Maximum Standard Uptake Value of Mediastinal Lymph Nodes on Integrated FDG-PET-CT Predicts Pathology in Patients with Non-Small Cell Lung Cancer

Bryant, Ayesha S.; Cerfolio, Robert J.; Klemm, Katrin; Ojha, Buddhiwardhan

doi:10.1016/j.athoracsur.2005.12.047

Cited by 148 publications

(130 citation statements)

References 14 publications

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“…Hellwig et al [13] preferred to use 2.5 as cutoff value, instead of 4.5 as their best accuracy, in order to reduce the FN results. In our study the cutoff value for SUVmax determined from the ROC curve was 5.96, which was still in the range of the finding from other studies varying from 4.2 to 6.2 [31][32][33][34], although our study only focused on adenocarcinoma of the lung subjects. The accuracy of CV and SUVmax were similar (83.0 vs 80.9), but the correlation between them was only moderate (R 2 0.4237; calculation is not shown), meaning there were cases of pathology-proven metastatic LNs having a negative finding of SUVmax but positive finding of CV, and also benign LNs having a positive finding of SUV but with a negative finding of CV.…”

Section: Discussionsupporting

confidence: 63%

Heterogeneity Analysis of 18F-FDG Uptake in Differentiating Between Metastatic and Inflammatory Lymph Nodes in Adenocarcinoma of the Lung: Comparison with Other Parameters and its Application in a Clinical Setting

Budiawan

Cheon

et al. 2013

Nucl Med Mol Imaging

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Purpose Lymph node (LN) characterization is crucial in determining the stage and treatment decisions in patient with lung cancer. Although Results Metastatic lymph nodes tended to have higher CVs than the inflammatory LNs. The mean CV of metastatic LNs (0.30±0.08; range: 0.08-0.55) was higher than that of inflammatory LNs (0.17+0.06; range, 0.07-0.32; P<0.0001). On receiver operating characteristic (ROC) curve analysis, the area under curve was 0.901, and using 0.20 as cut-off value, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 88.5 %, 76.2 %, 82.2 %, 84.3, and 83.0 % respectively. Accuracy of CV was slightly higher than SUVmax and diameter, but significantly higher than visual assessment and HUmax. Conclusions In patients with adenocarcinoma of the lung having no prior treatments, metastatic LNs showed more heterogeneous 18 F-FDG uptake than inflammatory LNs. Measuring the CV of the SUV derived from a manual volume of interest (VOI) can be helpful in determining metastatic LN of adenocarcinoma of the lung. Including diagnostic criteria of CV into the diagnostic approach can increase the accuracy of mediastinal node status.

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Section: Discussionsupporting

confidence: 63%

Heterogeneity Analysis of 18F-FDG Uptake in Differentiating Between Metastatic and Inflammatory Lymph Nodes in Adenocarcinoma of the Lung: Comparison with Other Parameters and its Application in a Clinical Setting

Budiawan

Cheon

et al. 2013

Nucl Med Mol Imaging

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“…Values identified in these studies included 4.4 and 5.3, yielding a diagnostic accuracy of 92% and 98%, respectively. [16,17] Although our post-hoc analysis of proposed SUVmax cut-offs suggested that a cut-off of 4.5 conferred an improvement in diagnostic accuracy from 64.0% to 84.7% compared with a cut-off of 2.5, it came at the cost of decreasing the sensitivity from 95.7% to 80.0% and the NPV from 90.6% to 83.5%. As PET-CT is used to exclude mediastinal spread rather than diagnose it, the reduction in NPV renders the cut-off of 4.5 less appropriate for clinical use.…”

Section: Discussionmentioning

confidence: 92%

“…It was therefore subsequently compared with the value identified by the ROC curve with regard to sensitivity, specificity, PPV, NPV and diagnostic accuracy. [16] …”

