From the Guidelines
A Standardized Uptake Value (SUV) of 21 is indicative of an aggressive disease process, particularly in the context of cancer, as it suggests high metabolic activity. SUV measures the concentration of radiotracer in tissues during PET scans, with higher values indicating increased metabolic activity. According to the study by T. BERGHMANS ET AL. 1, a high SUVmax is associated with shorter duration of response and poorer prognosis in patients with advanced NSCLC. Although there is no universal cutoff value that definitively indicates aggressiveness across all conditions, an SUV of 21 is substantially elevated compared to normal tissue (typically <2.5-3.0).
Some key points to consider when interpreting SUV values include:
- The specific type of cancer, as different cancers have different metabolic profiles
- The location of the tumor, as some areas may have naturally higher metabolic activity
- The patient's clinical context, including symptoms, medical history, and other diagnostic findings
- The potential for inflammatory or infectious processes to cause elevated SUV values without representing malignancy
As noted in the study by DE GEUS-OEI et al. 1, the predictive effect of initial SUV max of the primary tumour for morphological response to chemotherapy has been investigated, and SUVmax was found to be a significant predictor in univariate and multivariate analyses. However, the patients with high SUVmax had shorter duration of response and there was no overall difference in survival between patients with high and low SUVmax.
In clinical practice, an SUV of 21 should prompt further investigation and correlation with histopathology, clinical presentation, and other diagnostic tests to determine the aggressiveness of the disease. This may include additional imaging studies, biopsies, or other laboratory tests to confirm the diagnosis and guide treatment decisions.
From the Research
Standardized Uptake Value (SUV) and Disease Aggressiveness
- A Standardized Uptake Value (SUV) of 21 is considered high and may be indicative of an aggressive disease process, as seen in various studies 2, 3.
- In the context of non-Hodgkin's lymphoma, an SUV > 10 is associated with aggressive lymphoma, and an SUV > 13 is associated with aggressive lymphoma with > 90% certainty 2.
- Similarly, in patients with locally advanced non-small cell lung cancer, a high post-radiation SUV(max) is associated with a higher risk of death and disease recurrence 3.
- However, it is essential to consider the specific disease context and other factors when interpreting SUV values, as the relationship between SUV and disease aggressiveness can vary depending on the type of cancer and other factors.
Disease Context and SUV Interpretation
- In transformed lymphoma, the majority of patients have high SUVs on PET scanning, similar to diffuse large B-cell lymphoma (DLBCL) 2.
- In locally advanced non-small cell lung cancer, the decrease in SUV(max) after radiation therapy is associated with better survival outcomes 3.
- In other types of cancer, such as gastric carcinoma, the relationship between SUV and disease aggressiveness may be different, and other factors like treatment response and overall survival may be more relevant 4.