title: Value of 18F-FDG PET/CT for Predicting the World Health Organization Malignant Grade of Thymic Epithelial Tumors: Focused in Volume-Dependent Parameters.
abstract: OBJECTIVE
  We investigated whether preoperative parameters of 18F-FDG PET/CT were correlated with the World Health Organization (WHO) classification and/or Masaoka staging of thymic epithelial tumors.
  
  
  METHODS
  We reviewed 61 patients retrospectively who were diagnosed with thymic epithelial tumors after surgical resection and PET/CT. A volume of interest was drawn on the primary lesion, using an SUV cutoff of 2.5, and metabolic indices such as SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured.
  
  
  RESULTS
  There were 24 male patients (38.7%), and the mean (SD) age was 50.23 (12.54) years. The mean (SD) tumor size was 6.11 (3.41) cm. There were 22 low-risk thymomas (36.9%) (A, AB, B1), 32 high-risk thymomas (51.6%), and 7 thymic carcinomas (11.5%). The Masaoka stage was I in 15 (24.6%), II in 30 (49.2%), III in 11 (18.0%), and IV in 5 patients (8.2%). Mean (SD) SUVmax was 3.43 (1.01) in low-risk thymomas, 4.42 (1.70) in high-risk thymomas, and 8.23 (2.61) in thymic carcinoma; the differences were significant (P < 0.001). Mean (SD) MTV and TLG were 90.74 (114.56) and 229.36 (300.56) in low-risk thymomas, 80.82 (112.49) and 233.93 (340.91) in high-risk thymomas, and 90.63 (90.74) and 390.94 (437.62), respectively, in thymic carcinomas. MTV and TLG showed no correlation with the WHO classification. On receiver operating characteristic curve analysis, the cutoff value for discriminating thymomas and thymic carcinomas was 5.05. SUVmax and TLG were correlated with Masaoka stage.
  
  
  CONCLUSIONS
  Although volume-dependent parameters were not correlated with the WHO classification, a significant relationship was observed between SUVmax and WHO classification and Masaoka stage.
authors.affiliation: From the *Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon; †Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul; ‡Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Gyeonggi; and §Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seong Yong
authors.initials: SY
authors.lastname: Park
authors.forename: Arthur
authors.initials: A
authors.lastname: Cho
authors.forename: Mi Kyung
authors.initials: MK
authors.lastname: Bae
authors.forename: Chang Young
authors.initials: CY
authors.lastname: Lee
authors.forename: Dae Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Kyung Young
authors.initials: KY
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D060787:Neoplasm Grading; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D049268:Positron-Emission Tomography; D012372:ROC Curve; D012189:Retrospective Studies; D013945:Thymoma / Q000473:pathology; D013953:Thymus Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18