Additional value of FDG-PET to contrast enhanced-computed tomography (CT) for the diagnosis of mediastinal lymph node metastasis in non-small cell lung cancer: a Japanese multicenter clinical study

Kubota, Keiichi; Murakami, Koji; Inoue, Tomio; Itoh, Harumi; Saga, Tsuneo; Shiomi, Susumu; Hatazawa, Jun

doi:10.1007/s12149-011-0529-4

Cited by 22 publications

(10 citation statements)

References 27 publications

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“…Interestingly, we found concurrent lung disease or diabetics and non-adenocarcinoma were also risk factors for occult nodal metastasis, although Kubota [18] insisted on that the accuracy of PET/CT were not affected as long as the blood glucose level in diabetic patients was controlled at less than 140mg/dL and Kanzaki [19] thought occult lymph node metastasis more likely to occur in patients of lung adenocarcinoma. Obviously, it showed a distinct trend in this study that there are five diabetic patients of 17 false negative cases.…”

Section: Discussionmentioning

confidence: 83%

Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of 18F-FDG PET/CT

Zheng

et al. 2013

PLoS ONE

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BackgroundIntegrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is widely performed in hilar and mediastinal lymph node (HMLN) staging of non-small cell lung cancer (NSCLC). However, the diagnostic efficiency of PET/CT remains controversial. This retrospective study is to evaluate the accuracy of PET/CT and the characteristics of false negatives and false positives to improve specificity and sensitivity.Methods219 NSCLC patients with systematic lymph node dissection or sampling underwent preoperative PET/CT scan. Nodal uptake with a maximum standardized uptake value (SUVmax) >2.5 was interpreted as PET/CT positive. The results of PET/CT were compared with the histopathological findings. The receiver operating characteristic (ROC) curve was generated to determine the diagnostic efficiency of PET/CT. Univariate and multivariate analysis were conducted to detect risk factors of false negatives and false positives.ResultsThe sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/ CT in detecting HMLN metastases were 74.2% (49/66), 73.2% (112/153), 54.4% (49/90), 86.8% (112/129), and 73.5% (161/219). The ROC curve had an area under curve (AUC) of 0.791 (95% CI 0.723-0.860). The incidence of false negative HMLN metastases was 13.2% (17 of 129 patients). Factors that are significantly associated with false negatives are: concurrent lung disease or diabetes (p<0.001), non-adenocarcinoma (p<0.001), and SUVmax of primary tumor >4.0 (p=0.009). Postoperatively, 45.5% (41/90) patients were confirmed as false positive cases. The univariate analysis indicated age > 65 years old (p=0.009), well differentiation (p=0.002), and SUVmax of primary tumor ≦4.0 (p=0.007) as risk factors for false positive uptake.ConclusionThe SUVmax of HMLN is a predictor of malignancy. Lymph node staging using PET/CT is far from equal to pathological staging account of some risk factors. This study may provide some aids to pre-therapy evaluation and decision-making.

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Section: Discussionmentioning

confidence: 83%

Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of 18F-FDG PET/CT

Zheng

et al. 2013

PLoS ONE

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“…PET scanning is highly sensitive for the detection of mediastinal metastasis [18]. A controlled multicenter clinical study reported that FDG-PET improved diagnosis precision for mediastinal lymph nodes [19]. One of the limitations of the present study was that PET-scanning was initiated in 2004, and not all cases were examined using this method.…”

Section: Discussionmentioning

confidence: 95%

Lymph node ratio as a prognostic factor in patients with pathological N2 non-small cell lung cancer

et al. 2016

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BackgroundThe aim of this study was to investigate whether the lymph node ratio (LNR) was associated with the prognosis of patients, who underwent surgery for pathological N2 non-small cell lung cancer (NSCLC).MethodsA total of 182 patients were diagnosed with pathological N2 disease and underwent complete resection surgeries with systematic lymphadenectomies. We counted the number of positives and removed lymph nodes to calculate a ratio between them (LNR). We also investigated the association between skip mediastinal lymph node metastasis and survival.ResultsUnivariate analysis of survival in patients with N2 NSCLC showed that the T factor, clinical N factor, and LNR were significant prognostic factors. Multivariate analyses showed that the clinical N stage and LNR were significant independent prognostic factors for patients with pathological N2 NSCLC. Patients with a clinical lymph node status of 0 (cN0) and LNR ≤0.22 showed a significantly higher survival rate than patients with a cN1-2 and LNR ≥0.22 and 5-year survival rates were 47.1 and 10.3%, respectively (p < 0.0001).ConclusionsLNR is an important prognostic factor for poor outcome following surgery in patients with N2 disease. The combination of the LNR and cN status provides a valuable prognostic tool.

