FDG PET/CT as theranostic imaging in diagnosis of non-small cell lung cancer

Objective of this work was to evaluate the role of 18F-fluorodeoxyglucose (FDG) positron-emission tomography features as theranostic imaging biomarkers in non-small cell lung cancer. In a retrospective protocol, 31 stage I-III NSCLC patients were enrolled. Patients underwent FDG PET/CT for staging purposes before surgery and were followed for two years after surgery. PET images were quantitatively analyzed. For the primary lesion, metabolic tumour volume, maximum standardized uptake value (SUV), SUV corrected for partial volume effect, total lesion glycolysis, 14 histogram and four shape-and-size features were extracted as PET imaging features. PET features were correlated with histology and 2-year disease-free survival (DFS). Significant correlations were found between grading, T parameter, N status, pathological stage and different FDG PET features. Histogrambased features "energy" and "kurtosis" resulted to be predictive for DFS. The cut-off value identified for "kurtosis" was able to separate the adenocarcinoma patients with different outcomes. FDG PET features are able to characterize lung cancer lesions, suggesting the possibility of reliable "imaging biopsy", and have a predictive role in adenocarcinoma patients undergoing surgery.