Abstract
Objective
We assessed the diagnostic capacity of dynamic fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and dual-time-point (DTP) PET/CT to explore the optimal scan timing for nodal staging in lung cancer.
Methods
Thirty-four patients with lung cancer underwent dynamic and consecutive DTP PET/CT scans. Two readers visually evaluated FDG uptake within each lymph node (LN) and pulmonary artery (metastatic LN: n = 10; nonmetastatic LN: n = 121). For each dynamic and DTP scan, we compared the maximum standardized uptake value (SUVmax) and the retention index of the SUVmax (RI-SUVmax) between metastatic and nonmetastatic LNs. We compared the diagnostic capacity of the dynamic and DTP scans using receiver operating characteristic (ROC) analyses.
Results
In the visual analyses of LN metastases, a sensitivity of 20.0–60.0% and specificity of 97.5–100.0% were identified for the first to third dynamic scans. The sensitivity of the 1-h early and 2-h delayed scans was 80.0% and 90.0%, respectively, whereas the specificity was 66.9% and 47.9%, respectively. The visual analysis of the dynamic second phase had the highest accuracy. Semiquantitative analyses revealed that the SUVmax was significantly higher for metastatic LNs than for nonmetastatic LNs in the dynamic second and third phases and the 1-h early and 2-h delayed phases (p < 0.05 for all). The RI-SUVmax was higher in metastatic LNs than in nonmetastatic LNs for the dynamic scan (p = 0.004) and the DTP scan (p = 0.002). The ROC analyses showed that SUV2 and SUV3 had higher performances with high specificity, high negative predictive value, and high accuracy than the other parameters. The area under the ROC curve of the RI-SUV-dual-time-point had the highest value (0.794) without any significant differences between the area under the ROC curves for all parameters (p > 0.05 for all).
Conclusions
Based on the visual and semiquantitative analyses, 18F-FDG dynamic PET/CT exhibited excellent performance with extremely high specificity in the dynamic second phase.
Similar content being viewed by others
References
Shen G, Lan Y, Zhang K, Ren P, Jia Z. Comparison of 18F-FDG PET/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis. PLoS One. 2017;12:e0173104. https://doi.org/10.1371/journal.pone.0173104. (eCollection 2017. Erratum in: PLoS One. 2017; 12:e0176150).
Zhao L, He ZY, Zhong XN, Cui ML. (18)FDG-PET/CT for detection of mediastinal nodal metastasis in non-small cell lung cancer: a meta-analysis. Surg Oncol. 2012;21:230–6.
Shinya T, Rai K, Okumura Y, Fujiwara K, Matsuo K, Yonei T, et al. Dual-time-point F-18 FDG PET/CT for evaluation of intrathoracic lymph nodes in patients with non-small cell lung cancer. Clin Nucl Med. 2009;34:216–21.
Nishiyama Y, Yamamoto Y, Kimura N, Ishikawa S, Sasakawa Y, Ohkawa M. Dual-time-point FDG-PET for evaluation of lymph node metastasis in patients with non-small-cell lung cancer. Ann Nucl Med. 2008;22:245–50.
Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med. 2002;43:871–5.
Demura Y, Tsuchida T, Ishizaki T, Mizuno S, Totani Y, Ameshima S, et al. 18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax. J Nucl Med. 2003;44:540–8.
Prenzel KL, Mönig SP, Sinning JM, Baldus SE, Brochhagen HG, Schneider PM, et al. Lymph node size and metastatic infiltration in non-small cell lung cancer. Chest. 2003;123:463–7.
Yen RF, Chen KC, Lee JM, Chang YC, Wang J, Cheng MF, et al. 18F-FDG PET for the lymph node staging of non-small cell lung cancer in a tuberculosis-endemic country: is dual time point imaging worth the effort? Eur J Nucl Med Mol Imaging. 2008;35:1305–15.
Kim YK, Lee KS, Kim BT, Choi JY, Kim H, Kwon OJ, et al. Mediastinal nodal staging of nonsmall cell lung cancer using integrated 18F-FDG PET/CT in a tuberculosis-endemic country: diagnostic efficacy in 674 patients. Cancer. 2007;109:1068–77.
