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Purpose  Deriving links between imaging and genomic markers is an evolving field. 2-[ 18 F]FDG PET/CT ( 18 F-fluorodeoxyglucose positron emission tomography–computed tomography) is commonly used for cancer imaging, with maximum standardized uptake value (SUV max ) 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 SUV max , linking these two important parameters.    Methods  In 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-[ 18 F]FDG PET/CT within 6 months prior to the tissue biopsy, to ensure acceptable temporal correlation between imaging and genomic evaluation.    Results  We found a linear correlation between TMB and SUV max  ( p  < 0.001). In the multivariate analysis, only TMB independently correlated with SUV max , whereas age, gender, and tumor organ did not.    Conclusion  Our observations link SUV max  in readily available, routinely used, and noninvasive 2-[ 18 F]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 SUV max  can stratify patient response to immunotherapy.

ejnmmi research

Relationship between tumor mutational burden and maximum standardized uptake value in 2-[18F]FDG PET (positron emission tomography) scan in cancer patients