PET/CT reading for relapse in non-small cell lung cancer after chemoradiotherapy in the PET-Plan trial cohort

Cancer Imaging

Research Article

Marco Tosch¹  Susanne M. Eschmann²  Juri Ruf³  Kerstin Michalski⁴  Mathias Schreckenberger⁵  Ursula Nestle⁶  Alexander Brose⁷  Matthias Miederer⁸  Jochem König⁹ 

[1] Department of Nuclear Medicine, Helios University Hospital Wuppertal, Wuppertal, Germany;Department of Medicine, Faculty of Health, University of Witten/Herdecke, Witten, Germany;Department of Nuclear Medicine, Marienhospital Stuttgart, Stuttgart, Germany;Department of Nuclear Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany;Department of Nuclear Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Department of Nuclear Medicine, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany;Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany;Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany;Department of Translational Imaging in Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, University of Technology Dresden (TUD), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany;Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany;Department of Translational Imaging in Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, University of Technology Dresden (TUD), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany;Department of Nuclear Medicine, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany;Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany;

关键词: PET/CT;    NSCLC;    Oncology;    Tumor recurrence;    Relapse criteria;   

DOI  :  10.1186/s40644-023-00567-6

 received in 2022-07-07, accepted in 2023-05-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCurrent studies indicate that fluorine-18-fluorodeoxyglucose positron emission tomography/ computed tomography ([18F]FDG PET/CT) is the most accurate imaging modality for the detection of relapsed locally advanced non-small cell lung cancer (NSCLC) after curatively intended chemoradiotherapy. To this day, there is no objective and reproducible definition for the diagnosis of disease recurrence in PET/CT, the reading of which is relevantly influenced by post radiation inflammatory processes. The aim of this study was to evaluate and compare visual and threshold-based semi-automated evaluation criteria for the assessment of suspected tumor recurrence in a well-defined study population investigated during the randomized clinical PET-Plan trial.MethodsThis retrospective analysis comprises 114 PET/CT data sets of 82 patients from the PET-Plan multi-center study cohort who underwent [18F]FDG PET/CT imaging at different timepoints for relapse, as suspected by CT. Scans were first analyzed visually by four blinded readers using a binary scoring system for each possible localization and the associated reader certainty of the evaluation. Visual evaluations were conducted repeatedly without and with additional knowledge of the initial staging PET and radiotherapy delineation volumes. In a second step, uptake was measured quantitatively using maximum standardized uptake value (SUVmax), peak standardized uptake value corrected for lean body mass (SULpeak), and a liver threshold-based quantitative assessment model. Resulting sensitivity and specificity for relapse detection were compared to the findings in the visual assessment. The gold standard of recurrence was independently defined by prospective study routine including external reviewers using CT, PET, biopsies and clinical course of the disease.ResultsOverall interobserver agreement (IOA) of the visual assessment was moderate with a high difference between secure (ĸ = 0.66) and insecure (ĸ = 0.24) evaluations. Additional knowledge of the initial staging PET and radiotherapy delineation volumes improved the sensitivity (0.85 vs 0.92) but did not show significant impact on the specificity (0.86 vs 0.89). PET parameters SUVmax and SULpeak showed lower accuracy compared to the visual assessment, whereas threshold-based reading showed similar sensitivity (0.86) and higher specificity (0.97).ConclusionVisual assessment especially if associated with high reader certainty shows very high interobserver agreement and high accuracy that can be further increased by baseline PET/CT information. The implementation of a patient individual liver threshold value definition, similar to the threshold definition in PERCIST, offers a more standardized method matching the accuracy of experienced readers albeit not providing further improvement of accuracy.

【 授权许可】

CC BY   
© The Author(s) 2023

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