Assessment of intrathoracic lymph nodes by FDG PET/CT in patients with asbestos-related lung cancer

Abstract

Background: This study explored the assessment of intrathoracic lymph node metastasis by 18F-fluoro-2deoxy-D-glucose (FDG) positron emission tomography computed tomography (PET/CT) in patients with asbestos-related lung cancer (ARLC). Methods: We retrospectively reviewed the data on 35 patients with ARLC who underwent preoperative FDG-PET/CT and surgical resection between January 2012 and December 2018. We collected medical information from medical records and imaging systems and examined the FDG uptake in each lymph nodal region resected by surgery and the presence or absence of pathological lymph node metastasis. Results: Pathological lymph node metastases were detected in 14 (8.70%) of 161 nodal stations. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT were 71.4% (10/14), 87.8% (129/147), 35.7% (10/28), 97.0% (129/133), and 86.3% (139/161), respectively.Six of the eight false-positive patients had bilateral accumulations, whereas all six true-positive patients had unilateral accumulation (P=0.006). On histopathological examination, the false-positive nodes showed disruption of lymphoid follicles in the cortex, infiltration of histiocyte-like cells in the medulla, fibrous micronodules, and severe anthracosis. Conclusions: PET/CT scans of patients with ARLC showed comparable sensitivity and specificity to those of PET/CT scans of patients with conventional lung cancer reported in the literature. Many falsepositive cases also showed bilateral symmetric accumulation. This method can be used to evaluate lymph node involvement in lung cancer.

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“…However, several benign pathological conditions including tuberculosis, sarcoidosis, reactive lymphadenopathies and anthracosis can mimic malignancy in terms of 18 F-FDG avidity at these sites. [96][97][98] The risk of malignancy on PET imaging appears to increase with nodal size (>2 cm), irregular contours and heterogeneous density, 99 unilateral accumulation of 18 F-FDG 100 and high standardised uptake value (SUV). The exact SUV cut-off for determining the risk of malignancy ranges between 4.5 and 6.48.…”