Radiology
October 1, 2026 · via Europe PMC
Association of PET/CT Metabolic Parameters with Histologic Grade of Lung Adenocarcinoma: Implications for Surgical Decisions.
Shen X, Shi H, Wan Z, +13 more, She Y.
AI summary — for doctors, generated from the abstract only
SUVmax on PET/CT independently predicted grade 3 lung adenocarcinoma and helped identify patients likely to do worse with segmentectomy or limited nodal dissection in clinical stage IA disease.
What was studied
Retrospective study of 2789 patients with clinical stage IA lung adenocarcinoma who had preoperative PET/CT and complete resection; logistic regression for grade 3 tumors, multivariable Cox models with SUVmax-by-surgery interactions, propensity matching, and an external cohort.
Key findings
- Radiologic type and SUVmax interacted in predicting grade 3 disease (P = .008), with cutoffs of 4.25 for pure solid and 2.30 for subsolid nodules.
- In pure solid hypermetabolic lesions (SUVmax > 4.25), segmentectomy and limited nodal dissection were associated with worse overall survival (HR 2.06 for each).
- In the external cohort, AUCs were 0.72 for pure solid and 0.74 for subsolid nodules.
Clinical relevance
PET/CT metabolic activity might complement CT in choosing resection extent and lymph node dissection for early lung adenocarcinoma, flagging high-grade, higher-risk tumors.
Who should care
Limitations
Retrospective and observational, so surgical strategy choice may be confounded despite matching; the interaction P values were close to .05 and external discrimination was modest.
SUVmax adds prognostic information for surgical planning in stage IA adenocarcinoma, but prospective confirmation is needed.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background The grading system for invasive lung adenocarcinoma proposed by the International Association for the Study of Lung Cancer (IASLC) has been widely validated. However, the association of PET/CT with IASLC grade and its value in clinical decision-making is unknown. Purpose To investigate the association of PET/CT metabolic parameters with IASLC grade and determine the complementary clinical value of PET/CT in optimizing preoperative surgical decision-making in clinical stage IA (cIA) lung adenocarcinoma. Materials and Methods This retrospective study included consecutive patients who underwent preoperative PET/CT and complete resection for cIA lung adenocarcinoma between September 2020 and March 2022. Logistic regression was used to identify predictors of grade 3 lung adenocarcinoma. Multivariable Cox models assessed prognostic effects and interactions between maximum standardized uptake value (SUVmax) and surgical strategy. Propensity score matching was used to balance clinicopathologic characteristics across surgical strategies. Results The study included 2789 patients (median age, 62 years [IQR, 55-68 years]; 1574 women). Logistic regression analysis demonstrated a positive interaction between radiologic type and SUVmax (P = .008) in predicting grade 3 adenocarcinoma. Specific cutoff values for pure solid (cutoff of 4.25) and subsolid (cutoff of 2.30) nodules were identified. Positive interactions between SUVmax and surgery were observed exclusively in pure solid nodules (SUVmax-resection extent for overall survival [OS], P = .048; SUVmax-nodal dissection for OS, P = .045). Stratified analyses showed that segmentectomy and limited lymph node dissection were associated with worse outcomes only in hypermetabolic lesions (SUVmax > 4.25; resection extent hazard ratio [HR] for OS, 2.06 [P = .03]; nodal dissection HR for OS, 2.06 [P = .005]). SUVmax maintained robust predictive efficacy for grade 3 lung adenocarcinoma in the external cohort (area under the receiver operating curve, 0.72 for pure solid nodules and 0.74 for subsolid nodules). Conclusion In patients who underwent PET/CT and complete resection for clinical stage IA lung adenocarcinoma, maximum standardized uptake value was an independent predictor of grade 3 lung adenocarcinoma and helped identify high-risk patients treated with segmentectomy or limited nodal dissection. © RSNA, 2026 Supplemental material is available for this article.
Background The grading system for invasive lung adenocarcinoma proposed by the International Association for the Study of Lung Cancer (IASLC) has been widely validated. However, the association of PET/CT with IASLC grade and its value in clinical decision-making is unknown. Purpose To investigate the association of PET/CT metabolic parameters with IASLC grade and determine the complementary clinical value of PET/CT in optimizing preoperative surgical decision-making in clinical stage IA (cIA) lung adenocarcinoma. Materials and Methods This retrospective study included consecutive patients who underwent preoperative PET/CT and complete resection for cIA lung adenocarcinoma between September 2020 and March 2022. Logistic regression was used to identify predictors of grade 3 lung adenocarcinoma. Multivariable Cox models assessed prognostic effects and interactions between maximum standardized uptake value (SUVmax) and surgical strategy. Propensity score matching was used to balance clinicopathologic characteristics across surgical strategies. Results The study included 2789 patients (median age, 62 years [IQR, 55-68 years]; 1574 women). Logistic regression analysis demonstrated a positive interaction between radiologic type and SUVmax (P = .008) in predicting grade 3 adenocarcinoma. Specific cutoff values for pure solid (cutoff of 4.25) and subsolid (cutoff of 2.30) nodules were identified. Positive interactions between SUVmax and surgery were observed exclusively in pure solid nodules (SUVmax-resection extent for overall survival [OS], P = .048; SUVmax-nodal dissection for OS, P = .045). Stratified analyses showed that segmentectomy and limited lymph node dissection were associated with worse outcomes only in hypermetabolic lesions (SUVmax > 4.25; resection extent hazard ratio [HR] for OS, 2.06 [P = .03]; nodal dissection HR for OS, 2.06 [P = .005]). SUVmax maintained robust predictive efficacy for grade 3 lung adenocarcinoma in the external cohort (area under the receiver operating curve, 0.72 for pure solid nodules and 0.74 for subsolid nodules). Conclusion In patients who underwent PET/CT and complete resection for clinical stage IA lung adenocarcinoma, maximum standardized uptake value was an independent predictor of grade 3 lung adenocarcinoma and helped identify high-risk patients treated with segmentectomy or limited nodal dissection. © RSNA, 2026 Supplemental material is available for this article.
DOI
10.1148/radiol.261188
PMID
42867376
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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