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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?

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

This study was to compare 18F-FDG positron emission tomography (PET) with thoracic contrast-enhanced CT (CECT) in the ability of lymph node (LN) staging non-small cell lung cancer (NSCLC) in a tuberculosis-prevalent country. The usefulness of dual time point PET imaging (DTPI) in NSCLC nodal staging was also evaluated.

Methods

We reviewed 96 NSCLC patients (mean age, 65.3 ± 11.7 years) who had received PET studies before their surgery. DTPI were performed on 37 patients (mean age, 64.8 ± 12.2 years) who received an additional scan of thorax 3 h after tracer injection. The accuracies of nodal staging by CECT and PET were evaluated according to final histopathology of hilar and mediastinal LN resected by surgery.

Results

The accuracy for nodal staging by CECT was 65.6% and that by PET was 82.3% (p < 0.05). Six patients were over-staged and 11 were under-staged by PET. Tuberculosis (n = 3, 50%) were mostly responsible for false-positive, while small tumor foci (n = 7, 63.6%) were mostly accountable for false-negative. For the 37 patients with DTPI, 45 min standardized uptake value (SUV) and 3 h SUV for negative LNs are significantly lower than those for positive LNs (p < 0.0001). Nevertheless, the retention index (RI) showed no significant difference between these two groups.

Conclusions

Our study demonstrates that PET is more accurate than CECT in LN staging NSCLC patients in Taiwan where TB is still prevalent. Semi-quantitative SUV method or DTPI with RI does not result in better diagnostic accuracy than visual analysis of PET images.

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Acknowledgment

The study was approved by the institutional review board of National Taiwan University Hospital (NTUH-REC No. 950307) and was supported in part by grant NSC-95-2314-B-002-268-MY2 from the National Science Council, Taiwan.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Ruoh-Fang Yen, Mei-Fang Cheng & Yen-Wen Wu

  2. Thoracic Section, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan

    Ke-Cheng Chen, Jang-Ming Lee & Yung-Chie Lee

  3. Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Yeun-Chung Chang & Jane Wang

Authors
  1. Ruoh-Fang Yen
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  2. Ke-Cheng Chen
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Corresponding author

Correspondence to Yung-Chie Lee.

Additional information

Drs. Yen RF and Chen KC contributed equally to this work.

Financial support: The work was supported in part by grant NSC-95-2314-B-002-268-MY2 from the National Science Council, Taiwan.

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Yen, RF., Chen, KC., Lee, JM. 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 35, 1305–1315 (2008). https://doi.org/10.1007/s00259-008-0733-1

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  • DOI: https://doi.org/10.1007/s00259-008-0733-1

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