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SUVmax and Tumour Location in PET-CT Predict Oncogene Status in Lung Cancer
Paul M Putora1, Kinga Szentesi, Markus Glatzer
1Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Background:
In non-small cell lung cancer, anaplastic lymphoma kinase gene rearrangement (ALK+) and epidermal growth factor receptor mutations (EGFR+) are targetable with tyrosine kinase inhibitors.
Patients And Methods:
27 patients with ALK+ tumours, who underwent positron emission tomography-computed tomography (PET-CT) prior to any treatment, were identified. 2 equally sized control groups based on consecutive patients with EGFR+ and EGFR/ALK wild-type (wt) were identified. The maximum standardized uptake value (SUVmax), tumour location (central vs. peripheral), as well as patient- and disease-specific characteristics were collected.
Results:
Mutation status was significantly associated with SUVmax (p < 0.008). The median SUVmax of the primary tumour in the lung for ALK+ patients (SUVmax 13) was significantly higher compared to that of the EGFR+ (SUVmax 9.8, p = 0.010) and the EGFR/ALKwt group (SUVmax 9.6, p = 0.022). No difference was observed between the EGFR+ and the EGFR/ALKwt group (p = 0.961). Mutation status was also associated with primary tumour location (p = 0.001). There was a significantly lower rate of central tumours in the EGFR+ group when compared to ALK+ tumours (15%, p = 0.002). Among EGFR/ALKwt tumours, 41% were central compared to 63% of ALK+ tumours (p = 0.235).
Conclusion:
On initial PET-CT, ALK+ primary lung tumours showed a higher SUVmax and were more frequently centrally located while peripheral tumours were more likely to be EGFR+.
Insights
Anaplastic lymphoma kinase gene rearrangement (ALK+) lung tumors show higher metabolic activity (SUVmax) and central location on PET-CT scans compared to epidermal growth factor receptor mutations (EGFR+). Peripheral tumors were more often EGFR+.
Area of Science:
- Oncology
- Radiology
- Molecular Diagnostics
Background:
- Non-small cell lung cancer (NSCLC) harbors targetable genetic alterations like anaplastic lymphoma kinase gene rearrangement (ALK+) and epidermal growth factor receptor mutations (EGFR+).
- These mutations are amenable to treatment with tyrosine kinase inhibitors, highlighting the importance of precise molecular subtyping.
Purpose of the Study:
- To investigate the association between specific driver mutations (ALK+, EGFR+) and their metabolic activity and location in primary lung tumors using PET-CT.
- To differentiate imaging characteristics of ALK+ lung tumors from EGFR+ and wild-type tumors.
Main Methods:
- Retrospective analysis of 27 patients with ALK+ non-small cell lung cancer who underwent pre-treatment PET-CT.
- Comparison with two control groups of similar size: EGFR+ and EGFR/ALK wild-type (wt) patients.
- Collection of data on maximum standardized uptake value (SUVmax) and primary tumor location (central vs. peripheral).
Main Results:
- ALK+ tumors exhibited a significantly higher median SUVmax (13) compared to EGFR+ (9.8) and EGFR/ALKwt (9.6) tumors.
- Mutation status was significantly associated with SUVmax (p < 0.008) and primary tumor location (p = 0.001).
- ALK+ tumors were more frequently centrally located (63%) compared to EGFR+ tumors (15%).
Conclusions:
- Initial PET-CT imaging can reveal distinct characteristics of ALK+ lung tumors, including higher metabolic activity and a propensity for central location.
- EGFR+ tumors were more likely to be peripherally located.
- These findings may aid in the initial characterization and management of NSCLC based on molecular subtypes.
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