Abstract
PurposeDeriving links between imaging and genomic markers is an evolving field. 2-[18F]FDG PET/CT (18F-fluorodeoxyglucose positron emission tomography–computed tomography) is commonly used for cancer imaging, with maximum standardized uptake value (SUVmax) as the main quantitative parameter. Tumor mutational burden (TMB), the quantitative variable obtained using next-generation sequencing on a tissue biopsy sample, is a putative immunotherapy response predictor. We report the relationship between TMB and SUVmax, linking these two important parameters.MethodsIn this pilot study, we analyzed 1923 patients with diverse cancers and available TMB values. Overall, 273 patients met our eligibility criteria in that they had no systemic treatment prior to imaging/biopsy, and also had 2-[18F]FDG PET/CT within 6 months prior to the tissue biopsy, to ensure acceptable temporal correlation between imaging and genomic evaluation.ResultsWe found a linear correlation between TMB and SUVmax (p < 0.001). In the multivariate analysis, only TMB independently correlated with SUVmax, whereas age, gender, and tumor organ did not.ConclusionOur observations link SUVmax in readily available, routinely used, and noninvasive 2-[18F]FDG PET/CT imaging to the TMB, which requires a tissue biopsy and time to process. Since higher TMB has been implicated as a prognostic biomarker for better outcomes after immunotherapy, further investigation will be needed to determine if SUVmax can stratify patient response to immunotherapy.
Highlights
Creating a link between imaging findings and genomic data in patients with cancer is crucial in the evolving world of genomics
Patient characteristics Of 1923 patients in the database, we found 273 patients with metastatic cancer had no systemic treatment prior to imaging/biopsy, and had 2-[18F]FDG 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography–computed tomography (PET/computed tomography (CT)) within 6 months prior to the tissue biopsy (Table 1)
The most notable pattern was seen with melanoma, which expectedly had the highest percentage of patients among cancer types in the Tumor mutational burden (TMB) ≥ 12 mutations/mb category (60% vs. 7–30% in other cancer types) [12, 14]
Summary
Creating a link between imaging findings and genomic data in patients with cancer is crucial in the evolving world of genomics. Radiologic markers have shown promise for noninvasive identification of molecular properties [1]. 2-[18F]FDG PET/CT is standard of care and plays a pivotal role in cancer diagnosis and staging [5]. The maximum standardized uptake value (SUVmax), a relative. Haghighat Jahromi et al EJNMMI Res (2020) 10:150 measure of FDG uptake, is the most widely used quantitative parameter for the assessment of cancer patients [6, 7]. The S UVmax has been correlated with histopathological findings. As the era of personalized medicine continues to move rapidly toward molecular stratification, there have been studies to associate S UVmax with biologic pathways, S UVmax is still generally unspecified at a molecular level [4, 8]
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