Detection of Metastatic Disease in Cardiophrenic Lymph Nodes: FDG PET/CT Versus Contrast-Enhanced CT and Implications for Staging and Treatment of Disease

Abstract

Objective: To determine whether FDG PET/CT was more sensitive than CT in detecting metastatic disease in the cardiophrenic space and whether the presence of disease in this location would change the staging and clinical management.Materials and Methods: About 1200 PET/CT scans were retrospectively reviewed over 20 months for the presence of FDG-avid cardiophrenic lymph nodes. The SUVmax was used to quantify the metabolic activity in each of the lymph nodes. The radiographic data was used for correlation. A retrospective review of diagnostic CT reports performed within a 1-month period of time of the PET/CT in the same subset of patients determined whether cardiophrenic lymph nodes were mentioned.Results: About 9 (0.8%) of the 1200 studies were found to have FDG-avid cardiophrenic lymph nodes (four males and five females with a mean age of 55 years; range 7–69, median 59). The mean SUVmax was 2.4 (range 1.2–7.9; median 1.9). Only three of the patients were found to have suspicious lymph nodes on CT. The presence of cardiophrenic lymph nodes had the potential to change the staging and/or management in three of the patients.Conclusion: PET/CT is more accurate in the detection of pathologic cardiophrenic lymph nodes than CT, especially when they are subcentimeter in size. When present, staging and/or management was potentially affected in 33%. Therefore, these nodes should be included in the TNM staging classification.

Prognostic significance of supradiaphragmatic lymph node metastasis detected by 18F-FDG PET/CT in advanced epithelial ovarian cancer

“…The advantage of whole-body PET/CT is that it allows a surgeon to discover suspicious extra- and intra-peritoneal metastases. Farmakis et al found that PET/CT was more accurate than CT alone for identifying CPLNs [ 16 ]. Similarly, Fruscio et al also concluded that PET/CT was a better methodology than CT for detecting distant metastases in AEOC [ 8 ]: PET/CT accurately upstaged 26% of the patients from FIGO stage III to IV during preoperative PET/CT imaging.…”

Survival in Advanced-Stage Epithelial Ovarian Cancer Patients with Cardiophrenic Lymphadenopathy Who Underwent Cytoreductive Surgery: A Systematic Review and Meta-Analysis

“…Interestingly, all patients with PET/CT uptake in CPLN in this study— including those who had received NACT—had histologically positive lymph nodes [ 11 ]. Currently, many studies have demonstrated that PET/CT imaging increases the likelihood of finding CPLN metastases, in comparison with CT imaging, especially when they are <10 mm in size [ 26 , 27 , 41 ]. However, another study suggested that CPLN size ≥ 7 mm in a short axis on CT imaging has 85.7% positive predictive value and 58.8% negative predictive value [ 23 ], which is useful in settings where PET/CT is not always available.…”

Omitting cardiophrenic lymph nodes in the treatment of patients with Hodgkin lymphoma via modified involved-site radiation therapy

“…PET-CT is more sensitive for detecting involved CPLNs. One retrospective review of 1,200 PET-CT scans obtained from cancer patients over a 20-month period revealed that 9 patients had FDG-avid CPLNs, but only 3 of those 9 had evidence of CPLN involvement on CT scanning [23]. Because our patients were all referred for consolidative RT for HL, stage II disease and bulky involvement were common, which also could account for the higher rate of CPLN involvement.…”