Top

European Radiology

Published in:

01-12-2016 | Molecular Imaging

The diagnostic ability of ¹⁸F-FDG PET/CT for mediastinal lymph node staging using ¹⁸F-FDG uptake and volumetric CT histogram analysis in non-small cell lung cancer

Authors: Jeong Won Lee, Eun Young Kim, Dae Joon Kim, Jae-Hoon Lee, Won Jun Kang, Jong Doo Lee, Mijin Yun

Published in: European Radiology | Issue 12/2016

Abstract

Objectives

To evaluate the clinical implications of lymph node (LN) density on ¹⁸F-FDG PET/CT for mediastinal LN characterization in non-small cell lung cancer (NSCLC).

Methods

One hundred and fifty-two patients with 271 mediastinal LNs who underwent PET/CT and endobronchial ultrasound-guided transbronchial needle aspiration for staging were enrolled. Maximum standardized uptake value (SUVmax), short axis diameter, LN-to-primary cancer ratio of SUVmax, and median Hounsfield unit (HU) based on CT histogram were correlated to histopathology.

Results

Of 271 nodes, 162 (59.8 %) were malignant. SUVmax, short axis diameter, and LPR of malignant LNs were higher than those of benign nodes. Among malignant LNs, 71.0 % had median HU between 25 and 45, while 78.9 % of benign LNs had values <25 HU or >45 HU. Using a cutoff value of 4.0, SUVmax showed the highest diagnostic ability for detecting malignant LNs with a specificity of 94.5 %, but showing a sensitivity of 70.4 %. Using additional density criteria (median HU 25-45) in LNs with 2.0< SUVmax ≤4.0, the sensitivity increased to 88.3 % with the specificity of 82.6 %.

Conclusions

LN density is useful for the characterization of LNs with mild ¹⁸F-FDG uptake. The risk of mediastinal LN metastasis in NSCLC patients could be further stratified using both ¹⁸F-FDG uptake and LN density.

Key Points

• SUVmax showed the highest diagnostic ability for detecting malignant LNs.

• LN density was useful in characterization of LNs with mild FDG uptake.

• SUVmax and LN density together could stratify the risk of LN metastasis.

Alberts WM (2007) Diagnosis and management of lung cancer executive summary: ACCP evidence-based clinical practice guidelines (2nd Edition). Chest 132:1s–19sCrossRefPubMed

Detterbeck FC, Postmus PE, Tanoue LT (2013) The stage classification of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e191S–e210SCrossRefPubMed

Lee JW, Kim BS, Lee DS et al (2009) 18F-FDG PET/CT in mediastinal lymph node staging of non-small-cell lung cancer in a tuberculosis-endemic country: consideration of lymph node calcification and distribution pattern to improve specificity. Eur J Nucl Med Mol Imaging 36:1794–1802CrossRefPubMed

Lu P, Sun Y, Sun Y, Yu L (2014) The role of (18)F-FDG PET/CT for evaluation of metastatic mediastinal lymph nodes in patients with lung squamous-cell carcinoma or adenocarcinoma. Lung Cancer 85:53–58CrossRefPubMed

Li X, Zhang H, Xing L et al (2012) Mediastinal lymph nodes staging by 18F-FDG PET/CT for early stage non-small cell lung cancer: a multicenter study. Radiother Oncol 102:246–250CrossRefPubMed

Darling GE, Maziak DE, Inculet RI et al (2011) Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial. J Thorac Oncol 6:1367–1372CrossRefPubMed

Lee AY, Choi SJ, Jung KP, Park JS, Lee SM, Bae SK (2014) Characteristics of Metastatic Mediastinal Lymph Nodes of Non-Small Cell Lung Cancer on Preoperative F-18 FDG PET/CT. Nucl Med Mol Imaging 48:41–46CrossRefPubMed

Kwon SY, Min JJ, Song HC, Choi C, Na KJ, Bom HS (2011) Impact of Lymphoid Follicles and Histiocytes on the False-Positive FDG Uptake of Lymph Nodes in Non-Small Cell Lung Cancer. Nucl Med Mol Imaging 45:185–191CrossRefPubMedPubMedCentral

Lee SH, Min JW, Lee CH et al (2011) Impact of parenchymal tuberculosis sequelae on mediastinal lymph node staging in patients with lung cancer. J Korean Med Sci 26:67–70CrossRefPubMed

10.

