18F-FLT-PET/CT adds value to 18F-FDG-PET/CT for diagnosing relapse after definitive radiotherapy in patients with lung cancer. Results of a prospective clinical trial
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18F-FLT-PET/CT adds value to 18F-FDG-PET/CT for diagnosing relapse after definitive radiotherapy in patients with lung cancer. Results of a prospective clinical trial. / Christensen, Tine Noehr; Langer, Seppo W; Persson, Gitte F; Larsen, Klaus Richter; Loft, Annika; Amtoft, Annemarie Gjelstrup; Berthelsen, Anne Kiil; Johannesen, Helle Hjorth; Keller, Sune Hoegild; Kjaer, Andreas; Fischer, Barbara Malene.
In: The Journal of Nuclear Medicine, Vol. 62, No. 5, 2021, p. 628-635.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - 18F-FLT-PET/CT adds value to 18F-FDG-PET/CT for diagnosing relapse after definitive radiotherapy in patients with lung cancer.
T2 - Results of a prospective clinical trial
AU - Christensen, Tine Noehr
AU - Langer, Seppo W
AU - Persson, Gitte F
AU - Larsen, Klaus Richter
AU - Loft, Annika
AU - Amtoft, Annemarie Gjelstrup
AU - Berthelsen, Anne Kiil
AU - Johannesen, Helle Hjorth
AU - Keller, Sune Hoegild
AU - Kjaer, Andreas
AU - Fischer, Barbara Malene
N1 - Copyright © 2020 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
PY - 2021
Y1 - 2021
N2 - Diagnosing relapse after radiotherapy for lung cancer is challenging. The specificity of both CT and 2-deoxy-2-[18F]fluoro-D-glucose (FDG)-PET/CT is low due to radiation-induced changes. 3'-deoxy-3'-[18F]fluorothymidine (FLT)-PET has previously demonstrated higher specificity for malignancy than FDG-PET. We investigated the value of FLT-PET/CT for diagnosing relapse in irradiated lung cancer. Methods: Patients suspected for relapse of lung cancer after definitive radiotherapy (conventional fractionated radiotherapy (cRT) or stereotactic radiotherapy (SBRT)) were included. Sensitivity and specificity were analysed within the irradiated high-dose volume (HDV) and patient-based. Marginal differences and inter-observer agreement were assessed. Results: Sixty-three patients who had received radiotherapy in 70 HDVs (34 cRT; 36 SBRT) were included. The specificity of FLT-PET/CT was higher than FDG-PET/CT (HDV: 96% [87-100] vs. 71% [57-83]; P = 0.0039; patient-based (90 % [73-98] vs. 55% [36-74]; P = 0.0020)). The difference between specificity of FLT-PET/CT and FDG-PET/CT was higher after cRT compared with SBRT. Sensitivity of FLT-PET/CT was lower than FDG-PET/CT (HDV: 69% [41-89] vs. 94% [70-100]; P = 0.1250; patient-based: 70% [51-84] vs. 94% [80-99]; P = 0.0078). Adding FLT-PET/CT when FDG-PET/CT was positive or inconclusive improved diagnostic value compared with FDG-PET/CT only. In cRT-HDVs, the probability of malignancy increased from 67% for FDG-PET/CT alone to 100% when both PETs were positive. Conclusion: FLT-PET/CT adds diagnostic value to FDG-PET/CT in patients with suspected relapse. The diagnostic impact of FLT-PET/CT was highest after cRT. We suggest adding FLT-PET/CT when FDG-PET/CT is inconclusive or positive within the previously irradiated volume to improve diagnostic value in patients where histological confirmation is not easily obtained.
AB - Diagnosing relapse after radiotherapy for lung cancer is challenging. The specificity of both CT and 2-deoxy-2-[18F]fluoro-D-glucose (FDG)-PET/CT is low due to radiation-induced changes. 3'-deoxy-3'-[18F]fluorothymidine (FLT)-PET has previously demonstrated higher specificity for malignancy than FDG-PET. We investigated the value of FLT-PET/CT for diagnosing relapse in irradiated lung cancer. Methods: Patients suspected for relapse of lung cancer after definitive radiotherapy (conventional fractionated radiotherapy (cRT) or stereotactic radiotherapy (SBRT)) were included. Sensitivity and specificity were analysed within the irradiated high-dose volume (HDV) and patient-based. Marginal differences and inter-observer agreement were assessed. Results: Sixty-three patients who had received radiotherapy in 70 HDVs (34 cRT; 36 SBRT) were included. The specificity of FLT-PET/CT was higher than FDG-PET/CT (HDV: 96% [87-100] vs. 71% [57-83]; P = 0.0039; patient-based (90 % [73-98] vs. 55% [36-74]; P = 0.0020)). The difference between specificity of FLT-PET/CT and FDG-PET/CT was higher after cRT compared with SBRT. Sensitivity of FLT-PET/CT was lower than FDG-PET/CT (HDV: 69% [41-89] vs. 94% [70-100]; P = 0.1250; patient-based: 70% [51-84] vs. 94% [80-99]; P = 0.0078). Adding FLT-PET/CT when FDG-PET/CT was positive or inconclusive improved diagnostic value compared with FDG-PET/CT only. In cRT-HDVs, the probability of malignancy increased from 67% for FDG-PET/CT alone to 100% when both PETs were positive. Conclusion: FLT-PET/CT adds diagnostic value to FDG-PET/CT in patients with suspected relapse. The diagnostic impact of FLT-PET/CT was highest after cRT. We suggest adding FLT-PET/CT when FDG-PET/CT is inconclusive or positive within the previously irradiated volume to improve diagnostic value in patients where histological confirmation is not easily obtained.
U2 - 10.2967/jnumed.120.247742
DO - 10.2967/jnumed.120.247742
M3 - Journal article
C2 - 33037090
VL - 62
SP - 628
EP - 635
JO - The Journal of Nuclear Medicine
JF - The Journal of Nuclear Medicine
SN - 0161-5505
IS - 5
ER -
ID: 249787371