SUVmax Ratio on PET/CT May Differentiate Between Lung Metastases and Synchronous Multiple Primary Lung Cancer
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Cited by 19 publications
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It has been a big challenge to distinguish synchronous multiple primary lung cancer (sMPLC) from primary lung cancer with intrapulmonary metastases (IPM). We aimed to assess the clinical application of dynamic 18F-FDG PET/CT in patients with multiple lung cancer nodules. We enrolled patients with multiple pulmonary nodules who had undergone dynamic 18F-FDG PET/CT and divided them into sMPLC and IPM groups based on comprehensive features. The SUVmax, fitted K i value based on dynamic scanning, and corresponding maximum diameter ( D max ) from the two largest tumors were determined in each patient. We determined the absolute between-tumor difference of SU V max / D max and K i / D max ( Δ SU V max / D max ; Δ K i / D max ) and assessed the between-group differences. Further, the diagnostic accuracy was evaluated by ROC analysis and the correlation between Δ SU V max / D max and Δ K i / D max from all groups was determined. There was no significant difference for Δ SU V max / D max between the IPM and sMPLC groups, while the IPM group had a significantly higher Δ K i / D max than the sMPLC group. The AUC of Δ K i / D max for differentiating sMPLC from IPM was 0.80 (cut-off value of K i = 0.0059 , sensitivity 79%, specificity 75%, p < 0.001 ). There was a good correlation (Pearson r = 0.91 , 95% CI: 0.79-0.96, p < 0.0001 ) between Δ SU V max / D max and Δ K i / D max in the IPM group but not in the sMPLC group (Pearson r = 0.45 , p > 0.05 ). Dynamic 18F-FDG PET/CT could be a useful tool for distinguishing sMPLC from IPM. K i calculation based on Patlak graphic analysis could be more sensitive than SUVmax in discriminating IPM from sMPLC in patients with multiple lung cancer nodules.
It has been a big challenge to distinguish synchronous multiple primary lung cancer (sMPLC) from primary lung cancer with intrapulmonary metastases (IPM). We aimed to assess the clinical application of dynamic 18F-FDG PET/CT in patients with multiple lung cancer nodules. We enrolled patients with multiple pulmonary nodules who had undergone dynamic 18F-FDG PET/CT and divided them into sMPLC and IPM groups based on comprehensive features. The SUVmax, fitted K i value based on dynamic scanning, and corresponding maximum diameter ( D max ) from the two largest tumors were determined in each patient. We determined the absolute between-tumor difference of SU V max / D max and K i / D max ( Δ SU V max / D max ; Δ K i / D max ) and assessed the between-group differences. Further, the diagnostic accuracy was evaluated by ROC analysis and the correlation between Δ SU V max / D max and Δ K i / D max from all groups was determined. There was no significant difference for Δ SU V max / D max between the IPM and sMPLC groups, while the IPM group had a significantly higher Δ K i / D max than the sMPLC group. The AUC of Δ K i / D max for differentiating sMPLC from IPM was 0.80 (cut-off value of K i = 0.0059 , sensitivity 79%, specificity 75%, p < 0.001 ). There was a good correlation (Pearson r = 0.91 , 95% CI: 0.79-0.96, p < 0.0001 ) between Δ SU V max / D max and Δ K i / D max in the IPM group but not in the sMPLC group (Pearson r = 0.45 , p > 0.05 ). Dynamic 18F-FDG PET/CT could be a useful tool for distinguishing sMPLC from IPM. K i calculation based on Patlak graphic analysis could be more sensitive than SUVmax in discriminating IPM from sMPLC in patients with multiple lung cancer nodules.
Radical Resection for Second EGFR-mutated Primary Lung Cancer Following Immune Checkpoint Inhibitor Monotherapy for Stage IV Lung Adenocarcinoma
A 78-year-old woman with multiple lung nodules, epithelial growth factor receptor (EGFR) exon 20 insertion mutations, and diagnosed with advanced lung adenocarcinoma (cT4N3M1a, stage IVA), was referred to our hospital. She received immune checkpoint inhibitor (ICI) therapy. The therapy showed remarkable antitumor effects; only a single nodule remained in the right upper lobe. The nodule was diagnosed as adenocarcinoma through a biopsy. We subsequently performed right upper lobectomy for multiple primary lung cancer (MPLC). The surgical specimen contained EGFR exon 19 deletion mutations and not exon 20 insertion mutations.
With the wide application of computed tomography in lung cancer screening, the incidence of multiple primary lung cancer (MPLC) has been increasingly reported. Despite the established criteria, the differentiation between MPLC and intrapulmonary metastasis remains challenging. Although histologic features are helpful in some circumstances, a molecular analysis is often needed. The application of next-generation sequencing could aid in distinguishing MPLCs from intrapulmonary metastasis, decreasing ambiguity. For MPLC management, surgery with lobectomy is the main operation method. Limited resection does not appear to negatively affect survival, and it is a reasonable alternative. Stereotactic ablative radiotherapy (SABR) has become a standard of care for patients refusing surgery or for those with medically inoperable early-stage lung cancer. However, the efficacy of SABR in MPLC management could only be found in retrospective series. Other local ablation techniques are an emerging alternative for the control of residual lesions. Furthermore, systemic therapies, such as targeted therapy for oncogene-addicted patients, and immunotherapy have shown promising results in MPLC management after resection. In this paper, the recent advances in the diagnosis and management of MPLC are reviewed.
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