Baseline 18F FDG PET/CT imaging in NSCLC: Possible utility in predicting strong-positive PD-L1 expression

Authors : Özge Vural Topuz, Esranur Acar, Nur Büyükpınarbaşılı, Sefa Bayram, Burcu Esen Akkas, Meryem Kaya

Pages : 164-173

Doi:10.31067/acusaglik.1549756

View : 25 | Download : 39

Publication Date : 2025-01-01

Article Type : Research Paper

Abstract :Background/Purpose: To assess whether 18F FDG PET/CT imaging can predict non-small cell lung cancer (NSCLC) patients with strong PD-L1 expression (≥50%). Methods: This retrospective study analyzed 149 NSCLC patients who had undergone baseline 18F FDG PET/CT imaging from June 2021 to May 2024. We recorded age, sex, smoking history, histopathology, TNM stage, metastasis, and PD-L1 expression levels. PET/CT parameters such as SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were recorded. Patients were dichotomized based on two PD-L1 expression thresholds, as measured by immunohistochemistry: higher or lower than 1% ( 1%, n = 87) and higher or lower than 50% (<50%, n = 100 versus ≥50%, n = 39). Results: No significant results were found for the comparison of PD-L1 negative (<1%) and positive (≥1%) patients. The <50% and ≥50% groups were similar in terms of all examined characteristics and PET/CT parameters except for TLG, which was significantly higher among patients with strong PD-L1 expression. ROC analysis revealed an area under curve of 0.606 (95% CI: 0.508–0.705, p = 0.049) for the discrimination of patients with and without strong PD-L1 expression, yielding 89.7% sensitivity, 30% specificity, and 45.6% overall accuracy. Conclusion: This study identified TLG as a potential predictor for NSCLC patients with strong PD-L1 expression (≥50%) based on 18F FDG PET/CT imaging, despite low accuracy. High sensitivity and negative predictive value suggest a role as a supportive tool in screening.
Keywords : 18F-fluorodeoxyglucose, positron emission tomography, programmed death-ligand-1, non-small cell lung cancer