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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2013

01-05-2013 | Thoracic Oncology

Advantages of Diffusion-Weighted Imaging Over Positron Emission Tomography-Computed Tomography in Assessment of Hilar and Mediastinal Lymph Node in Lung Cancer

Authors: Katsuo Usuda, MD, Motoyasu Sagawa, MD, Nozomu Motono, MD, Masakatsu Ueno, MD, Makoto Tanaka, MD, Yuichiro Machida, MD, Munetaka Matoba, MD, Yasuaki Kuginuki, MD, Mitsuru Taniguchi, MD, Yoshimichi Ueda, MD, Tsutomu Sakuma, MD

Published in: Annals of Surgical Oncology | Issue 5/2013

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Abstract

Background

The significance of diffusion-weighted imaging (DWI) is uncertain for the diagnosis of nodal involvement. The purpose of this study was to examine diagnostic capability of DWI compared with PET-CT for nodal involvement of lung cancer.

Methods

A total of 160 lung cancers (114 adenocarcinomas, 36 squamous cell carcinomas, and 10 other cell types) were analyzed in this study. DWI and PET-CT were performed preoperatively.

Results

The optimal cutoff values to diagnose metastatic lymph nodes were 1.70 × 10−3 mm2/s for ADC value and 4.45 for SUVmax. DWI correctly diagnosed N staging in 144 carcinomas (90 %) but incorrectly diagnosed N staging in 16 (10 %) [3 (1.9 %) had overstaging, 13 (8.1 %) had understaging]. PET-CT correctly diagnosed N staging in 133 carcinomas (83.1 %) but incorrectly diagnosed N staging in 27 (16.8 %) [4 (2.5 %) had overstaging, 23 (14.4 %) had understaging]. Sensitivity, accuracy, and negative predictive value for N staging by DWI were significantly higher than those by PET-CT. Of the 705 lymph node stations examined, 61 had metastases, and 644 did not. The maximum diameter of metastatic lesions in lymph nodes were 3.0 ± 0.9 mm in 21 lymph node stations not detected by either DWI or PET-CT: 7.2 ± 4.1 mm in 39 detected by DWI, and 11.9 ± 4.1 mm in 24 detected by PET-CT. There were significant differences among them. The sensitivity (63.9 %) for metastatic lymph node stations by DWI was significantly higher than that (39.3 %) by PET-CT. The accuracy (96.2 %) for all lymph node stations by DWI was significantly higher than that (94.3 %) by PET-CT.

Conclusions

DWI has advantages over PET-CT in diagnosing malignant from benign lymph nodes of lung cancers.
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Metadata
Title
Advantages of Diffusion-Weighted Imaging Over Positron Emission Tomography-Computed Tomography in Assessment of Hilar and Mediastinal Lymph Node in Lung Cancer
Authors
Katsuo Usuda, MD
Motoyasu Sagawa, MD
Nozomu Motono, MD
Masakatsu Ueno, MD
Makoto Tanaka, MD
Yuichiro Machida, MD
Munetaka Matoba, MD
Yasuaki Kuginuki, MD
Mitsuru Taniguchi, MD
Yoshimichi Ueda, MD
Tsutomu Sakuma, MD
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2799-z

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