Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-05-2018 | Original Article

Value of ¹⁸F–FDG PET/CT for predicting EGFR mutations and positive ALK expression in patients with non-small cell lung cancer: a retrospective analysis of 849 Chinese patients

Authors: Zhilei Lv, Jinshuo Fan, Juanjuan Xu, Feng Wu, Qi Huang, Mengfei Guo, Tingting Liao, Shuqing Liu, Xiaoli Lan, Shanshan Liao, Wei Geng, Yang Jin

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 5/2018

Abstract

Purpose

Epidermal growth factor receptor (EGFR) mutations and the anaplastic lymphoma kinase (ALK) rearrangement are the two most common druggable targets in non-small cell lung cancer (NSCLC). However, genetic testing is sometimes unavailable. Previous studies regarding the predictive role of ¹⁸F–FDG PET/CT for EGFR mutations in NSCLC patients are conflicting. We investigated whether or not ¹⁸F–FDG PET could be a valuable noninvasive method to predict EGFR mutations and ALK positivity in NSCLC using the largest patient cohort to date.

Methods

We retrospectively reviewed and included 849 NSCLC patients who were tested for EGFR mutations or ALK status and subjected to ¹⁸F–FDG PET/CT prior to treatment. The differences in several clinical characteristics and three parameters based on ¹⁸F–FDG PET/CT, including the maximal standard uptake value (SUV_max) of the primary tumor (pSUV_max), lymph node (nSUV_max) and distant metastasis (mSUV_max), between the different subgroups were analyzed. Multivariate logistic regression analysis was performed to identify predictors of EGFR mutations and ALK positivity.

Results

EGFR mutations were identified in 371 patients (45.9%). EGFR mutations were found more frequently in females, non-smokers, adenocarcinomas and stage I disease. Low pSUV_max, nSUV_max and mSUV_max were significantly associated with EGFR mutations. Multivariate analysis demonstrated that pSUV_max < 7.0, female sex, non-smoker status and adenocarcinoma were predictors of EGFR mutations. The receiver operating characteristic (ROC) curve yielded area under the curve (AUC) values of 0.557 and 0.697 for low pSUV_max alone and the combination of the four factors, respectively. ALK-positive patients tended to have a high nSUV_max. Younger age and distant metastasis were the only two independent predictors of ALK positivity.

Conclusion

We demonstrated that low pSUVmax is associated with mutant EGFR status and could be integrated with other clinical factors to enhance the discriminability on the EGFR mutation status in some NSCLC patients whose EGFR testing is unavailable.

Minguet J, Smith KH, Bramlage P. Targeted therapies for treatment of non-small cell lung cancer--recent advances and future perspectives. Int J Cancer. 2016;138:2549–61. https://doi.org/10.1002/ijc.29915.CrossRefPubMed

Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009;361:947–57. https://doi.org/10.1056/NEJMoa0810699.CrossRefPubMed

Pao W, Miller V, Zakowski M, Doherty J, Politi K, Sarkaria I, et al. EGF receptor gene mutations are common in lung cancers from "never smokers" and are associated with sensitivity of tumors to gefitinib and erlotinib. Proc Natl Acad Sci U S A. 2004;101:13306–11. https://doi.org/10.1073/pnas.0405220101.CrossRefPubMedPubMedCentral

Solomon BJ, Mok T, Kim DW, Wu YL, Nakagawa K, Mekhail T, et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N Engl J Med. 2014;371:2167–77. https://doi.org/10.1056/NEJMoa1408440.CrossRefPubMed

Shaw AT, Kim DW, Nakagawa K, Seto T, Crino L, Ahn MJ, et al. Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med. 2013;368:2385–94. https://doi.org/10.1056/NEJMoa1214886.CrossRefPubMed

Lindeman NI, Cagle PT, Beasley MB, Chitale DA, Dacic S, Giaccone G, et al. Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. J Mol Diagnostics : JMD. 2013;15:415–53. https://doi.org/10.1016/j.jmoldx.2013.03.001.CrossRef

Leighl NB, Rekhtman N, Biermann WA, Huang J, Mino-Kenudson M, Ramalingam SS, et al. Molecular testing for selection of patients with lung cancer for epidermal growth factor receptor and anaplastic lymphoma kinase tyrosine kinase inhibitors: American Society of Clinical Oncology endorsement of the College of American Pathologists/international association for the study of lung cancer/association for molecular pathology guideline. J Clin Oncol : Off J Am Soc Clin Oncol. 2014;32:3673–9. https://doi.org/10.1200/JCO.2014.57.3055.CrossRef

