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European Journal of Nuclear Medicine and Molecular Imaging

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01-02-2019 | Original Article

Why harmonization is needed when using FDG PET/CT as a prognosticator: demonstration with EARL-compliant SUV as an independent prognostic factor in lung cancer

Authors: Benjamin Houdu, Charline Lasnon, Idlir Licaj, Guy Thomas, Pascal Do, Anne-Valerie Guizard, Cédric Desmonts, Nicolas Aide

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 2/2019

Abstract

Background

To determine EARL-compliant prognostic SUV thresholds in a mature cohort of patients with locally advanced NSCLC, and to demonstrate how detrimental it is to use a threshold determined on an older-generation PET system with a newer PET/CT machine, and vice versa, or to use such a threshold with non-harmonized multicentre pooled data.

Materials and methods

This was a single-centre retrospective study including 139 consecutive stage IIIA-IIIB patients. PET data were acquired as per the EANM guidelines and reconstructed with unfiltered point spread function (PSF) reconstruction. Subsequently, a 6.3 mm Gaussian filter was applied using the EQ.PET (Siemens Healthineers) methodology to meet the EANM/EARL harmonizing standards (PSF_EARL). A multicentre study including non-EARL-compliant systems was simulated by randomly creating four groups of patients whose images were reconstructed with unfiltered PSF and PSF with Gaussian post-filtering of 3, 5, and 10 mm. Identification of optimal SUV thresholds was based on a two-fold cross-validation process that partitioned the overall sample into learning and validation subsamples. Proportional Cox hazards models were used to estimate age-adjusted and multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals. Kaplan–Meier curves were compared using the log rank test.

Results

Median follow-up was 28 months (1–104 months). For the whole population, the estimated overall survival rate at 36 months was 0.39 [0.31–0.47]. The optimal SUV_max cutoff value was 25.43 (95% CI: 23.41–26.31) and 8.47 (95% CI: 7.23–9.31) for the PSF and for the EARL-compliant dataset respectively. These SUV_max cutoff values were both significantly and independently associated with lung cancer mortality; HRs were 1.73 (1.05–2.84) and 1.92 (1.16–3.19) for the PSF and the EARL-compliant dataset respectively. When (i) applying the optimal PSF SUV_max cutoff on an EARL-compliant dataset and the optimal EARL SUV_max cutoff on a PSF dataset or (ii) applying the optimal EARL compliant SUV_max cutoff to a simulated multicentre dataset, the tumour SUV_max was no longer significantly associated with lung cancer mortality.

Conclusion

The present study provides the PET community with an EARL-compliant SUV_max as an independent prognosticator for advanced NSCLC that should be confirmed in a larger cohort, ideally at other EARL accredited centres, and highlights the need to harmonize PET quantitative metrics when using them for risk stratification of patients.

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Title: Why harmonization is needed when using FDG PET/CT as a prognosticator: demonstration with EARL-compliant SUV as an independent prognostic factor in lung cancer
Authors: Benjamin Houdu
Charline Lasnon
Idlir Licaj
Guy Thomas
Pascal Do
Anne-Valerie Guizard
Cédric Desmonts
Nicolas Aide
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 2/2019
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4151-8

Keynote webinar | Spotlight on medication adherence

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Why harmonization is needed when using FDG PET/CT as a prognosticator: demonstration with EARL-compliant SUV as an independent prognostic factor in lung cancer

Abstract

Background

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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