Original article
General thoracic
Usefulness of Fluorine-18 Fluorodeoxyglucose-Positron Emission Tomography in Management Strategy for Thymic Epithelial Tumors

https://doi.org/10.1016/j.athoracsur.2012.09.052Get rights and content

Background

This study investigated the usefulness of fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) during the treatment of thymic epithelial tumors in combination with Ki-67 evaluation based on surgical cases in our department.

Methods

Between November 2003 and May 2011, 39 patients with thymic epithelial tumor underwent preoperative FDG-PET. The maximum standardized uptake value (SUVmax) of each category within Masaoka stage, World Health Organization classification, tumor diameter, myasthenia gravis, and Ki-67 label index were compared. To examine risk factors for relapse, SUVmax, age, sex, and surgical radicality were investigated in addition to those items.

Results

The mean SUVmax was 4.5 (range, 1.2 to 14.6) and was significantly higher for Masaoka stage IV than for I and II (all p < 0.008) and for World Health Organization classified thymic cancer compared with all other types (all p < 0.0001). Mean SUVmax revealed significantly higher values for large tumors than for small tumors (p = 0.02). Mean SUVmax was significantly higher for high Ki-67–positive samples (p = 0.0004), indicating a strong correlation between SUVmax and the Ki-67 label index (ρ = 0.77, p = 0.0001). SUVmax accurately reflected therapeutic efficacy in patients with induction therapy. Univariate analysis revealed Masaoka stages III and IV and pathologically incomplete resection as risk factors for relapse. On multivariate analysis, independent risk factors for relapse comprised only Masaoka stages III and IV.

Conclusions

FDG-PET SUVmax does reflect proliferation and invasiveness of thymic epithelial tumors and can provide an index for diagnosis and treatment, although it is not a risk factor for relapse. FDG-PET is also useful for evaluating induction therapy efficacy and detecting relapse.

Section snippets

Patients and Methods

The Kanazawa University Committee for Medical Ethics approved this retrospective study. Individual consent was obtained from the patients to use their resected specimen for research.

Results

There were 16 men and 23 women, with a mean age of 55 years (range, 26 to 81 years). The mean maximum diameter of thymic tumor was 61.5 mm (range, 20 to 137 mm). The number of patients classified as Masaoka stages I, II, III, or IV were 4, 22, 8, and 5, and those classified WHO type A, AB, B1, B2, B3, or thymic cancer were 1, 4, 13, 11, 7 and 3, respectively. Eight patients were complicated by MG, and 5 underwent IT. For IT, patients basically received a unified multiagent chemotherapeutic

Comment

According to the results of this study, FDG-PET SUVmax tended to be higher for advanced-stage tumors and those at a higher malignant grade with a large amount of epithelial components, especially in thymic cancer. In addition, because a strong correlation between SUVmax and Ki-67 LI was confirmed, SUVmax was demonstrated to reflect proliferation and invasiveness and can provide an index for diagnosis and treatment. SUVmax is also useful for evaluating IT efficacy and detecting relapse; thus,

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