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01-08-2009 | Original Article

Differential diagnosis between ¹⁸F-FDG-avid metastatic lymph nodes in non-small cell lung cancer and benign nodes on dual-time point PET/CT scan

Authors: Kazuyoshi Suga, Yasuhiko Kawakami, Atsuto Hiyama, Kazurou Sugi, Kazutomo Okabe, Tsuneo Matsumoto, Kazuhiro Ueda, Nobuyuki Tanaka, Naofumi Matsunaga

Published in: Annals of Nuclear Medicine | Issue 6/2009

Abstract

Objective

To clarify the difference of ¹⁸F-FDG uptake kinetics between FDG-avid metastatic lymph nodes (LNs) in patients with non-small-cell lung cancer (NSCLC) and FDG-avid benign LNs associated with various etiologies on dual-time point PET/CT scan, and to determine the optimal parameter for differentiation.

Methods

The subjects were 134 FDG-avid metastatic LNs in 67 patients with NSCLC and 62 FDG-avid benign LNs in 61 patients with various lung disorders including NSCLC. PET/CT scan was performed at 2 time points (at 60 min and at 120 min) after intravenous injection of 4.4 MBq/kg ¹⁸F-FDG. The maximum standardized uptake value (SUVmax) on early and delayed scans and the percent change of SUVmax (%ΔSUVmax) were measured at each FDG-avid LN. The optimal parameter for differentiation was determined by the receiver-operating characteristic analysis.

Results

Delayed SUVmax was increased compared with early SUVmax in 114 (85.0%) FDG-avid metastatic LNs and 42 (67.7%) FDG-avid benign LNs, with significant higher delayed SUVmax than early values (7.0 ± 5.0 vs. 5.9 ± 3.4; P < 0.0001, and 3.0 ± 1.3 vs. 2.8 ± 1.0; P < 0.05, respectively). Early and delayed SUVmax and %ΔSUVmax in metastatic LNs were significantly higher than those in benign LNs (P < 0.0001). The optimal parameter for the differentiation was the combined use of early SUVmax > 3.0 or delayed SUVmax > 4.0, yielding sensitivity of 88.8%, specificity of 80.6%, accuracy of 86.2%, negative predictive value of 76.9%, and positive predictive value of 90.6%. It provided better results than the use of early SUVmax > 3.0 alone (P = 0.019) or the optimal parameter for %ΔSUVmax (>5%) (P = 0.012). However, 12 (19.3%) benign LNs were indistinguishable from metastatic LNs.

Conclusions

Although dual-time point PET/CT scan enhances the difference of FDG uptake between FDG-avid metastatic and benign LNs and improves the differentiation when compared with a single scan, biopsy procedure may be still required for accurate assessment of LN status in patients with NSCLC and possible etiologies showing intensive FDG uptake in benign LNs.

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Title: Differential diagnosis between 18F-FDG-avid metastatic lymph nodes in non-small cell lung cancer and benign nodes on dual-time point PET/CT scan
Authors: Kazuyoshi Suga
Yasuhiko Kawakami
Atsuto Hiyama
Kazurou Sugi
Kazutomo Okabe
Tsuneo Matsumoto
Kazuhiro Ueda
Nobuyuki Tanaka
Naofumi Matsunaga
Publication date: 01-08-2009
Publisher: Springer Japan
Published in: Annals of Nuclear Medicine / Issue 6/2009
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-009-0268-y

2024 ASCO Annual Meeting

Springer Medicine

Differential diagnosis between ¹⁸F-FDG-avid metastatic lymph nodes in non-small cell lung cancer and benign nodes on dual-time point PET/CT scan

Abstract

Objective

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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