Characteristics of Metastatic Mediastinal Lymph Nodes of Non-Small Cell Lung Cancer on Preoperative F-18 FDG PET/CT

Overview

Journal Nucl Med Mol Imaging

Publisher Springer

Date 2014 Jun 6

PMID 24900137

Citations 16

Authors

Ah Young Lee

Su Jung Choi

Kyung Pyo Jung

Ji Sun Park

Seok Mo Lee

Sang Kyun Bae

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to evaluate the characteristics of PET and CT features of mediastinal metastatic lymph nodes on F-18 FDG PET/CT and to determine the diagnostic criteria in nodal staging of non-small cell lung cancer.

Methods: One hundred four non-small cell lung cancer patients who had preoperative F-18 FDG PET/CT were included. For quantitative analysis, the maximum SUV of the primary tumor, maximum SUV of the lymph nodes (SUVmax), size of the lymph nodes, and average Hounsfield units (aHUs) and maximum Hounsfield units (mHUs) of the lymph nodes were measured. The SUVmax, SUV ratio of the lymph node to blood pool (LN SUV/blood pool SUV), SUV ratio of the lymph node to primary tumor (LN SUV/primary tumor SUV), size, aHU, and mHU were compared between the benign and malignant lymph nodes.

Results: Among 372 dissected lymph node stations that were pathologically diagnosed after surgery, 49 node stations were malignant and 323 node stations benign. SUVmax, LN SUV/blood pool SUV, and size were significantly different between the malignant and benign lymph node stations (P < 0.0001). However, there was no significant difference in LN SUV/primary tumor SUV (P = 0.18), mHU (P = 0.42), and aHU (P = 0.98). Using receiver-operating characteristic curve analyses, there was no significant difference among these three variables (SUVmax, LN SUV/blood pool SUV, and size). The optimal cutoff values were 2.9 for SUVmax, 1.4 for LN SUV/blood pool SUV, and 5 mm for size. When the cutoff value of SUVmax ≥2.9 and size ≥5 mm were used in combination, the positive predictive value was 44.2 %, and the negative predictive value was 90.9 %. When we evaluated the results based on the histology of the primary tumor, the negative predictive value was 92.3 % in adenocarcinoma (cutoff values of SUVmax ≥2.3 and size ≥5 mm) and 97.2 % in squamous cell carcinoma (cutoff values of SUVmax ≥3.6 and size ≥8 mm), separately.

Conclusions: In the lymph node staging of non-small cell lung cancer, SUVmax, LN SUV/blood pool SUV, and size show statistically significant differences between malignant and benign lymph nodes. These variables can be used to differentiate malignant from benign lymph nodes. The combination of the SUVmax and size of lymph node might have a good negative predictive value.

Citing Articles

A Comparative Evaluation of Mediastinal Nodal SUVmax and Derived Ratios from F-FDG PET/CT Imaging to Predict Nodal Metastases in Non-Small Cell Lung Cancer.

AlRasheedi M, Han S, Thygesen H, Neilson M, Hendry F, Alkarn A Diagnostics (Basel). 2023; 13(7).

PMID: 37046427 PMC: 10093125. DOI: 10.3390/diagnostics13071209.

Diagnostic utility of metabolic parameters on FDG PET/CT for lymph node metastasis in patients with cN2 non-small cell lung cancer.

Nakanishi K, Nakamura S, Sugiyama T, Kadomatsu Y, Ueno H, Goto M BMC Cancer. 2021; 21(1):983.

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Nodal immune flare mimics nodal disease progression following neoadjuvant immune checkpoint inhibitors in non-small cell lung cancer.

Cascone T, Weissferdt A, Godoy M, William Jr W, Leung C, Lin H Nat Commun. 2021; 12(1):5045.

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N-staging in large cell neuroendocrine carcinoma of the lung: diagnostic value of [F]FDG PET/CT compared to the histopathology reference standard.

Hautzel H, Alnajdawi Y, Fendler W, Rischpler C, Darwiche K, Eberhardt W EJNMMI Res. 2021; 11(1):68.

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The Predictive Value of Proportional Evaluation Based on the Metabolic Activity of Cervical Lymph Nodes on PET/CT Imaging in Patients with Larynx Cancer.

Saglampinar Karyagar S, Karyagar S, Guven O, Ustun O, Atar Y, Uyar Y Mol Imaging Radionucl Ther. 2020; 29(2):59-64.

PMID: 32368876 PMC: 7201430. DOI: 10.4274/mirt.galenos.2019.92300.

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