Section: Statistical Aspectsmentioning

confidence: 99%

Integrated positron emission tomography/computed tomography for evaluation of mediastinal lymph node staging of non-small-cell lung cancer in a tuberculosis-endemic area: A 5-year prospective observational study

et al. 2015

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Background. Integrated positron emission tomography/computed tomography (PET-CT) is a well-validated modality for assessing mediastinal lymph node metastasis in non-small-cell lung cancer (NSCLC), which determines management and predicts survival. Tuberculosis (TB) is known to lead to false-positive PET-CT findings. Objectives. To assess the diagnostic accuracy of PET-CT in identifying mediastinal lymph node involvement of NSCLC in a high TB-endemic area. Methods. Patients who underwent both PET-CT and lymph node tissue sampling for the investigation of suspected NSCLC were prospectively included in this observational study. Results were analysed per patient and per lymph node stage. A post-hoc analysis was performed to test the validity of a maximum standardised uptake value (SUV max) cut-off for lymph node positivity. Results. PET-CT had a sensitivity of 92.6%, specificity of 48.6%, positive predictive value of 56.8% and negative predictive value (NPV) of 90.0% in the per-patient analysis. Diagnostic accuracy was 67.2%. Similar values were obtained in the per-lymph node stage analysis. TB was responsible for 21.1% of false-positive results. A SUVmax cut-off of 4.5 yielded an improvement in diagnostic accuracy from 64.0% to 84.7% compared with a cut-off of 2.5, but at the cost of decreasing the NPV from 90.6% to 83.5%. Conclusion. In a high TB-endemic area, PET-CT remains a valuable method for excluding mediastinal lymph node involvement in NSCLC. Patients with a negative PET-CT may proceed to definitive management without further invasive procedures. However, PET-CT-positive lymph nodes require pathological confirmation, and the possibility of TB must be considered.

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“…EBUS could synergistically complement our system's guidance, but further miniaturization of the EBUS device would be necessary for them to be feasible at peripheral sites. Positron emission tomography (PET) and the recent innovation of combined PET-CT scanners adds yet another tool for procedure planning [61][62][63]. While researchers assert that PET can specifically identify positive cancer sites, its inherent low resolution limits its diagnostic capability for small lesions.…”

Section: Discussionmentioning

confidence: 99%

3D CT-Video Fusion for Image-Guided Bronchoscopy

Higgins¹,

Helferty²,

Lü³

et al. 2008

Computerized Medical Imaging and Graphics

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Bronchoscopic biopsy of the central-chest lymph nodes is an important step for lung-cancer staging. Before bronchoscopy, the physician first visually assesses a patient's three-dimensional (3D) computed tomography (CT) chest scan to identify suspect lymph-node sites. Next, during bronchoscopy, the physician guides the bronchoscope to each desired lymph-node site. Unfortunately, the physician has no link between the 3D CT image data and the live video stream provided during bronchoscopy. Thus, the physician must essentially perform biopsy blindly, and the skill levels between different physicians differ greatly. We describe an approach that enables synergistic fusion between the 3D CT data and the bronchoscopic video. Both the integrated planning and guidance system and the internal CT-video registration and fusion methods are described. Phantom, animal, and human studies illustrate the efficacy of the methods.

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Maximum Standard Uptake Value of Mediastinal Lymph Nodes on Integrated FDG-PET-CT Predicts Pathology in Patients with Non-Small Cell Lung Cancer

Cited by 148 publications

References 14 publications

Heterogeneity Analysis of 18F-FDG Uptake in Differentiating Between Metastatic and Inflammatory Lymph Nodes in Adenocarcinoma of the Lung: Comparison with Other Parameters and its Application in a Clinical Setting

Heterogeneity Analysis of 18F-FDG Uptake in Differentiating Between Metastatic and Inflammatory Lymph Nodes in Adenocarcinoma of the Lung: Comparison with Other Parameters and its Application in a Clinical Setting

Integrated positron emission tomography/computed tomography for evaluation of mediastinal lymph node staging of non-small-cell lung cancer in a tuberculosis-endemic area: A 5-year prospective observational study

3D CT-Video Fusion for Image-Guided Bronchoscopy

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