CT imaging have been previously described [12][13][14]. All patients were requested to fast for at least 6 h prior to the FDG PET or FDG PET/CT scan.…”

Impact of the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of stage IA adenocarcinoma of the lung: Correlation between computed tomography images and EGFR and KRAS gene mutations

“…The authors reported that a low EGFR gene copy number was more commonly observed in adenocarcinoma with a GGO of >50%. In 2013, Lee et al (47) reported that tumors with a GGO proportion of >50% were less frequent among tumors with EGFR-overexpression compared with tumors without EGFR-overexpression in 214 patients with stage I NSCLC. Furthermore, in 2011, Hsu et al (48) retrospectively surveyed 162 patients with stage I lung adenocarcinoma with a tumor size of <3 cm, and found that the part-solid and solid pattern tumors had more typical EGFR mutations compared with the pGGO tumors.…”

Pulmonary ground-glass opacity: computed tomography features, histopathology and molecular pathology

“…EGFR amplification were inversely correlated with the GGO percentage, indeed the frequency of FISH-positivity increased as the proportion of GGO decreased (6,46,47).…”