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Weber WA, Gatsonis CA, Mozley PD, Hanna LG, Shields AF, Aberle DR, Govindan R, Torigan DA, Karp JS, Yu JQ, Subramaniam RM, Halvorsen RA, Siegel BA
Repeatability of 18F-FDG PET/CT in Advanced Non-small Cell Lung Cancer: Prospective Assessment in Two Multicenter Trials
J Nucl Med (2015) 56:1137-43.
PET/CT with the glucose analogue 18F-fluorodeoxyglucose (18F-FDG) has several potential applications for monitoring tumor response to therapy in patients with non-small cell lung cancer (NSCLC). A prerequisite for many of these applications is detailed knowledge of the repeatability of quantitative parameters derived from 18F-FDG PET/CT studies. METHODS: The repeatability of the 18F-FDG signal was evaluated in two prospective multicenter trials. Patients with advanced NSCLC (tumor stage III-IV) underwent two 18F-FDG PET/CT studies while not receiving therapy. Tumor 18F-FDG uptake was quantified by measurement of the maximum standardized uptake value within a lesion (SUVmax) and the average SUV within a small volume of interest around the site of maximum uptake (SUVpeak). Analysis was performed for the lesion in the chest with the highest FDG uptake and a size of at least 2 cm (target lesion) as well as for up to six additional lesions per patient. Repeatability was assessed by Bland-Altman plots and (by) calculation of 95% repeatability coefficients (RCs) of the log-transformed SUV differences. RESULTS: Test-retest repeatability was assessed in a total of 74 patients (34 from the ACRIN 6678 trial and 40 from the Merck MK-0646-008 trial). SUVpeak was 11.57+/-7.89 g/mL for the ACRIN trial and 6.89+/-3.02 for the Merck trial, respectively. The lower and upper RCs were -28% [95% confidence interval (CI): -35% to 23%] and +39% (95% CI: 31% to 54%) in the ACRIN trial, indicating that a decrease of SUVpeak by more than 28% or an increase by more than 39% has a probability of less than 2.5%. The corresponding RCs from the Merck trial were -35% (95% CI: -42% to -29%) and +53% (95% CI: 41% to 72%). Repeatability was similar for SUVmax of the target lesion, averaged SUVmax, and averaged SUVpeak of up to six lesions per patient. CONCLUSION: The variability of repeated measurements of tumor 18F-FDG uptake in patients with NSCLC is somewhat larger than previously reported in smaller single-center studies, but comparable to that of gastrointestinal malignancies in a previous multicenter trial. The variability of measurements supports the definitions of tumor response according to PERCIST (PET response criteria in solid tumors).
Publication Date: 2015-04-23.
PMCID: 4699428
Last updated on Friday, January 03, 2020