Feasibility of Early Dynamic ¹⁸F-FDG PET/CT Imaging for Predicting EGFR and TP53 Mutations in Lung Adenocarcinoma

To investigate the feasibility of early dynamic 2-[¹⁸F]-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) imaging in predicting epidermal growth factor receptor (EGFR) and tumor protein 53 (TP53) mutation status in lung adenocarcinoma (AC).

In total, 81 patients with lung nodules underwent early dynamic PET (10 min after injection) and late static PET (60 min after injection), and 41 (18 male, 23 female; mean age 64 ± 10 years) with confirmed AC were included in the final analysis. Dynamic images were reconstructed into 25 frames, and time-to-activity curves were generated. An irreversible two-tissue compartment model was used to derive kinetic parameters (K_1, k₂, k₃, Ki, and MR_FDG). EGFR and TP53 mutation statuses were determined via histological analysis. Statistical tests, including the Wilcoxon rank-sum test, Kruskal-Wallis H test, and Spearman's correlation, were used to assess differences and associations among groups. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive performance.

In patients with AC, k₃, Ki, and MR_FDG were strongly correlated with SUV_max (r = 0.821, 0.862, and 0.778, respectively; all P < 0.001). SUV_max, k₃, Ki, and MR_FDG differed significantly between patients with AC and SCC, as well as across TNM and pathological stage subgroups (P < 0.05). SUV_max and k₃ were significantly lower in the EGFR-positive group, while Ki was higher in the TP53-positive group (P < 0.05). AUCs for predicting EGFR mutation were 0.718 (SUV_max) and 0.776 (k₃), and 0.703 (Ki) for TP53 mutation.

Early dynamic ¹⁸F-FDG PET/CT may serve as a valuable non-invasive tool for predicting EGFR and TP53 mutation status in AC, for screening patients for targeted therapy.