Bryant AS, Cerfolio RJ, Klemm KM, Ojha B (2006) Maximum standard uptake value of mediastinal lymph nodes on integrated FDG-PET-CT predicts pathology in patients with non-small cell lung cancer. Ann Thorac Surg 82:417–422CrossRefPubMed

11.

Moloney F, Ryan D, McCarthy L et al (2014) Increasing the accuracy of 18F-FDG PET/CT interpretation of "mildly positive" mediastinal nodes in the staging of non-small cell lung cancer. Eur J Radiol 83:843–847CrossRefPubMed

12.

Vansteenkiste JF, Stroobants SG, De Leyn PR et al (1998) Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. J Clin Oncol 16:2142–2149PubMed

13.

Kim BT, Lee KS, Shim SS et al (2006) Stage T1 non-small cell lung cancer: preoperative mediastinal nodal staging with integrated FDG PET/CT--a prospective study. Radiology 241:501–509CrossRefPubMed

14.

Flechsig P, Kratochwil C, Schwartz LH et al (2014) Quantitative volumetric CT-histogram analysis in N-staging of 18F-FDG-equivocal patients with lung cancer. J Nucl Med 55:559–564CrossRefPubMed

15.

Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P (2009) 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 4:568–577CrossRefPubMed

16.

Deasy JO, Blanco AI, Clark VH (2003) CERR: a computational environment for radiotherapy research. Med Phys 30:979–985CrossRefPubMed

17.

El Naqa I, Grigsby P, Apte A et al (2009) Exploring feature-based approaches in PET images for predicting cancer treatment outcomes. Pattern Recognit 42:1162–1171CrossRefPubMedPubMedCentral

18.

Lee JW, Yun M, Cho A et al (2015) The predictive value of metabolic tumor volume on FDG PET/CT for transarterial chemoembolization and transarterial chemotherapy infusion in hepatocellular carcinoma patients without extrahepatic metastasis. Ann Nucl Med 29:400–408CrossRefPubMed

19.

Shim SS, Lee KS, Kim BT et al (2005) Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology 236:1011–1019CrossRefPubMed

20.

Nambu A, Kato S, Motosugi U et al (2010) Thin-section CT of the mediastinum in preoperative N-staging of non-small cell lung cancer: comparison with FDG PET. Eur J Radiol 73:510–517CrossRefPubMed

21.

Al-Sarraf N, Gately K, Lucey J, Wilson L, McGovern E, Young V (2008) Mediastinal lymph node staging by means of positron emission tomography is less sensitive in elderly patients with non-small-cell lung cancer. Clin Lung Cancer 9:39–43CrossRefPubMed

22.

Lee JE, Kim HY, Lim KY et al (2010) Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer. Lung Cancer 70:51–56CrossRefPubMed

23.

Rintoul RC, Tournoy KG, El Daly H et al (2009) EBUS-TBNA for the clarification of PET positive intra-thoracic lymph nodes-an international multi-centre experience. J Thorac Oncol 4:44–48CrossRefPubMed

24.

Hwangbo B, Kim SK, Lee HS et al (2009) Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest 135:1280–1287CrossRefPubMed

Title: The diagnostic ability of 18F-FDG PET/CT for mediastinal lymph node staging using 18F-FDG uptake and volumetric CT histogram analysis in non-small cell lung cancer
Authors: Jeong Won Lee
Eun Young Kim
Dae Joon Kim
Jae-Hoon Lee
Won Jun Kang
Jong Doo Lee
Mijin Yun
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 12/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4292-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The diagnostic ability of ¹⁸F-FDG PET/CT for mediastinal lymph node staging using ¹⁸F-FDG uptake and volumetric CT histogram analysis in non-small cell lung cancer

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 12/2016

The diagnostic value of magnetic resonance urography using a balanced turbo field echo sequence

Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique

Mesenteric panniculitis: systematic review of cross-sectional imaging findings and risk of subsequent malignancy

Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma

Clinical significance of post-treatment 18F-fluorodeoxyglucose uptake in cervical lymph nodes in patients with diffuse large B-cell lymphoma

Quantitative assessment of morphology, T1ρ, and T2 of shoulder cartilage using MRI