Abstract
Purpose
The aim of this study was to evaluate the characteristics of PET and CT features of mediastinal metastatic lymph nodes on F-18 FDG PET/CT and to determine the diagnostic criteria in nodal staging of non-small cell lung cancer.
Methods
One hundred four non-small cell lung cancer patients who had preoperative F-18 FDG PET/CT were included. For quantitative analysis, the maximum SUV of the primary tumor, maximum SUV of the lymph nodes (SUVmax), size of the lymph nodes, and average Hounsfield units (aHUs) and maximum Hounsfield units (mHUs) of the lymph nodes were measured. The SUVmax, SUV ratio of the lymph node to blood pool (LN SUV/blood pool SUV), SUV ratio of the lymph node to primary tumor (LN SUV/primary tumor SUV), size, aHU, and mHU were compared between the benign and malignant lymph nodes.
Results
Among 372 dissected lymph node stations that were pathologically diagnosed after surgery, 49 node stations were malignant and 323 node stations benign. SUVmax, LN SUV/blood pool SUV, and size were significantly different between the malignant and benign lymph node stations (P < 0.0001). However, there was no significant difference in LN SUV/primary tumor SUV (P = 0.18), mHU (P = 0.42), and aHU (P = 0.98). Using receiver-operating characteristic curve analyses, there was no significant difference among these three variables (SUVmax, LN SUV/blood pool SUV, and size). The optimal cutoff values were 2.9 for SUVmax, 1.4 for LN SUV/blood pool SUV, and 5 mm for size. When the cutoff value of SUVmax ≥2.9 and size ≥5 mm were used in combination, the positive predictive value was 44.2 %, and the negative predictive value was 90.9 %. When we evaluated the results based on the histology of the primary tumor, the negative predictive value was 92.3 % in adenocarcinoma (cutoff values of SUVmax ≥2.3 and size ≥5 mm) and 97.2 % in squamous cell carcinoma (cutoff values of SUVmax ≥3.6 and size ≥8 mm), separately.
Conclusions
In the lymph node staging of non-small cell lung cancer, SUVmax, LN SUV/blood pool SUV, and size show statistically significant differences between malignant and benign lymph nodes. These variables can be used to differentiate malignant from benign lymph nodes. The combination of the SUVmax and size of lymph node might have a good negative predictive value.
Similar content being viewed by others
References
Tanaka F, Yanagihara K, Otake Y, Miyahara R, Kawano Y, Nakagawa T, et al. Surgery for non-small cell lung cancer: postoperative survival based on the revised tumor-node-metastasis classification and its time trend. Eur J Cardiothorac Surg. 2000;18:147–55.
Ministry of Health and Welfare, National cancer center. National cancer registration Statistics (updated 2012 Jan 5) Available from: http://www.cancer.go.kr/ncic/cics_f/02/022/index.html.
Bonomo L, Ciccotosto C, Guidotti A, Storto ML. Lung cancer staging: the role of computed tomography and magnetic resonance imaging. Eur J Radiol. 1996;23:35–45.
McLoud T, Bourgouin P, Greenberg R, Kosiuk J, Templeton P, Shepard J, et al. Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. Radiology. 1992;182:319–23.
Kubota K. From tumor biology to clinical PET: a review of positron emission tomography (PET) in oncology. Ann Nucl Med. 2001;15:471–86.
Beyer T, Townsend D, Blodgett T. Dual-modality PET/CT tomography for clinical oncology. Q J Nucl Med. 2002;46:24–34.
Gupta NC, Tamim WJ, Graeber GG, Bishop HA, Hobbs GR. Mediastinal lymph node sampling following positron emission tomography with fluorodeoxyglucose imaging in lung cancer staging. Chest. 2001;120:521–7.
Yoon YC, Lee KS, Shim YM, Kim BT, Kim K, Kim TS. Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG PET for presurgical detection—prospective study1. Radiology. 2003;227:764–70.
Scott WJ, Gobar LS, Terry JD, Dewan NA, Sunderland JJ. Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography. J Thorac Cardiovasc Surg. 1996;111:642–8.
Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics. 1999;19:61–77.
An YS, Sun JS, Park KJ, Hwang SC, Park KJ, Sheen SS, et al. Diagnostic performance of 18F-FDG PET/CT for lymph node staging in patients with operable non-small-cell lung cancer and inflammatory lung disease. Lung. 2008;186:327–36.
Kim HY. Staging of lung cancer. J Korean Med Assoc. 2008;51:1118–24.
Glazer G, Orringer M, Gross B, Quint L. The mediastinum in non-small cell lung cancer: CT-surgical correlation. Am J Roentgenol. 1984;142:1101–5.
Beadsmoore C, Screaton N. Classification, staging and prognosis of lung cancer. Eur J Radiol. 2003;45:8–17.
Webb W, Gatsonis C, Zerhouni E, Heelan R, Glazer G, Francis I, et al. CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the radiologic diagnostic oncology group. Radiology. 1991;178:705–13.
