Biological Significance of the Maximum Standardized Uptake Values on Positron Emission Tomography in Non-Small Cell Lung Cancer

Background: The 2-[F-18]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has recently become an important non-invasive tool for the diagnosis and staging in several cancers. The standardized uptake value (SUV) of primary tumor has been reported to relate to cancer progression and prognosis, however, biological mechanism is still unclear. Method: Seventy-nine patients with non-small cell lung cancer (NSCLC) who had undergone preoperative FDG-PET and a surgical resection were enrolled in this study. NSCLC tissue samples prepared from the surgical specimens were subjected to an immunohistochemical analysis for the expression of Ki-67 and vascular endothelial growth factor (VEGF) proteins. The relationships between the expression status of these proteins and SUVmax of primary tumors were evaluated. Result: Concerning the relationship with various clinicopathological findings, SUVmax of primary tumors was associated with histology, tumor proliferation, pleural or vascular invasion, and pathological stage. A significant correlation was observed between the SUVmax and either the Ki-67 or VEGF expression (P < 0.001, P = 0.006), respectively. Cases with both Ki-67-negative and VEGF-negative findings exhibited a significantly lower SUVmax than those with single positive or double positive cases (P = 0.006, P < 0.001). Conclusion: The SUVmax was associated with the expression of Ki-67 and VEGF in NSCLC. These findings indicated that the SUVmax of primary tumors might therefore reflect the biological malignant potential in NSCLC. J Surg. Oncol. 2009;100:688-692. (C) 2009 Wiley-Liss, Inc.