Is Delayed Image of 18F-FDG PET/CT Necessary for Mediastinal Lymph Node Staging in Non–Small Cell Lung Cancer Patients?

Abstract

The purpose of this study was to evaluate the diagnostic accuracies of dual-time-point (DTP) 18 F-FDG PET/CT for detection of mediastinal lymph node (LN) metastasis in non-small cell lung cancer (NSCLC) patients through a systematic review and meta-analysis. Patients and Methods: The PubMed, Cochrane database, and EMBASE database, from the earliest available date of indexing through October 31, 2021, were searched for studies evaluating diagnostic performance of DTP 18 F-FDG PET/CT for detection of metastatic mediastinal LN in NSCLC patients. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic curves. Results: Ten studies (758 patients) were included in the current study. In patient-based analysis, early image showed a sensitivity of 0.76 and a specificity of 0.75. Delayed image revealed a sensitivity of 0.84 and a specificity of 0.71. In LN-based analysis, early image showed a sensitivity of 0.80 and a specificity of 0.83. Delayed image revealed a sensitivity of 0.84 and a specificity of 0.87. Retention index or %ΔSUV max is superior to early or delayed images of DTP 18 F-FDG PET/CT for detection of mediastinal LN metastasis. Conclusions: Dual-time-point 18 F-FDG PET/CT showed a good diagnostic performances for detection of metastatic mediastinal LNs in NSCLC patients. Early and delayed images of DTP 18 F-FDG PET/CT revealed similar diagnostic accuracies for LN metastasis. However, retention index or %ΔSUV max is superior to early or delayed images of DTP 18 F-FDG PET/CT for detection of mediastinal LN metastasis in NSCLC patients. Further large multicenter studies would be necessary to substantiate the diagnostic accuracy of DTP 18 F-FDG PET/CT for mediastinal LN staging in NSCLC patients.

Optimisation of animal handing and timing of 2-deoxy-2-[18F]fluoro-D-glucose PET tumour imaging in mice

“…A meta-analysis of using delayed [ 18 F]FDG PET for differentiating benign and malignant pulmonary nodules failed to demonstrate a bene t for delayed imaging [13]. Conversely, a meta-analysis of 758 patients concluded that the diagnostic accuracy of [ 18 F]FDG PET for mediastinal lymph node metastases was improved by using the retention index of [ 18 F]FDG calculated from dual time point imaging [12].…”

PET/CT in Staging and Treatment Evaluation of Non-Small Cell Lung Cancer

“…Lee et al [30] used a double check-in time (early and late study) of PET/CT images and concluded that they have an adequate diagnostic system for the detection of metastases in mediastinal nodes in patients with non-small cell lung cancer with the same accuracy in the early and late study. They suggested that multicenter studies should be carried out with this methodology to firmly establish the usefulness of the late images.…”

PET/CT en estadiaje y evaluación del tratamiento en cáncer de pulmón de células no pequeñas

“…Lee y colaboradores (31) utilizan un doble chequeo en el tiempo (estudio temprano y estudio tardío) de las imágenes PET/CT y concluyen que, de esta manera, se tiene un adecuado sistema diagnóstico en la detección de metástasis en ganglios mediastinales en pacientes con cáncer de pulmón de células no pequeñas, teniendo la misma exactitud en el estudio temprano y tardío. Sugieren que se realicen estudios multicéntricos con esta metodología, a fin de establecer firmemente la utilidad de las imágenes tardías.…”