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New PET/CT criterion for nodal staging in non-small cell lung cancer: measurement of the ratio of section area of standard uptake values ≥2.5/lymph node section area

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Abstract

Background

The aim of the present study was to use surgical and histological results to develop a simple noninvasive technique for improving nodal staging using preoperative PET/CT in patients with resectable non-small cell lung cancer (NSCLC).

Methods

Preoperative PET/CT findings (163 patients) and pathological diagnoses after surgical resection were evaluated. Using PET/CT images, lymph node section area (SA), the maximum standardized uptake value (SUVmax), SA of SUV ≥2.5 and ≥3.0 were drawn freehand and measured using caliper software. Receiver operating characteristic (ROC) curves were then used to analyze those data.

Results

Based on ROC analyses, the cut-off values for SA of SUV ≥2.5, SA of SUV ≥3.0, SUV ≥2.5 SA/node SA and SUV ≥3.0 SA/node SA for diagnosis of lymph node metastasis were 200 mm2, 30 mm2, 1.0 and 0.4. SUV ≥2.5 SA/node SA ≥1.0 had the highest negative predictive value, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of nodal staging were 61.1, 73.4, 36.7, 88.2 and 70.9%.

Conclusions

When diagnosing nodal staging based a lymph node SUV ≥2.5 SA/node SA ratio of ≥1.0, it can be an effective criterion for use to determine surgical indications.

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Abbreviations

NSCLC:

Non-small cell lung cancer

PPV:

Positive predictive value

SUVmax:

Maximum standardized uptake value

FDG:

18F-2-deoxy-2-fluoro-d-glucose

UICC:

Union Internationale Contre le Cancer

ROI:

Region of interest

SA:

Section area

ROC:

Receiver operating characteristic

AUC:

The areas under receiver operating characteristic curves

NPV:

Negative predictive value

FLT:

3′-Deoxy-3′-18F-fluorothymidine

4DST:

4′-[Methyl-11C]-thiothymidine

BAC:

Bronchoalveolar cell carcinoma

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Acknowledgements

The authors are grateful to Profs. Hiroshi Nanjo (Department of Pathology, Akita University Graduate School of Medicine) and Akiteru Goto (Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine) for suggesting pathological diagnoses. And we thank Prof. Katsuyuki Murata (Department of Environmental Health Sciences, Akita University Graduate School of Medicine) for suggesting statistics.

Author contributions

SY collected and analyzed the data. Imai K designed the research, analyzed data and wrote the paper. Ishiyama K, MS, SH, SY, KH, and FS supported this research and helped to collect the data. HM participated in this study’s design and coordination. MY supervised the research. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Yoshitaro Saito, Kazuhiro Imai, Hajime Saito, Satoru Motoyama, Yusuke Sato, Hayato Konno, Satoshi Fujishima & Yoshihiro Minamiya

  2. Division of Radiology and Radiation Medicine, Department of Integrated Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Koichi Ishiyama & Manabu Hashimoto

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  1. Yoshitaro Saito
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  2. Kazuhiro Imai
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Correspondence to Kazuhiro Imai.

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Saito, Y., Imai, K., Ishiyama, K. et al. New PET/CT criterion for nodal staging in non-small cell lung cancer: measurement of the ratio of section area of standard uptake values ≥2.5/lymph node section area. Gen Thorac Cardiovasc Surg 65, 350–357 (2017). https://doi.org/10.1007/s11748-017-0756-2

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