title: Histopathologic characterization of lung adenocarcinoma in relation to fluorine-18-fluorodeoxyglucose uptake on positron emission tomography.
abstract: BACKGROUND
  Fluorine-18-fluorodeoxyglucose uptake on positron emission tomography is reported to have prognostic significance in patients after resection of lung adenocarcinoma. However, its relationship with histopathologic features remains unknown.
  
  
  METHODS
  We conducted a retrospective analysis of 205 patients who had undergone surgical resection of primary lung adenocarcinoma (> 1.0 cm) after preoperative fluorine-18-fluorodeoxyglucose-positron emission tomography between January 1999 and December 2008 at Hokkaido University Hospital. Fluorine-18-fluorodeoxyglucose uptake was measured by the maximum standardized uptake value. A histopathologic review was performed according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, and various histopathologic factors were evaluated semi-quantitatively. Correlations between these clinicopathologic factors and the maximum standardized uptake value (high ≥ 2.0 vs low < 2.0) were analyzed.
  
  
  RESULTS
  Univariate analysis of clinicopathologic factors demonstrated that the following were significantly correlated with a high maximum standardized uptake value: an elevated carcinoembryonic antigen level, larger tumor size, upgraded pT, pN, pStage, non-lepidic histology, abundant fibroblastic/hyalinized stroma, necrosis, presence of pleural involvement, lymphatic and vascular invasion and more intra- and extracellular mucin. Multivariate analysis demonstrated that a tumor size of > 2.0 cm, non-lepidic histology and abundant fibroblastic/hyalinized stroma were significantly correlated with the high maximum standardized uptake value.
  
  
  CONCLUSIONS
  More histopathologic factors are known to correlate with poor prognosis in lung adenocarcinomas showing high maximum standardized uptake values than in those showing low maximum standardized uptake values. Therefore, prognostication of patients with a resectable lung adenocarcinoma on the basis of preoperative fluorine-18-fluorodeoxyglucose uptake is histopathologically valid. Such observations may also help us to clarify the pathobiological mechanism responsible for the increased fluorine-18-fluorodeoxyglucose uptake in lung adenocarcinomas with a poor prognosis.
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo 060-8648, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Domen
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hida
authors.forename: Shozo
authors.initials: S
authors.lastname: Okamoto
authors.forename: Kanako C
authors.initials: KC
authors.lastname: Hatanaka
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hatanaka
authors.forename: Kichizo
authors.initials: K
authors.lastname: Kaga
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsuno
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology* / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000378:metabolism; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: fluorine-19-fluorodeoxyglucose; histopathology; lung adenocarcinoma; maximum standardized uptake value; positron emission tomography