Dwamena BA, Sonnad SS, Angobaldo JO, Wahl RL. Metastases from non-small cell lung cancer: mediastinal staging in the 1990s Meta-analytic comparison of PET and CT1. Radiology. 1999;213:530–6.
Hellwig D, Ukena D, Paulsen F, Bamberg M, Kirsch C. Meta-analysis of the efficacy of positron emission tomography with F-18-fluorodeoxyglucose in lung tumors. basis for discussion of the german consensus conference on PET in oncology 2000. Pneumologie. 2001;55:367–77.
Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, et al. Staging of non–small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348:2500–7.
Cerfolio RJ, Ojha B, Bryant AS, Bass CS, Bartalucci AA, Mountz JM. The role of FDG-PET scan in staging patients with nonsmall cell carcinoma. Ann Thorac Surg. 2003;76:861–6.
Schmücking M, Baum R, Bonnet R, Junker K, Müller K. Correlation of histologic results with PET findings for tumor regression and survival in locally advanced non-small cell lung cancer after neoadjuvant treatment. Pathologe. 2005;26:178–89.
Rodríguez Fernández A, Gómez Río M, Llamas Elvira JM, Sánchez-Palencia Ramos A, Bellón Guardia M, Ramos Font C, et al. Diagnosis efficacy of structural (CT) and functional (FDG-PET) imaging methods in the thoracic and extrathoracic staging of non-small cell lung cancer. Clin Transl Oncol. 2007;9:32–9.
Yang W, Fu Z, Yu J, Yuan S, Zhang B, Li D, et al. Value of PET/CT versus enhanced CT for locoregional lymph nodes in non-small cell lung cancer. Lung Cancer. 2008;61:35–43.
Turkmen C, Sonmezoglu K, Toker A, Ylmazbayhan D, Dilege S, Halac M, et al. The additional value of FDG PET imaging for distinguishing N0 or N1 from N2 stage in preoperative staging of non-small cell lung cancer in region where the prevalence of inflammatory lung disease is high. Clin Nucl Med. 2007;32:607–12.
Balogova S, Grahek D, Kerrou K, Montravers F, Younsi N, Aide N, et al. 18F-FDG imaging in apparently isolated pleural lesions. Rev Pneumol Clin. 2003;59:275–88.
Tournoy K, Maddens S, Gosselin R, Van Maele G, Van Meerbeeck J, Kelles A. Integrated FDG-PET/CT does not make invasive staging of the intrathoracic lymph nodes in non-small cell lung cancer redundant: a prospective study. Thorax. 2007;62:696–701.
Kumar A, Dutta R, Kannan U, Kumar R, Khilnani GC, Gupta SD. Evaluation of mediastinal lymph nodes using 18F-FDG PET-CT scan and its histopathologic correlation. Ann Thorac Med. 2011;6:11–6.
Nakamoto Y, Tatsumi M, Hammoud D, Cohade C, Osman MM, Wahl RL. Normal FDG distribution patterns in the head and neck: PET/CT Evaluation1. Radiology. 2005;234:879–85.
Nguyen XC, So Y, Chung JH, Lee WW, Park SY, Kim SE. High correlations between primary tumours and loco-regional metastatic lymph nodes in non-small-cell lung cancer with respect to glucose transporter type 1-mediated 2-deoxy-2-F18-fluoro-D-glucose uptake. Eur J Cancer. 2008;44:692–8.
Kim DW, Kim WH, Kim CG. Dual-time-point FDG PET/CT: is it useful for lymph node staging in patients with non-small-cell lung cancer? Nucl Med Mol Imaging. 2012;46:196–200.
Koksal D, Demirag F, Bayiz H, Ozmen O, Tatci E, Berktas B, et al. The correlation of SUVmax with pathological characteristics of primary tumor and the value of Tumor/Lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients. J Cardiothorac Surg. 2013. doi:10.1186/1749-8090-8-63.
Weder W. Lung cancer: new opportunities—changing algorithm in staging. Ann Oncol. 2008;19 suppl 7:vii28–30.
De Leyn P, Lardinois D, Van Schil PE, Rami-Porta R, Passlick B, Zielinski M, et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardio Thorac Surg. 2007;32:1–8.
Acknowledgments
This research was supported by the 2012 Collaborative Research Program of Nuclear Medical Sciences through the Dongnam Institute of Radiological and Medical Sciences (DIRAMS) funded by the Ministry of Education, Science and Technology (MEST) and Busan Metropolitan City.
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, A.Y., Choi, S.J., Jung, K.P. et al. Characteristics of Metastatic Mediastinal Lymph Nodes of Non-Small Cell Lung Cancer on Preoperative F-18 FDG PET/CT. Nucl Med Mol Imaging 48, 41–46 (2014). https://doi.org/10.1007/s13139-013-0244-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13139-013-0244-2