A Proposal for Combined MRI and PET/CT Interpretation Criteria for Preoperative Nodal Staging in Non-small-cell Lung Cancer

Overview

Journal Eur Radiol

Specialty Radiology

Date 2012 Feb 28

PMID 22367469

Citations 12

Authors

Yoo Na Kim

Chin A Yi

Kyung Soo Lee

O Jung Kwon

Ho Yun Lee

Byung-Tae Kim

Joon Young Choi

Seon Woo Kim

Man Pyo Chung

Joungho Han

Tae Sung Kim

Myung Jin Chung

Young Mog Shim

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine the positive reading criteria for malignant nodes when interpreting combined MRI and PET/CT images for preoperative nodal staging in non-small-cell lung cancer (NSCLC).

Methods: Forty-nine patients with biopsy-proven NSCLC underwent both PET/CT and thoracic MRI [diffusion weighted imaging (DWI)]. Each nodal station was evaluated for the presence of metastasis by applying either inclusive (positive if either one read positive) or exclusive (positive if both read positive) criteria in the combined interpretation of PET/CT and MRI. Nodal stage was confirmed pathologically. The combined diagnostic accuracy of PET/CT and MRI was determined on per-nodal station and per-patient bases and compared with that of PET/CT alone.

Results: In 49 patients, 39 (19%) of 206 nodal stations harboured malignant cells. Out of 206 nodal stations, 186 (90%) had concordant readings, while the rest (10%) had discordant readings. Inclusive criteria of combined PET/CT and MRI helped increase sensitivity for detecting nodal metastasis (69%) compared with PET/CT alone (46%; P = 0.003), while specificity was not significantly decreased.

Conclusion: Inclusive criteria in combined MRI and PET/CT readings help improve significantly the sensitivity for detecting nodal metastasis compared with PET/CT alone and may decrease unnecessary open thoracotomy. Key Points • Combined interpretation of MRI and PET/CT enhances the detection of nodal metastasis. • Inclusive criteria of combined MRI/PET/CT improved the sensitivity for detecting nodal metastasis. • Combined interpretation of MRI and PET/CT may reduce unnecessary open thoracotomies.

Citing Articles

Current status and prospect of PET-related imaging radiomics in lung cancer.

Tang X, Wu F, Chen X, Ye S, Ding Z Front Oncol. 2024; 13:1297674.

PMID: 38164195 PMC: 10757959. DOI: 10.3389/fonc.2023.1297674.

State of the Art MR Imaging for Lung Cancer TNM Stage Evaluation.

Ohno Y, Ozawa Y, Koyama H, Yoshikawa T, Takenaka D, Nagata H Cancers (Basel). 2023; 15(3).

PMID: 36765907 PMC: 9913625. DOI: 10.3390/cancers15030950.

Diagnostic value and clinical significance of MRI and CT in detecting lymph node metastasis of early cervical cancer.

Luo L, Luo Q, Tang L Oncol Lett. 2020; 19(1):700-706.

PMID: 31897185 PMC: 6924181. DOI: 10.3892/ol.2019.11180.

A decision tree model for predicting mediastinal lymph node metastasis in non-small cell lung cancer with F-18 FDG PET/CT.

Pak K, Kim K, Kim M, Eom J, Lee M, Cho J PLoS One. 2018; 13(2):e0193403.

PMID: 29486012 PMC: 5828356. DOI: 10.1371/journal.pone.0193403.

Prediction of Advanced Axillary Lymph Node Metastases (ypN2-3) Using Breast MR imaging and PET/CT after Neoadjuvant Chemotherapy in Invasive Ductal Carcinoma Patients.

Kim W, Lee S, Kim H, Chae Y, Jeong S, Jung J Sci Rep. 2018; 8(1):3181.

PMID: 29453385 PMC: 5816592. DOI: 10.1038/s41598-018-21554-z.

