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Differential diagnosis between 18F-FDG-avid metastatic lymph nodes in non-small cell lung cancer and benign nodes on dual-time point PET/CT scan

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Abstract

Objective

To clarify the difference of 18F-FDG uptake kinetics between FDG-avid metastatic lymph nodes (LNs) in patients with non-small-cell lung cancer (NSCLC) and FDG-avid benign LNs associated with various etiologies on dual-time point PET/CT scan, and to determine the optimal parameter for differentiation.

Methods

The subjects were 134 FDG-avid metastatic LNs in 67 patients with NSCLC and 62 FDG-avid benign LNs in 61 patients with various lung disorders including NSCLC. PET/CT scan was performed at 2 time points (at 60 min and at 120 min) after intravenous injection of 4.4 MBq/kg 18F-FDG. The maximum standardized uptake value (SUVmax) on early and delayed scans and the percent change of SUVmax (%ΔSUVmax) were measured at each FDG-avid LN. The optimal parameter for differentiation was determined by the receiver-operating characteristic analysis.

Results

Delayed SUVmax was increased compared with early SUVmax in 114 (85.0%) FDG-avid metastatic LNs and 42 (67.7%) FDG-avid benign LNs, with significant higher delayed SUVmax than early values (7.0 ± 5.0 vs. 5.9 ± 3.4; P < 0.0001, and 3.0 ± 1.3 vs. 2.8 ± 1.0; P < 0.05, respectively). Early and delayed SUVmax and %ΔSUVmax in metastatic LNs were significantly higher than those in benign LNs (P < 0.0001). The optimal parameter for the differentiation was the combined use of early SUVmax > 3.0 or delayed SUVmax > 4.0, yielding sensitivity of 88.8%, specificity of 80.6%, accuracy of 86.2%, negative predictive value of 76.9%, and positive predictive value of 90.6%. It provided better results than the use of early SUVmax > 3.0 alone (P = 0.019) or the optimal parameter for %ΔSUVmax (>5%) (P = 0.012). However, 12 (19.3%) benign LNs were indistinguishable from metastatic LNs.

Conclusions

Although dual-time point PET/CT scan enhances the difference of FDG uptake between FDG-avid metastatic and benign LNs and improves the differentiation when compared with a single scan, biopsy procedure may be still required for accurate assessment of LN status in patients with NSCLC and possible etiologies showing intensive FDG uptake in benign LNs.

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Authors and Affiliations

  1. Department of Radiology, St. Hill Hospital, 1462-3 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan

    Kazuyoshi Suga, Yasuhiko Kawakami & Atsuto Hiyama

  2. Department of Thoracic Surgery, Yamaguchi-Ube Medical Center, Ube, Yamaguchi, Japan

    Kazurou Sugi & Kazutomo Okabe

  3. Department of Imaging Diagnosis, Yamaguchi-Ube Medical Center, Ube, Yamaguchi, Japan

    Tsuneo Matsumoto

  4. Department of Thoracic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan

    Kazuhiro Ueda

  5. Department of Radiology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan

    Nobuyuki Tanaka & Naofumi Matsunaga

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  1. Kazuyoshi Suga
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  2. Yasuhiko Kawakami
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Correspondence to Kazuyoshi Suga.

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Suga, K., Kawakami, Y., Hiyama, A. et al. Differential diagnosis between 18F-FDG-avid metastatic lymph nodes in non-small cell lung cancer and benign nodes on dual-time point PET/CT scan. Ann Nucl Med 23, 523–531 (2009). https://doi.org/10.1007/s12149-009-0268-y

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