Makinoshima H, Takita M, Matsumoto S, Yagishita A, Owada S, Esumi H, et al. Epidermal growth factor receptor (EGFR) signaling regulates global metabolic pathways in EGFR-mutated lung adenocarcinoma. J Biol Chem. 2014;289:20813–23. https://doi.org/10.1074/jbc.M114.575464.CrossRefPubMedPubMedCentral

De Rosa V, Iommelli F, Monti M, Fonti R, Votta G, Stoppelli MP, et al. Reversal of Warburg effect and reactivation of oxidative Phosphorylation by differential inhibition of EGFR signaling pathways in non-small cell lung cancer. Clin Cancer Res : Off J Am Assoc Cancer Res. 2015;21:5110–20. https://doi.org/10.1158/1078-0432.CCR-15-0375.CrossRef

10.

Ko KH, Hsu HH, Huang TW, Gao HW, Shen DH, Chang WC, et al. Value of (1)(8)F-FDG uptake on PET/CT and CEA level to predict epidermal growth factor receptor mutations in pulmonary adenocarcinoma. Eur J Nucl Med Mol Imaging. 2014;41:1889–97. https://doi.org/10.1007/s00259-014-2802-y.CrossRefPubMed

11.

Caicedo C, Garcia-Velloso MJ, Lozano MD, Labiano T, Vigil Diaz C, Lopez-Picazo JM, et al. Role of [(1)(8)F]FDG PET in prediction of KRAS and EGFR mutation status in patients with advanced non-small-cell lung cancer. Eur J Nucl Med Mol Imaging. 2014;41:2058–65. https://doi.org/10.1007/s00259-014-2833-4.CrossRefPubMed

12.

Mak RH, Digumarthy SR, Muzikansky A, Engelman JA, Shepard JA, Choi NC, et al. Role of 18F-fluorodeoxyglucose positron emission tomography in predicting epidermal growth factor receptor mutations in non-small cell lung cancer. Oncologist. 2011;16:319–26. https://doi.org/10.1634/theoncologist.2010-0300.CrossRefPubMedPubMedCentral

13.

Lee EY, Khong PL, Lee VH, Qian W, Yu X, Wong MP. Metabolic phenotype of stage IV lung adenocarcinoma: relationship with epidermal growth factor receptor mutation. Clin Nucl Med. 2015;40:e190–5. https://doi.org/10.1097/RLU.0000000000000684.CrossRefPubMed

14.

Huang CT, Yen RF, Cheng MF, Hsu YC, Wei PF, Tsai YJ, et al. Correlation of F-18 fluorodeoxyglucose-positron emission tomography maximal standardized uptake value and EGFR mutations in advanced lung adenocarcinoma. Med Oncol. 2010;27:9–15. https://doi.org/10.1007/s12032-008-9160-1.CrossRefPubMed

15.

Kanmaz ZD, Aras G, Tuncay E, Bahadir A, Kocaturk C, Yasar ZA, et al. Contribution of (1)(8)Fluorodeoxyglucose positron emission tomography uptake and TTF-1 expression in the evaluation of the EGFR mutation in patients with lung adenocarcinoma. Cancer Biomarkers : Section A Dis Markers. 2016;16:489–98. https://doi.org/10.3233/CBM-160588.CrossRef

16.

Yip SS, Kim J, Coroller TP, Parmar C, Velazquez ER, Huynh E, et al. Associations between somatic mutations and metabolic imaging phenotypes in non-small cell lung cancer. J Nucl Med : Off Publ Soc Nucl Med. 2017;58:569–76. https://doi.org/10.2967/jnumed.116.181826.CrossRef

17.

Apostolova I, Ego K, Steffen IG, Buchert R, Wertzel H, Achenbach HJ, et al. The asphericity of the metabolic tumour volume in NSCLC: correlation with histopathology and molecular markers. Eur J Nucl Med Mol Imaging. 2016;43:2360–73. https://doi.org/10.1007/s00259-016-3452-z.CrossRefPubMed

18.

Na II, Byun BH, Kim KM, Cheon GJ, du Choe H, Koh JS, et al. 18F-FDG uptake and EGFR mutations in patients with non-small cell lung cancer: a single-institution retrospective analysis. Lung Cancer. 2010;67:76–80. https://doi.org/10.1016/j.lungcan.2009.03.010.CrossRefPubMed

19.