Schierz JH, Opfermann T, Steenbeck J, Lopatta E, Settmacher U, Stallmach A, et al. Early dynamic 18F-FDG PET to detect hyperperfusion in hepatocellular carcinoma liver lesions. J Nucl Med. 2013;54:848–54.
Bernstine H, Braun M, Yefremov N, Lamash Y, Carmi R, Stern D, et al. FDG PET/CT early dynamic blood flow and late standardized uptake value determination in hepatocellular carcinoma. Radiology. 2011;260:503–10.
Epelbaum R, Frenkel A, Haddad R, Sikorski N, Strauss LG, Israel O, et al. Tumour aggressiveness and patient outcome in cancer of the pancreas assessed by dynamic 18F-FDG PET/CT. J Nucl Med. 2013;54:12–8.
Belakhlef S, Church C, Jani C, Lakhanpl S. Early dynamic PET/CT and 18F-FDG blood flow imaging in bladder cancer detection: a novel approach. Clin Nucl Med. 2012;37:366–8.
Nakajima R, Abe K, Kondo T, Tanabe K, Sakai S. Clinical role of early dynamic FDG-PET/CT for the evaluation of renal cell carcinoma. Eur Radiol. 2016;26(6):1852–62.
Kwee TC, Basu S, Cheng G, Alavi A. FDG PET/CT in carcinoma of unknown primary. Eur J Nucl Med Mol Imaging. 2010;37:635–44. https://doi.org/10.1007/s00259-009-1295-6. Epub 2009 Oct 31. Review.
Brierley JD, Mary K, Gospodarowicz C, Wittekind, editors. UICC TNM Classification of Malignant Tumours. 8th ed. Hoboken: Wiley-Blackwell; 2016.
El-Sherief AH, Lau CT, Wu CC, Drake RL, Abbott GF, Rice TW. International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration. Radiographics. 2014;34:1680–91. https://doi.org/10.1148/rg.346130097.
Kim JH, van Beek EJ, Murchison JT, Marin A, Mirasadraee S. The International Association for the study of lung cancer lymph node map: a radiologic atlas and review. Tuberc Respir Dis (Seoul). 2015;78:180–9. https://doi.org/10.4046/trd.2015.78.3.180. (Epub 2015 Jun 30).
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.
Gupta N, Gill H, Graeber G, Bishop H, Hurst J, Stephens T. Dynamic positron emission tomography with F-18 fluorodeoxyglucose imaging in differentiation of benign from malignant lung/mediastinal lesions. Chest. 1998;114:1105–11.
Yang Z, Zan Y, Zheng X, Hai W, Chen K, Huang Q, et al. Dynamic FDG-PET imaging to differentiate malignancies from inflammation in subcutaneous and in situ mouse model for non-small cell lung carcinoma (NSCLC). PLoS One. 2015;10:e0139089. https://doi.org/10.1371/journal.pone.0139089. eCollection 2015.
Huang YE, Lu HI, Liu FY, Huang YJ, Lin MC, Chen CF, et al. Solitary pulmonary nodules differentiated by dynamic F-18 FDG PET in a region with high prevalence of granulomatous disease. J Radiat Res. 2012;53:306–12. Epub 2012 Feb 25.
Kwon SY, Min JJ, Song HC, Choi C, Na KJ, Bom HS. 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. 2011;45:185–91.
Acknowledgements
We are grateful to the radiology technologists Yamato Kunikane, Masafumi Amano, Akihiko Fujita, Yukiko Fukunaga, Satoru Takashi, Ryota Bando, and Shota Azane for their technical assistance in the dynamic PET/CT examinations. We have no conflicts of interest with regard to this paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest with regard to this paper.
IRB statement
This prospective study was approved by our institutional review board and ethics committee in Tokushima University Hospital.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shinya, T., Otomi, Y., Kubo, M. et al. Preliminary clinical assessment of dynamic 18F-fluorodeoxyglucose positron emission tomography/computed tomography for evaluating lymph node metastasis in patients with lung cancer: a prospective study. Ann Nucl Med 33, 414–423 (2019). https://doi.org/10.1007/s12149-019-01350-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12149-019-01350-z