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Treatment perspectives for non-small cell lung cancer (NSCLC) have been significantly expanded by the integration of immune checkpoint inhibitors into multimodal therapy concepts. Currently, combined, immune checkpoint-inhibitor-based therapy concepts are also advancing into early, resectable stages of NSCLC. Neoadjuvant and perioperative chemoimmunotherapy opened up a promising new preoperative treatment approach, but also raises some new questions and challenges. With the expanded perioperative treatment options and the perspective on a further improvement in the absence of recurrence after tumor resection, there is push towards comprehensively collecting therapy-relevant findings for imaging, molecular and histopathological diagnostics at an early stage. All patients with lung carcinoma, regardless of the therapy intention, should be presented to an interdisciplinary tumor board with thoracic oncological expertise. This is regularly given in certified lung cancer centers.A standardized procedure contributes to optimized pre-therapeutic diagnostics and facilitates coordination for the best possible multimodal approach in the interdisciplinary tumor board. In the case of centrally located resectable tumors, for example, neoadjuvant treatment increases the chances of a procedure that is as parenchymal sparing as possible. Some questions cannot yet be answered conclusively. Perioperative systemic therapy with molecular-targeted and immune checkpoint inhibitors is the subject of numerous ongoing studies. The considerable dynamics in newly approved therapies and the development of perioperative therapy concepts require continuous adaptation of diagnostic algorithms and standards. Integration into standard pre-surgical routine makes rapid classification of the relevant findings as well as close coordination between the diagnostic and interventional disciplines essential., Competing Interests: KW: Aktienbesitz (AstraZeneca, Roche, Pfizer, BMS, Bayer, Novartis, J&J); indirekte Interessen (Präsidentschaft DGT 2021-23; VS-Mitgliedschaft DGT, DGCH; VS Mitgliedschaft ESTS); Mitarbeit an Advisory Boards/Data Safety Monitoring Boards (AstraZeneca, BMS, Roche, J&J). DJ: Erstattung von Fortbildungsbeiträgen. AD: Honorare für Vortragstätigkeit (Takeda); Mitarbeit an Advisory Boards/Data Safety Monitoring Boards (BMS). CKS: Honorare für Beratungstätigkeit (AstraZeneca, Amgen, BMS, Daiichi-Sankyo, MSD, onkowissen, Roche, Sanofi), Honorare für Vortragstätigkeit (Amgen, AstraZeneca, Art tempi/medtoday, BMS, Daiichi-Sankyo, MSD, Lilly, Novartis, onkowissen, Pfizer, Roche, Sanofi, Streamed Up, Takeda); indirekte Interessen (AIO, POA, SDGP); Reise-/Tagungskostenzuschüsse (Amgen, AstraZeneca, BMS Boheringer Ingelheim, Janssen). AS: Honorare für Vortragstätigkeit; Mitarbeit an Advisory Boards (Aignostics, Amgen, Astellas, AstraZeneca, Bayer, BMS, Eli Lilly, Illumina, Incyte, Janssen, MSD, Novartis, Pfizer, Qlucore, QuiP, Roche, Sanofi, Seagen, Servier, Takeda, Thermo Fisher); Förderung von Forschungsvorhaben (Bayer, BMS, Chugai, Incyte). AT: Honorare für Beratungstätigkeit; Honorare für Vortragstätigkeit (AstraZeneca, Boehringer Ingelheim, BMS, Daiichi-Sankyo, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi); indirekte Interessen (AIO, ERS); Reise-/Tagungskostenzuschüsse (AstraZeneca, BMS, Daiichi-Sankyo, MSD, Janssen, Sanofi). MZ: Honorare für Beratungstätigkeit (AstraZeneca, BMS, Novocure); Honorare für Vortragstätigkeit (AstraZeneca); Mitarbeit an Advisory Boards (AstraZeneca, BMS); Reise-/Tagungskostenzuschüsse (AstraZeneca, BMS). MT: Förderung von Forschungsvorhaben (AstraZeneca, BMS, Merck, Roche Takeda); Honorare für Beratungstätigkeit; Mitarbeit an Advisory Boards (Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Daiichi-Sankyo, GSK, Janssen, Lilly, Merck, MSD, Novartis, Pfizer, Roche, Sanofi, Takeda); Honorare für Vortragstätigkeit; Mitarbeit an Advisory Boards (Amgen, AstraZeneca, Beigene, BMS, Boehringer Ingelheim, Celgene, Chugai, Daiichi-Sankyo, GSK, Janssen, Lilly, Merck, MSD, Novartis, Pfizer, Roche, Sanofi, Takeda); Reise-/Tagungskostenzuschüsse (AstraZeneca, BMS, Boehringer Ingelheim, Daiichi Sankyo, Janssen, Lilly, Merck, MSD, Novartis, Pfizer, Roche, Sanofi, Takeda)., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Aim: The aim of this study was to derive prognostic parameters from 2-[ 18 F]fluoro-2-deoxy-D-glucose ([ 18 F]FDG-PET/CT) in patients with low-risk NSCLC and determine their prognostic value., Methods: 81 (21 female, mean age 66 a) therapy-naive patients that underwent [18F]FDG-PET/CT before histologic confirmation of NSCLC with stadium I and II between 2008-2016 were included. A mean follow-up time of 58 months (13-176), overall and progression free survival (OS, PFS) were registered. A volume of interest for the primary tumor was defined on PET and CT images. Parameters SUV max , PET-solidity, PET-circularity, and CT-volume were analyzed. To evaluate the prognostic value of each parameter for OS, a minimum p-value approach was used to define cutoff values, survival analysis, and log-rank tests were performed, including subgroup analysis for combinations of parameters., Results: Mean OS was 58±28 months. Poor OS was associated with a tumor CT-volume >14.3 cm 3 (p=0.02, HR=7.0, CI 2.7-17.7), higher SUV max values >12.2 (p=0.003; HR=3.0, CI 1.3-6.7) and PET-solidity >0.919 (p=0.004; HR=3.0, CI 1.0-8.9). Combined parameter analysis revealed worse prognosis in larger volume/high SUV max tumors compared to larger volume/lower SUV max (p=0.028; HR=2.5, CI 1.1-5.5), high PET-solidity/low volume (p=0.01; HR=2.4, CI 0.8-6.6) and low SUV max /high PET-solidity (p=0.02, HR=4.0, CI 0.8-19.0)., Conclusion: Even in this group of low-risk NSCLC patients, we identified a subgroup with a significantly worse prognosis by combining morphologic-metabolic biomarkers from [18F]FDG-PET/CT. The combination of SUV max and CT-volume performed best. Based on these preliminary data, future prospective studies to validate this combined morphologic-metabolic imaging biomarker for potential therapeutic decisions seem promising., Competing Interests: Beer AJ: AAA GmbH - Honorar Vortragstätigkeit Advisory Board Meeting Janssen-Cilag - Honorar Vortragstätigkeit VSRN Baden-Baden über KelCon - Honorar Vortragstätigkeit AAA GmbH - Honorar Vortragstätigkeit Fa. NVision Imaging Technologies GmbH Ulm - Mitglied Scientific Advisory Board - Ärztlicher Direktor Klinik für Nuklearmedizin, Universitätsklinikum Ulm - Präsident Südwestdeutsche Gesellschaft für Nuklearmedizin SWDGN - Forschungskooperation PET/MRT mit Siemens Healthcare GmbH Erlangen, (Thieme. All rights reserved.)