References

Koh D, Collins D . Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. 2007; 188(6):1622-35. DOI: 10.2214/AJR.06.1403. View

Toloza E, Harpole L, McCrory D . Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest. 2003; 123(1 Suppl):137S-146S. DOI: 10.1378/chest.123.1_suppl.137s. View

Rusch V, Asamura H, Watanabe H, Giroux D, Rami-Porta R, Goldstraw P . The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2009; 4(5):568-77. DOI: 10.1097/JTO.0b013e3181a0d82e. View

Nakayama J, Miyasaka K, Omatsu T, Onodera Y, Terae S, Matsuno Y . Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative assessment with diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient. J Comput Assist Tomogr. 2010; 34(1):1-8. DOI: 10.1097/RCT.0b013e3181a9cc07. View

Gupta N, Graeber G, Bishop H . Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (<1 cm), intermediate (1 to 3 cm), and large (>3 cm) lymph node lesions. Chest. 2000; 117(3):773-8. DOI: 10.1378/chest.117.3.773. View

Seely J, Mayo J, Miller R, Muller N . T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. Radiology. 1993; 186(1):129-32. DOI: 10.1148/radiology.186.1.8416552. View

Glazer G, Orringer M, Chenevert T, Borrello J, Penner M, Quint L . Mediastinal lymph nodes: relaxation time/pathologic correlation and implications in staging of lung cancer with MR imaging. Radiology. 1988; 168(2):429-31. DOI: 10.1148/radiology.168.2.3393661. View

Bottomley P, Hardy C, Argersinger R . A review of 1H nuclear magnetic resonance relaxation in pathology: are T1 and T2 diagnostic?. Med Phys. 1987; 14(1):1-37. DOI: 10.1118/1.596111. View

Ohno Y, Koyama H, Nogami M, Takenaka D, Yoshikawa T, Yoshimura M . STIR turbo SE MR imaging vs. coregistered FDG-PET/CT: quantitative and qualitative assessment of N-stage in non-small-cell lung cancer patients. J Magn Reson Imaging. 2007; 26(4):1071-80. DOI: 10.1002/jmri.21106. View

10.

Padhani A, Liu G, Koh D, Chenevert T, Thoeny H, Takahara T . Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia. 2009; 11(2):102-25. PMC: 2631136. DOI: 10.1593/neo.81328. View

11.

Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C . Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative and qualitative assessment with STIR turbo spin-echo MR imaging. Radiology. 2004; 231(3):872-9. DOI: 10.1148/radiol.2313030103. View

12.

Scott W, Gobar L, Terry J, Dewan N, Sunderland J . Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography. J Thorac Cardiovasc Surg. 1996; 111(3):642-8. DOI: 10.1016/s0022-5223(96)70317-3. View

13.

McLoud T, Bourgouin P, Greenberg R, Kosiuk J, Templeton P, Shepard J . Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. Radiology. 1992; 182(2):319-23. DOI: 10.1148/radiology.182.2.1732943. View

14.

Wiener J, Chako A, MERTEN C, Gross S, Coffey E, STEIN H . Breast and axillary tissue MR imaging: correlation of signal intensities and relaxation times with pathologic findings. Radiology. 1986; 160(2):299-305. DOI: 10.1148/radiology.160.2.3726104. View

15.

Eiber M, Beer A, Holzapfel K, Tauber R, Ganter C, Weirich G . Preliminary results for characterization of pelvic lymph nodes in patients with prostate cancer by diffusion-weighted MR-imaging. Invest Radiol. 2009; 45(1):15-23. DOI: 10.1097/RLI.0b013e3181bbdc2f. View

16.

Bennett B . On comparisons of sensitivity, specificity and predictive value of a number of diagnostic procedures. Biometrics. 1972; 28(3):793-800. View

17.

Akduman E, Momtahen A, Balci N, Mahajann N, Havlioglu N, Wolverson M . Comparison between malignant and benign abdominal lymph nodes on diffusion-weighted imaging. Acad Radiol. 2008; 15(5):641-6. DOI: 10.1016/j.acra.2007.12.023. View

18.

Kim Y, Lee K, Kim B, Choi J, Kim H, Kwon O . Mediastinal nodal staging of nonsmall cell lung cancer using integrated 18F-FDG PET/CT in a tuberculosis-endemic country: diagnostic efficacy in 674 patients. Cancer. 2007; 109(6):1068-77. DOI: 10.1002/cncr.22518. View

19.

Takenaka D, Ohno Y, Hatabu H, Ohbayashi C, Yoshimura M, Ohkita Y . Differentiation of metastatic versus non-metastatic mediastinal lymph nodes in patients with non-small cell lung cancer using respiratory-triggered short inversion time inversion recovery (STIR) turbo spin-echo MR imaging. Eur J Radiol. 2002; 44(3):216-24. DOI: 10.1016/s0720-048x(02)00271-1. View

20.

Chakraborti K, Jena A . MR evaluation of the mediastinal lymph nodes. Indian J Chest Dis Allied Sci. 1997; 39(1):19-25. View