FDG PET-CT Aids in the Preoperative Assessment of Patients with Newly Diagnosed Thymic Epithelial Malignancies

Advanced thymoma (stage III and IV) is difficult to detect by computed tomography (CT), yet it is important to distinguish between early (stage I and II) and advanced disease before surgery, as patients with locally advanced tumors require neoadjuvant chemotherapy to enable effective resection. This...

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Bibliographic Details
Published in:Journal of thoracic oncology 2013-04, Vol.8 (4), p.502-510
Main Authors: Benveniste, Marcelo F.K., Moran, Cesar A., Mawlawi, Osama, Fox, Patricia S., Swisher, Stephen G., Munden, Reginald F., Marom, Edith M.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carcinoid Tumor
Female
Fluorodeoxyglucose F18
Follow-Up Studies
Humans
Male
Masaoka–Koga
Middle Aged
Neoplasm Staging
Neoplasms, Glandular and Epithelial - diagnosis
Neoplasms, Glandular and Epithelial - surgery
PET-CT
Positron-Emission Tomography
Preoperative Care
Prognosis
Radiopharmaceuticals
Retrospective Studies
Thymoma
Thymoma - diagnosis
Thymoma - surgery
Thymus Neoplasms - diagnosis
Thymus Neoplasms - surgery
Tomography, X-Ray Computed
Young Adult
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Summary:Advanced thymoma (stage III and IV) is difficult to detect by computed tomography (CT), yet it is important to distinguish between early (stage I and II) and advanced disease before surgery, as patients with locally advanced tumors require neoadjuvant chemotherapy to enable effective resection. This study assessed whether the amount of fluorodeoxyglucose (FDG) uptake can predict advanced thymoma and whether it can separate thymoma from thymic cancer. We retrospectively reviewed FDG positron emission tomography (PET)-CT scans of 51 consecutive newly diagnosed patients with thymic epithelial malignancy. PET-CT findings documented focal FDG activity: SUVmax, SUVmean, SUVpeak, and total body volumetric standardized uptake value (SUV) measurements. These were correlated with Masaoka–Koga staging and World Health Organization classification. Wilcoxon ranked sum tests were used to assess association between SUV and pathological stage, cancer type, and classification. Among the study patients, 37 had thymoma, 12 thymic carcinoma, and 2 thymic carcinoid. Higher focal FDG uptake was seen in patients with type B3 thymoma than in those with type A, AB, B1, or B2 thymoma (p < 0.006). FDG uptake was higher in patients with thymic carcinoma or carcinoid than in patients with thymoma (p < 0.0003), with more variable associations with volumetric SUV measurements. There was no significant association observed between higher focal FDG uptake and advanced-stage disease in thymoma patients (p > 0.09), although greater FDG-avid tumor volume was significantly associated with advanced disease (p < 0.03). Focal FDG uptake cannot predict advanced thymoma but is helpful in distinguishing thymoma from thymic carcinoma, or the more aggressive thymoma, type B3.
ISSN:1556-0864
1556-1380
DOI:10.1097/JTO.0b013e3182835549