Close association of IASLC/ATS/ERS lung adenocarcinoma subtypes with glucose-uptake in positron emission tomography
Introduction
In 2011, new histopathologic classification criteria of lung adenocarcinoma [1] were proposed by the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS). According to the new criteria, lung adenocarcinomas are classified into eight main subtypes: adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), lepidic predominant invasive adenocarcinoma (LPA), acinar predominant invasive adenocarcinoma (APA), papillary predominant invasive adenocarcinoma (PPA), micropapillary predominant invasive adenocarcinoma (MPA), solid predominant invasive adenocarcinoma (SPA), and rare variants of invasive adenocarcinomas, including invasive mucinous (IMA), colloid (CA), fetal (FA), and enteric (EA) adenocarcinoma subtypes [2]. In addition to histopathologic points of view, recent oncological, biological, radiological, and surgical findings have contributed to define the proposed subtyping scheme [3].
The maximum standardized uptake value (SUVmax) in fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) demonstrates a semiquantitative value of glucose uptake in specific lesions of the body. In many institutions, lung cancer staging is routinely performed by FDG-PET/CT, providing useful information on local and distant spread of the tumor [4]. Multiple studies [5], [6], [7], [8], [9] suggested that a higher SUVmax value of a primary lung tumor was associated with advanced disease stages and worse prognosis. In the histologic analysis of lung cancer, SUVmax shows higher values in lung small cell carcinomas or squamous cell carcinomas than adenocarcinomas [10], [11]. Two factors, proliferation potential of tumor cells demonstrated by the grade of glucose-uptake and spatial distribution of tumor cells determined by the growing pattern of each histologic type, affect SUVmax. However, information regarding the relationships of SUVmax and the newly proposed histologic subtypes of adenocarcinoma is limited. We therefore retrospectively evaluated the relationships between SUVmax and IASLC/ATS/ERS adenocarcinoma subtypes with the outcome of postoperative survival.
Section snippets
Patients
This retrospective study was approved by the Institutional Review Board of St. Marianna University School of Medicine (Kanagawa, Japan). A database of lung cancer patients who underwent surgery in our department from January 2008 to December 2013 was screened to identify associations between preoperative FDG-PET/CT and histologic subtypes of lung adenocarcinoma categorized by the new classification criteria [2].
FDG-PET/CT
Preoperative FDG-PET/CT was performed using an integrated PET/CT scanner (Eminence-G
Results
A total of 255 patients who underwent complete resection for lung adenocarcinoma were included in the study. The patients included 130 men and 125 women (mean age, 69 years; range, 22–88 years). Surgical procedures were lobectomy in 177 patients and sublobar resection (segmentectomy or wedge resection) in 78. The clinical stages as defined by the American Joint Committee on Cancer/Union for International Cancer Control/IASLC included IA in 151 patients, IB in 79, IIA in 9, IIB in 10, and IIIA
Discussion
The new IASLC/ATS/ERS histologic classification criteria of adenocarcinomas include the radiologic features of subtypes in addition to other interdisciplinary factors [3]. Concerning CT findings, higher ground-glass opacity volume, air bronchogram, and round shape were observed with higher frequencies in AIS + MIA + LPA subtypes compared to the other subtypes [12]. However, these differences are between adenocarcinomas showing lepidic growth and other subtypes showing solid growth. Differences in
Conclusion
Adenocarcinoma subtyping is useful to predict postoperative DFS and OS. SUVmax reflects the malignant grade of tumors and is closely associated with both adenocarcinoma subtype and aggregated subgroups. In addition to features demonstrated by chest CT of the primary lesion or longest tumor dimension, SUVmax by FDG-PET/CT can be used as a good predictor of postoperative survival. Surgical options and indications for adjuvant therapy in consideration of adenocarcinoma subtypes and SUVmax warrant
Conflict of interest
No conflicts of interest are declared.
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