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“…A similarly designed, larger study from Belgium confirmed the superiority of 18 F-FDG-PET added to CT in the accurate staging of N2/N3 metastasis (Vansteenkiste et al, 1998). Pieterman et al (2000) reported a sensitivity and specificity of 91 and 86% for 18 F-FDG-PET compared with 75 and 66% for CT. A multicenter prospective investigation from Japan similarly demonstrated a statistically significant improvement in the accuracy and specificity of integrated 18 F-FDG-PET/CT with a modern hybrid scanner over standard CT alone in the evaluation of mediastinal lymph nodes (Kubota et al, 2011). A summary of the studies that have evaluated the performance of 18 F-FDG-PET and 18 F-FDG-PET/CT in evaluating the mediastinum is shown in Table 1 .…”

Section: Staging Of the Mediastinummentioning

confidence: 99%

Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer

Cuaron¹,

Dunphy²,

Rimner³

2013

Front. Oncol.

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The integral role of positron-emission tomography (PET) using the glucose analog tracer fluorine-18 fluorodeoxyglucose (FDG) in the staging of non-small cell lung cancer (NSCLC) is well established. Evidence is emerging for the role of PET in response assessment to neoadjuvant therapy, combined-modality therapy, and early detection of recurrence. Here, we review the current literature on these aspects of PET in the management of NSCLC. FDG-PET, particularly integrated 18F-FDG-PET/CT, scans have become a standard test in the staging of local tumor extent, mediastinal lymph node involvement, and distant metastatic disease in NSCLC. 18F-FDG-PET sensitivity is generally superior to computed tomography (CT) scans alone. Local tumor extent and T stage can be more accurately determined with FDG-PET in certain cases, especially in areas of post-obstructive atelectasis or low CT density variation. FDG-PET sensitivity is decreased in tumors <1 cm, at least in part due to respiratory motion. False-negative results can occur in areas of low tumor burden, e.g., small lymph nodes or ground-glass opacities. 18F-FDG-PET-CT nodal staging is more accurate than CT alone, as hilar and mediastinal involvement is often detected first on 18F-FDG-PET scan when CT criteria for malignant involvement are not met. 18F-FDG-PET scans have widely replaced bone scintography for assessing distant metastases, except for the brain, which still warrants dedicated brain imaging. 18F-FDG uptake has also been shown to vary between histologies, with adenocarcinomas generally being less FDG avid than squamous cell carcinomas. 18F-FDG-PET scans are useful to detect recurrences, but are currently not recommended for routine follow-up. Typically, patients are followed with chest CT scans every 3–6 months, using 18F-FDG-PET to evaluate equivocal CT findings. As high 18F-FDG uptake can occur in infectious, inflammatory, and other non-neoplastic conditions, 18F-FDG-PET-positive findings require pathological confirmation in most cases. There is increased interest in the prognostic and predictive role of FDG-PET scans. Studies show that absence of metabolic response to neoadjuvant therapy correlates with poor pathologic response, and a favorable 18F-FDG-PET response appears to be associated with improved survival. Further work is underway to identify subsets of patients that might benefit individualized management based on FDG-PET.

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Additional value of FDG-PET to contrast enhanced-computed tomography (CT) for the diagnosis of mediastinal lymph node metastasis in non-small cell lung cancer: a Japanese multicenter clinical study

Abstract: The addition of FDG-PET to contrast-enhanced CT imaging for the staging of NSCLC improved the diagnostic accuracy for mediastinal lymph node metastasis. FDG-PET improved the precision of the staging of NSCLC and contributed to the surgical decisions.

Cited by 22 publications

References 27 publications

Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of 18F-FDG PET/CT

Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of 18F-FDG PET/CT

Lymph node ratio as a prognostic factor in patients with pathological N2 non-small cell lung cancer

Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer

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