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      Prediction of Pathologic Grade and Prognosis in Mucoepidermoid Carcinoma of the Lung Using 18F-FDG PET/CT

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          Abstract

          Objective

          The maximum standardized uptake value (SUV max) of pulmonary mucoepidermoid carcinoma (PMEC) in fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT) was evaluated as a preoperative predictor of pathologic grade and survival rate.

          Materials and Methods

          Twenty-three patients who underwent preoperative PET/CT and complete resection for PMEC were enrolled. The optimal cut-off SUV max for tumor grade was calculated as 6.5 by receiver operating characteristic curve. The patients were divided into a high SUV group (n = 7) and a low SUV group (n = 16). Clinicopathologic features were compared between the groups by χ 2 test and overall survival was determined by Kaplan-Meier analysis.

          Results

          The mean SUV max was 15.4 ± 11.5 in the high SUV group and 3.9 ± 1.3 in the low SUV group. All patients except one from the low SUV group had low grade tumors and all had no nodal metastasis. The sensitivity and specificity of SUV max from PET/CT for predicting tumor grade was 85.7% and 93.8%, respectively. During the follow-up period (mean, 48.6 ± 38.7 months), four patients from the high SUV group experienced cancer recurrence, and one died of cancer. In contrast, none of the low SUV group had recurrence or mortality. Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031).

          Conclusion

          Pulmonary mucoepidermoid carcinoma patients with high SUV max in PET/CT had higher tumor grade, more frequent lymph node metastasis and worse long-term outcome. Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.

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          Most cited references21

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          The 2004 World Health Organization classification of lung tumors.

          Mary Beasley, Elisabeth Brambilla, William Travis (2005)
          Article 0 comments Cited 148 times – based on 0 reviews     Review now
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            Mucoepidermoid carcinoma of the major salivary glands: clinical and histopathologic analysis of 234 cases with evaluation of grading criteria.

            Yvonne G. Ellis, P Auclair, R Goode (1998)
            The authors had previously conducted an investigation of minor salivary gland mucoepidermoid carcinoma, in which they demonstrated that certain clinical and histopathologic features were useful in predicting biologic outcome. The current study investigated the usefulness of these features in determining the prognoses of patients with mucoepidermoid carcinomas of the major salivary glands. Clinical data and 15 histopathologic features were compared in 4 patient groups based on outcome after initial treatment. The outcome groups were 1) survival without disease, 2) survival with tumor recurrence only, 3) survival with metastasis, and 4) death related to tumor. A numeric score was assigned to each unfavorable histopathologic feature. Low grade tumors had scores of 0-4. Intermediate grade tumors scored 5 or 6. High grade tumors had scores higher than 6. Most patients (75%) were tumor free after the initial treatment. Twenty-one patients (9%) had local recurrence only, 12 (5%) demonstrated metastasis and survived, and 25 patients (11%) died of their disease. Clinical features associated with metastasis or death were more advanced age, tumor size, and preoperative symptoms. Histopathologic features that correlated with poor outcome were cystic component less than 20%, 4 or more mitotic figures per 10 high-power fields, neural involvement, necrosis, and anaplasia. All five of these histopathologic features demonstrated statistical prognostic significance when parotid gland tumors from Groups 1 and 4 were compared (P < 0.001). The point-based grading system demonstrated a statistically significant correlation with outcome for parotid tumors but not for submandibular tumors. The authors' findings indicate that patients with tumors of equal histopathologic grade have a better prognosis when their tumors are in the parotid gland than when their tumors are in the submandibular gland. Six of eight submandibular tumors that metastasized or resulted in death were low grade lesions, and none were high grade.
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              Primary salivary gland-type lung cancer: spectrum of clinical presentation, histopathologic and prognostic factors.

              Julian R. Molina, Marie Aubry, Jean E Lewis … (2007)
              Primary salivary-type lung cancers are rare tumors that include adenoid cystic carcinoma (ACC) and mucoepidermoid carcinoma (MEC). The clinicopathologic profiles, symptoms on presentation, and long-term outcomes of patients with ACC and MEC as an overall group have not been defined recently. In this study, the authors analyzed clinical outcome data from 62 patients who presented with a diagnosis of primary salivary-type lung cancer at the Mayo Clinic (Rochester, Minn) from 1972 to 2002. The median age at diagnosis for patients with MEC was 40 years (range, 6-78 years); and, for patients ACC, the median age at diagnosis was 54 years (range, 21-76 years). ACC was observed more frequently among women and girls. The main presenting symptom for both tumors was cough (70%), followed by dyspnea (51.7%), wheezing (38.3%), obstructive pneumonia (30%), hemoptysis (28.3%), and fever (16.7%). Tissues were available for review from all patients. Among the ACC tumors, 29 (74.4%) were cribriform, 7 (17.9%) were tubular, and 3 (7.7%) were the solid type. Most MEC tumors (65%) were intermediate grade (grade 2), and 30% were low grade (grade 1). Most salivary-type lung cancers presented in the trachea, in the carina, or in a main stem bronchus (70.7%). This location was observed more often (82.5%) for ACC tumors compared with MEC tumors (44.4%). Involvement of the lymph nodes was observed in 20% of patients and was more common among the patients with ACC (30.8%). Distant metastases were observed in 30.4% of the patients (15 patients in the ACC group [40.5%] compared with only 2 patients in the MEC group [10.5%]; P = .03). For patients who underwent complete surgical resection, the 3-, 5-, and 10-year survival rates were 82%, 70%, and 63%, respectively. The survival rates for surgical MEC patients were 94% at 3 years and 87% at both 5 years and 10 years. For surgical ACC patients, the survival rates were 73%, 57%, and 45% at 3, 5, and 10 years, respectively. The survival rate for patients with ACC who did not undergo surgery was 74% at 3 years, 53% at 5 years, and 31% at 10 years. The difference in survival between surgical and nonsurgical patients was statistically significant (P < .01). Patients with MEC and ACC frequently have a good long-term prognosis but do not always have indolent diseases. Local recurrence is likely if complete surgical resection is not achieved. ACC has a higher likelihood than MEC to metastasize. Overall, patients with MEC survive better than patients with ACC. (c) 2007 American Cancer Society.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Radiol
                Journal ID (iso-abbrev): Korean J Radiol
                Journal ID (publisher-id): KJR
                Title: Korean Journal of Radiology
                Publisher: The Korean Society of Radiology
                ISSN (Print): 1229-6929
                ISSN (Electronic): 2005-8330
                Publication date (Print): Jul-Aug 2015
                Publication date (Electronic): 01 July 2015
                Volume: 16
                Issue: 4
                Pages: 929-935
                Affiliations
                [1 ]Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
                [2 ]Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
                Author notes
                Corresponding author: Young Mog Shim, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: (822) 3410-1696, Fax: (822) 3410-6986, youngmog.shim@ 123456samsung.com
                Article
                DOI: 10.3348/kjr.2015.16.4.929
                PMC ID: 4499560
                PubMed ID: 26175595
                SO-VID: da303189-ff20-472a-bd04-81971116c0e8
                Copyright © Copyright © 2015 The Korean Society of Radiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 November 2014
                Date accepted : 13 April 2015
                Categories
                Subject: Thoracic Imaging
                Subject: Original Article

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: mucoepidermoid carcinoma,lung cancer,18f-fdg pet/ct
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: mucoepidermoid carcinoma, lung cancer, 18f-fdg pet/ct

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