Jeong CJ, Lee HY, Han J, Jeong JY, Lee KS, Choi YL, et al. Role of imaging biomarkers in predicting anaplastic lymphoma kinase-positive lung adenocarcinoma. Clin Nucl Med. 2015;40:e34–9. https://doi.org/10.1097/RLU.0000000000000581.CrossRefPubMed

20.

Choi H, Paeng JC, Kim DW, Lee JK, Park CM, Kang KW, et al. Metabolic and metastatic characteristics of ALK-rearranged lung adenocarcinoma on FDG PET/CT. Lung Cancer. 2013;79:242–7. https://doi.org/10.1016/j.lungcan.2012.11.021.CrossRefPubMed

21.

Cho A, Hur J, Moon YW, Hong SR, Suh YJ, Kim YJ, et al. Correlation between EGFR gene mutation, cytologic tumor markers, 18F-FDG uptake in non-small cell lung cancer. BMC Cancer. 2016;16:224. https://doi.org/10.1186/s12885-016-2251-z.CrossRefPubMedPubMedCentral

22.

Lee SM, Bae SK, Jung SJ, Kim CK. FDG uptake in non-small cell lung cancer is not an independent predictor of EGFR or KRAS mutation status: a retrospective analysis of 206 patients. Clin Nucl Med. 2015;40:950–8. https://doi.org/10.1097/RLU.0000000000000975.CrossRefPubMed

23.

Chung HW, Lee KY, Kim HJ, Kim WS, So Y. FDG PET/CT metabolic tumor volume and total lesion glycolysis predict prognosis in patients with advanced lung adenocarcinoma. J Cancer Res Clin Oncol. 2014;140:89–98. https://doi.org/10.1007/s00432-013-1545-7.CrossRefPubMed

24.

Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–32. https://doi.org/10.3322/caac.21338.CrossRefPubMed

25.

Zou XN, Lin DM, Wan X, Chao A, Feng QF, Dai Z, et al. Histological subtypes of lung cancer in Chinese males from 2000 to 2012. Biomed Environ Sci : BES. 2014;27:3–9. https://doi.org/10.3967/bes2014.010.PubMed

26.

Zou XN, Lin D, Chao A, Wan X, Feng Q, Li J, et al. Histological subtypes of lung cancer in Chinese women from 2000 to 2012. Thorac Cancer. 2014;5:447–54. https://doi.org/10.1111/1759-7714.12121.CrossRefPubMedPubMedCentral

27.

Jiang R, Dong X, Zhu W, Duan Q, Xue Y, Shen Y, et al. Combining PET/CT with serum tumor markers to improve the evaluation of histological type of suspicious lung cancers. PLoS One. 2017;12:e0184338. https://doi.org/10.1371/journal.pone.0184338.CrossRefPubMedPubMedCentral

28.

Goodwin J, Neugent ML, Lee SY, Choe JH, Choi H, Jenkins DMR, et al. The distinct metabolic phenotype of lung squamous cell carcinoma defines selective vulnerability to glycolytic inhibition. Nat Commun. 2017;8:15503. https://doi.org/10.1038/ncomms15503.CrossRefPubMedPubMedCentral

29.

Zhi X, Shi Y, Yu J. Chinese primary lung cancer diagnosis and treatment standard (2015 edition). Chin J Oncol. 2015;37:67–78. https://doi.org/10.3760/cma.j.issn.0253-3766.2015.01.014.

30.

Novello S, Barlesi F, Califano R, Cufer T, Ekman S, Levra MG, et al. Metastatic non-small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol : Off J Eur Soc Med Oncol. 2016;27:v1–v27. https://doi.org/10.1093/annonc/mdw326.CrossRef

31.

Hanna N, Johnson D, Temin S, Baker S Jr, Brahmer J, Ellis PM, et al. Systemic therapy for stage IV non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol : Off J Am Soc Clin Oncol. 2017;35:3484–515. https://doi.org/10.1200/JCO.2017.74.6065.CrossRef

32.

Ettinger DS, Wood DE, Aisner DL, Akerley W, Bauman J, Chirieac LR, et al. Non-small cell lung cancer, version 5.2017, NCCN clinical practice guidelines in oncology. J Nat Comprehensive Cancer Netw : JNCCN. 2017;15:504–35.CrossRef

33.

