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European Radiology
Published in: European Radiology 2/2022

01-02-2022 | Computed Tomography | Nuclear Medicine

Diagnostic and prognostic values of 2-[18F]FDG PET/CT in resectable thymic epithelial tumour

Authors: Sangwon Han, Yong-il Kim, Jungsu S. Oh, Seung Yeon Seo, Min-Jae Park, Geun Dong Lee, Sehoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Jin-Sook Ryu

Published in: European Radiology | Issue 2/2022

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Abstract

Objectives

We aimed to evaluate the diagnostic ability for the prediction of histologic grades and prognostic values on recurrence and death of pretreatment 2-[18F]FDG PET/CT in patients with resectable thymic epithelial tumours (TETs).

Methods

One hundred and fourteen patients with TETs who underwent pretreatment 2-[18F]FDG PET/CT between 2012 and 2018 were retrospectively evaluated. TETs were classified into three histologic subtypes: low-risk thymoma (LRT, WHO classification A/AB/B1), high-risk thymoma (HRT, B2/B3), and thymic carcinoma (TC). Area under the receiver operating characteristics curve (AUC) was used to assess the diagnostic performance of PET/CT variables (maximum standardised uptake value [SUVmax], metabolic tumour volume [MTV], total lesion glycolysis [TLG], maximum diameter). Cox proportional hazards models were built using PET/CT and clinical variables.

Results

The tumours included 52 LRT, 33 HRT, and 29 TC. SUVmax showed good diagnostic ability for differentiating HRT/TC from LRT (AUC 0.84, 95% confidence interval [CI] 0.76 − 0.92) and excellent ability for differentiating TC from LRT/HRT (AUC 0.94, 95% CI 0.90 − 0.98), with significantly higher values than MTV, TLG, and maximum diameter. With an optimal cut-off value of 6.4, the sensitivity, specificity, and accuracy for differentiating TC from LRT/HRT were 69%, 96%, and 89%, respectively. In the multivariable Cox proportional hazards analyses for freedom-from-recurrence, SUVmax was an independent prognostic factor (p < 0.001), whereas MTV and TLG were not. SUVmax was a significant predictor for overall survival in conjunction with clinical stage and resection margin.

Conclusion

SUVmax showed excellent diagnostic performance for prediction of TC and significant prognostic value in terms of recurrence and survival.

Key Points

• Maximum standardised uptake value (SUVmax) shows excellent performance in the differentiation of thymic carcinoma from low- and high-risk thymoma.
• SUVmax is an independent prognostic factor for freedom-from-recurrence in the multivariable Cox proportional hazard model and a significant predictor for overall survival.
• 2-[ 18 F]FDG PET/CT can provide a useful diagnostic and prognostic imaging biomarker in conjunction with histologic classification and stage and help choose appropriate management for thymic epithelial tumours.
Appendix
Available only for authorised users
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Metadata
Title
Diagnostic and prognostic values of 2-[18F]FDG PET/CT in resectable thymic epithelial tumour
Authors
Sangwon Han
Yong-il Kim
Jungsu S. Oh
Seung Yeon Seo
Min-Jae Park
Geun Dong Lee
Sehoon Choi
Hyeong Ryul Kim
Yong-Hee Kim
Dong Kwan Kim
Seung-Il Park
Jin-Sook Ryu
Publication date
01-02-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-021-08230-z

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