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Risk Factors for Predicting Occult Lymph Node Metastasis in Patients with Clinical Stage I Non-small Cell Lung Cancer Staged by Integrated Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

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Abstract

Background

Lymph nodes in patients with non-small cell lung cancer (NSCLC) are often staged using integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). However, this modality has limited ability to detect micrometastases. We aimed to define risk factors for occult lymph node metastasis in patients with clinical stage I NSCLC diagnosed by preoperative integrated FDG-PET/CT.

Methods

We retrospectively reviewed the records of 246 patients diagnosed with clinical stage I NSCLC based on integrated FDG-PET/CT between April 2007 and May 2015. All patients were treated by complete surgical resection. The prevalence of occult lymph node metastasis in patients with clinical stage I NSCLC was analysed according to clinicopathological factors. Risk factors for occult lymph node metastasis were defined using univariate and multivariate analyses.

Results

Occult lymph node metastasis was detected in 31 patients (12.6 %). Univariate analysis revealed CEA (P = 0.04), SUVmax of the primary tumour (P = 0.031), adenocarcinoma (P = 0.023), tumour size (P = 0.002) and pleural invasion (P = 0.046) as significant predictors of occult lymph node metastasis. Multivariate analysis selected SUVmax of the primary tumour (P = 0.049), adenocarcinoma (P = 0.003) and tumour size (P = 0.019) as independent predictors of occult lymph node metastasis.

Conclusions

The SUVmax of the primary tumour, adenocarcinoma and tumour size were risk factors for occult lymph node metastasis in patients with NSCLC diagnosed as clinical stage I by preoperative integrated FDG-PET/CT. These findings would be helpful in selecting candidates for mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.

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Abbreviations

AUC:

Area under the curve

CEA:

Carcinoembryonic antigen

CT:

Computed tomography

EBUS-TBNA:

Endobronchial ultrasound-guided transbronchial needle aspiration

FDG-PET:

18F-fluorodeoxyglucose positron emission tomography

NEMA:

National Electrical Manufacturers’ Association

NPV:

Negative predictive value

NSCLC:

Non-small cell lung cancer

ROC:

Receiver operating characteristics

ROI:

Region of interest

SABR:

Stereotactic ablative radiotherapy

SUVmax :

Maximum standardized uptake value

TNM:

Tumour node metastasis

VOI:

Volume of interest

WHO:

World Health Organization

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Acknowledgments

The author thanks Mr. Tomoyuki Kanno, Yuai Clinic, for data acquisition.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Sagamihara Kyodo Hospital, 2-8-18 Hashimoto, Midori-ku, Sagamihara, Kanagawa, 252-5188, Japan

    Kaoru Kaseda & Keisuke Asakura

  2. Department of Pathology, Sagamihara Kyodo Hospital, Kanagawa, Japan

    Akio Kazama

  3. Yuai Clinic, Kanagawa, Japan

    Yukihiko Ozawa

Authors
  1. Kaoru Kaseda
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  2. Keisuke Asakura
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  3. Akio Kazama
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  4. Yukihiko Ozawa
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Correspondence to Kaoru Kaseda.

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Kaseda, K., Asakura, K., Kazama, A. et al. Risk Factors for Predicting Occult Lymph Node Metastasis in Patients with Clinical Stage I Non-small Cell Lung Cancer Staged by Integrated Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. World J Surg 40, 2976–2983 (2016). https://doi.org/10.1007/s00268-016-3652-5

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  • DOI: https://doi.org/10.1007/s00268-016-3652-5

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