Spicer JBT, Tischer B. EGFR mutation testing and oncologist treatment choice in advanced NSCLC: global trends and differences. Ann Oncol : Off J Eur Soc Med Oncol. 2015;26:i57–61. https://doi.org/10.1093/annonc/mdv128.4.CrossRef

34.

Xue C, Hu Z, Jiang W, Zhao Y, Xu F, Huang Y, et al. National survey of the medical treatment status for non-small cell lung cancer (NSCLC) in China. Lung Cancer. 2012;77:371–5. https://doi.org/10.1016/j.lungcan.2012.04.014.CrossRefPubMed

35.

Yatabe Y, Kerr KM, Utomo A, Rajadurai P, Tran VK, Du X, et al. EGFR mutation testing practices within the Asia Pacific region: results of a multicenter diagnostic survey. J Thorac Oncol : Off Publ Int Assoc Stud Lung Cancer. 2015;10:438–45. https://doi.org/10.1097/JTO.0000000000000422.CrossRef

36.

Cheng YYW, J. Zhao, Y. Liu, H. Gao, K. Ma, S. Zhang. A multicenter, non-interverntional study on real world EGFR testing and in patients with IIIB/IV NSCLC in northern China. IASLC 18th World Conference on Lung Cancer / Abstracts. 2017.

37.

NLCA HaSCIC. National Lung Cancer Audit Report 2012 Available at: http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2012–13/Lung-Cancer-National-Audit-Report-pub-2012.pdf. Accessed September 27, 2013.

38.

Thunnissen E, Kerr KM, Herth FJ, Lantuejoul S, Papotti M, Rintoul RC, et al. The challenge of NSCLC diagnosis and predictive analysis on small samples. Practical approach of a working group. Lung Cancer. 2012;76:1–18. https://doi.org/10.1016/j.lungcan.2011.10.017.CrossRefPubMed

39.

Shiau CJ, Babwah JP, da Cunha SG, Sykes JR, Boerner SL, Geddie WR, et al. Sample features associated with success rates in population-based EGFR mutation testing. J Thorac Oncol : Off Publ Int Assoc Stud Lung Cancer. 2014;9:947–56. https://doi.org/10.1097/JTO.0000000000000196.CrossRef

40.

Leary AF, Castro DG, Nicholson AG, Ashley S, Wotherspoon A, O'Brien ME, et al. Establishing an EGFR mutation screening service for non-small cell lung cancer - sample quality criteria and candidate histological predictors. Eur J Cancer. 2012;48:61–7. https://doi.org/10.1016/j.ejca.2011.09.022.CrossRefPubMed

41.

Hlinkova K, Babal P, Berzinec P, Majer I, Mikle-Barathova Z, Piackova B, et al. Evaluation of 2-year experience with EGFR mutation analysis of small diagnostic samples. Diagn Mol Pathol : Am J Surg Pathol Part B. 2013;22:70–5. https://doi.org/10.1097/PDM.0b013e31827e6984.CrossRef

42.

Fukuoka M, Wu YL, Thongprasert S, Sunpaweravong P, Leong SS, Sriuranpong V, et al. Biomarker analyses and final overall survival results from a phase III, randomized, open-label, first-line study of gefitinib versus carboplatin/paclitaxel in clinically selected patients with advanced non-small-cell lung cancer in Asia (IPASS). J Clin Oncol : Off J Am Soc Clin Oncol. 2011;29:2866–74. https://doi.org/10.1200/JCO.2010.33.4235.CrossRef

43.

Han JY, Park K, Kim SW, Lee DH, Kim HY, Kim HT, et al. First-SIGNAL: first-line single-agent iressa versus gemcitabine and cisplatin trial in never-smokers with adenocarcinoma of the lung. J Clin Oncol : Off J Am Soc Clin Oncol. 2012;30:1122–8. https://doi.org/10.1200/JCO.2011.36.8456.CrossRef

44.

Xu C, Zhou Q, Wu YL. Can EGFR-TKIs be used in first line treatment for advanced non-small cell lung cancer based on selection according to clinical factors? - a literature-based meta-analysis. J Hematol Oncol. 2012;5:62. https://doi.org/10.1186/1756-8722-5-62.CrossRefPubMedPubMedCentral

45.

