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J Thorac Cardiovasc Surg 2006;132:1189-1195
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Tumor fluoro-2-deoxy-D-glucose avidity on positron emission tomographic scan predicts mortality in patients with early-stage pure and mixed bronchioloalveolar carcinoma

^a Department of Surgery, University of California, San Francisco, San Francisco, Calif
^b School of Medicine, University of California, San Francisco, San Francisco, Calif
^c Department of Nuclear Medicine, University of California, San Francisco, San Francisco, Calif.

Received for publication March 7, 2006; revisions received May 22, 2006; accepted for publication June 15, 2006.

^_* Address for reprints: Dan J. Raz, MD, University of California, San Francisco, 513 Parnassus Ave, S-321, San Francisco, CA 94131. (Email: Dan.raz{at}ucsf.edu).

OBJECTIVE: Bronchioloalveolar carcinoma is a clinically heterogeneous subtype of non–small cell lung carcinoma that frequently has low 2-[18F]fluoro-D-glucose (FDG) uptake on positron emission tomographic scanning. We investigated whether tumor FDG avidity was associated with worse survival among patients with completely resected node-negative pure and mixed bronchioloalveolar carcinoma.

METHODS: We performed a cohort study of 36 patients who had completely resected pure and mixed bronchioloalveolar carcinoma between 1998 and 2004, who had no hilar or mediastinal lymph node metastases, and who had undergone a preoperative positron emission tomographic scan. Tumor FDG avidity was defined as a standardized uptake value of 2.5 or greater. Survival analysis was performed with a proportional hazards model.

RESULTS: Of 36 patients studied, 26 patients (72%) were alive and 10 patients (28%) were dead after a median follow-up of 31 months (interquartile range 17-41months). Seventeen patients (47%) had FDG-avid tumors, and 19 patients (53%) had non-avid tumors. Three-year survival was 49% in the FDG-avid group and 95% in the non-avid group (P = .005). FDG avidity had a hazard ratio of death of 8.6 (95% confidence interval 1.4-244.7, P = .02) after adjusting for tumor size, the presence of multifocal bronchioloalveolar carcinoma, and the presence of histologically mixed bronchioloalveolar carcinoma.

CONCLUSIONS: Preoperative tumor FDG standardized uptake value of 2.5 or greater on positron emission tomography is a powerful predictor of long-term mortality in patients with lymph node–negative pure and mixed bronchioloalveolar carcinoma who undergo complete surgical resection. Patients with a high level of FDG uptake (standardized uptake value 2.5) may benefit from adjuvant chemotherapy or more frequent clinical follow-up.