Won YW, Han JY, Lee GK, Park SY, Lim KY, Yoon KA, et al. Comparison of clinical outcome of patients with non-small-cell lung cancer harbouring epidermal growth factor receptor exon 19 or exon 21 mutations. J Clin Pathol. 2011;64:947–52. https://doi.org/10.1136/jclinpath-2011-200169.CrossRefPubMed

46.

Carey KD, Garton AJ, Romero MS, Kahler J, Thomson S, Ross S, et al. Kinetic analysis of epidermal growth factor receptor somatic mutant proteins shows increased sensitivity to the epidermal growth factor receptor tyrosine kinase inhibitor, erlotinib. Cancer Res. 2006;66:8163–71. https://doi.org/10.1158/0008-5472.CAN-06-0453.CrossRefPubMed

47.

Kumar A, Petri ET, Halmos B, Boggon TJ. Structure and clinical relevance of the epidermal growth factor receptor in human cancer. J Clin Oncol : Off J Am Soc Clin Oncol. 2008;26:1742–51. https://doi.org/10.1200/JCO.2007.12.1178.CrossRef

48.

Choi YJ, Cho BC, Jeong YH, Seo HJ, Kim HJ, Cho A, et al. Correlation between (18)f-fluorodeoxyglucose uptake and epidermal growth factor receptor mutations in advanced lung cancer. Nucl Med Mol Imaging. 2012;46:169–75. https://doi.org/10.1007/s13139-012-0142-z.CrossRefPubMedPubMedCentral

49.

Ying J, Guo L, Qiu T, Shan L, Ling Y, Liu X, et al. Diagnostic value of a novel fully automated immunochemistry assay for detection of ALK rearrangement in primary lung adenocarcinoma. Ann Oncol : Off J Eur Soc Med Oncol. 2013;24:2589–93. https://doi.org/10.1093/annonc/mdt295.CrossRef

50.

van der Wekken AJ, Pelgrim R, Hart TN, Werner N, Mastik MF, Hendriks L, et al. Dichotomous ALK-IHC is a better predictor for ALK inhibition outcome than traditional ALK-FISH in advanced non-small cell lung cancer. Clin Cancer Res : Off J Am Assoc Cancer Res. 2017; https://doi.org/10.1158/1078-0432.CCR-16-1631.

51.

Marchetti A, Di Lorito A, Pace MV, Iezzi M, Felicioni L, D'Antuono T, et al. ALK protein analysis by IHC staining after recent regulatory changes: a comparison of two widely used approaches, revision of the literature, and a new testing algorithm. J Thorac Oncol : Off Publ Int Assoc Stud Lung Cancer. 2016;11:487–95. https://doi.org/10.1016/j.jtho.2015.12.111.CrossRef

52.

Midha A, Dearden S, McCormack R. EGFR mutation incidence in non-small-cell lung cancer of adenocarcinoma histology: a systematic review and global map by ethnicity (mutMapII). Am J Cancer Res. 2015;5:2892–911.PubMedPubMedCentral

53.

Tian M, Zhang H, Endo K, Mogi K. Expression of Glut-1, HK-II, HIF-1 alpha, VEGF, p53 and Ki-67 in head and neck squamous cell carcinoma: Correlation with FDG uptake measured by PET. AACR; 2005.

54.

Webb BA, Chimenti M, Jacobson MP, Barber DL. Dysregulated pH: a perfect storm for cancer progression. Nat Rev Cancer. 2011;11:671–7. https://doi.org/10.1038/nrc3110.CrossRefPubMed

55.

Gray JA. Kinetics of enamel dissolution during formation of incipient caries-like lesions. Arch Oral Biol. 1966;11:397–422.CrossRefPubMed

56.

Putney LK, Barber DL. Expression profile of genes regulated by activity of the Na-H exchanger NHE1. BMC Genomics. 2004;5:46. https://doi.org/10.1186/1471-2164-5-46.CrossRefPubMedPubMedCentral

57.

Andres V, Carreras J, Cusso R. Regulation of muscle phosphofructokinase by physiological concentrations of bisphosphorylated hexoses: effect of alkalinization. Biochem Biophys Res Commun. 1990;172:328–34.CrossRefPubMed

58.

Trivedi B, Danforth WH. Effect of pH on the kinetics of frog muscle phosphofructokinase. J Biol Chem. 1966;241:4110–2.PubMed

59.

Babic I, Anderson ES, Tanaka K, Guo D, Masui K, Li B, et al. EGFR mutation-induced alternative splicing of max contributes to growth of glycolytic tumors in brain cancer. Cell Metab. 2013;17:1000–8. https://doi.org/10.1016/j.cmet.2013.04.013.CrossRefPubMedPubMedCentral

60.

Makinoshima H, Takita M, Saruwatari K, Umemura S, Obata Y, Ishii G, et al. Signaling through the Phosphatidylinositol 3-Kinase (PI3K)/mammalian target of Rapamycin (mTOR) Axis is responsible for aerobic Glycolysis mediated by glucose transporter in epidermal growth factor receptor (EGFR)-mutated lung Adenocarcinoma. J Biol Chem. 2015;290:17495–504. https://doi.org/10.1074/jbc.M115.660498.CrossRefPubMedPubMedCentral

61.

Velpula KK, Bhasin A, Asuthkar S, Tsung AJ. Combined targeting of PDK1 and EGFR triggers regression of glioblastoma by reversing the Warburg effect. Cancer Res. 2013;73:7277–89. https://doi.org/10.1158/0008-5472.CAN-13-1868.CrossRefPubMed

62.

Alamgeer M, Ganju V, Watkins DN. Novel therapeutic targets in non-small cell lung cancer. Curr Opin Pharmacol. 2013;13:394–401. https://doi.org/10.1016/j.coph.2013.03.010.CrossRefPubMed

63.

Rios Velazquez E, Parmar C, Liu Y, Coroller TP, Cruz G, Stringfield O, et al. Somatic mutations drive distinct imaging phenotypes in lung cancer. Cancer Res. 2017;77:3922–30. https://doi.org/10.1158/0008-5472.CAN-17-0122.CrossRefPubMed

64.

Bahce I, Yaqub M, Smit EF, Lammertsma AA, van Dongen GA, Hendrikse NH. Personalizing NSCLC therapy by characterizing tumors using TKI-PET and immuno-PET. Lung Cancer. 2017;107:1–13. https://doi.org/10.1016/j.lungcan.2016.05.025.CrossRefPubMed

65.

Bahce I, Smit EF, Lubberink M, van der Veldt AA, Yaqub M, Windhorst AD, et al. Development of [(11)C]erlotinib positron emission tomography for in vivo evaluation of EGF receptor mutational status. Clin Cancer Res : Off J Am Assoc Cancer Res. 2013;19:183–93. https://doi.org/10.1158/1078-0432.CCR-12-0289.CrossRef

66.

Memon AA, Weber B, Winterdahl M, Jakobsen S, Meldgaard P, Madsen HH, et al. PET imaging of patients with non-small cell lung cancer employing an EGF receptor targeting drug as tracer. Br J Cancer. 2011;105:1850–5. https://doi.org/10.1038/bjc.2011.493.CrossRefPubMedPubMedCentral

67.

Meng X, Loo BW Jr, Ma L, Murphy JD, Sun X, Yu J. Molecular imaging with 11C-PD153035 PET/CT predicts survival in non-small cell lung cancer treated with EGFR-TKI: a pilot study. J Nucl Med : Off Publ Soc Nucl Med. 2011;52:1573–9. https://doi.org/10.2967/jnumed.111.092874.CrossRef

Title: Value of 18F–FDG PET/CT for predicting EGFR mutations and positive ALK expression in patients with non-small cell lung cancer: a retrospective analysis of 849 Chinese patients
Authors: Zhilei Lv
Jinshuo Fan
Juanjuan Xu
Feng Wu
Qi Huang
Mengfei Guo
Tingting Liao
Shuqing Liu
Xiaoli Lan
Shanshan Liao
Wei Geng
Yang Jin
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 5/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-017-3885-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Value of ¹⁸F–FDG PET/CT for predicting EGFR mutations and positive ALK expression in patients with non-small cell lung cancer: a retrospective analysis of 849 Chinese patients

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2018

Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe)

Preoperative prediction of microvascular invasion of hepatocellular carcinoma using 18F-FDG PET/CT: a multicenter retrospective cohort study

Bone radionuclide therapy and increased survival with radium-223 is the way to go for nuclear medicine: the offer that oncologists cannot refuse

Prediction of outcome using pretreatment 18F-FDG PET/CT and MRI radiomics in locally advanced cervical cancer treated with chemoradiotherapy

Combining baseline TMTV and gene profiling for a better risk stratification in diffuse large B cell lymphoma

Interim FDG PET/CT in primary mediastinal diffuse large B-cell lymphoma: really almost useless procedure?