Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non–Small-Cell Lung Cancer

Gould, Michael K.; Kuschner, Ware G.; Rydzak, Chara E.; Maclean, Courtney C.; Demas, Anita N; Shigemitsu, Hidenobu; Chan, Jo Kay; Owens, Douglas K

doi:10.7326/0003-4819-139-11-200311180-00013

Cited by 645 publications

(387 citation statements)

References 82 publications

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“…A large meta-analysis reported that the average sensitivity and specificity for LN staging were approximately 85 % and 90 %, respectively [15]. The present study showed comparable sensitivity (84.7 %).…”

Section: Discussionsupporting

confidence: 58%

Dual-time-point FDG PET/CT: Is It Useful for Lymph Node Staging in Patients with Non-Small-Cell Lung Cancer?

Kim

2012

Nucl Med Mol Imaging

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Purpose Dual-time-point (DTP) FDG PET/CT has been shown to be useful for lymph node (LN) staging in patients with non-small-cell lung cancer (NSCLC). The aim of this study was to evaluate the LN staging ability of DTP FDG PET/CT in the predominant area of pulmonary tuberculosis. Methods Sixty-nine NSCLC patients underwent DTP PET/ CT. Regions of interest were placed on each LN of each station, and the maximum SUVs were measured. Three variables were obtained: (1) the SUV on the early scan (SUV early ), (2) the SUV on the delayed scan (SUV delayed ), and (3) the retention index of the SUV (RI). Each patient had one final LN stage and three other LN stages according to the cutoff values of SUV early , SUV delayed , and RI. Results In the LN-based analysis, the area under the ROC curve of SUV delayed (0.884) was significantly larger (P< 0.01) than those of SUV early (0.868) and RI (0.717). Among the three variables, SUV delayed was more accurate (P<0.01) for detecting the mediastinal LN metastasis than SUV early and RI. In the patient-based analysis, SUV delayed had correctly determined LN stages in 55 of 69 patients (sensitivity, specificity, and accuracy088.7 %, 50.0 %, and 79.7 %), whereas SUV early and RI correctly determined LN stages in 53 and 52 patients, respectively. Conclusions In this study, comparing the diagnostic efficacy of SUV early , SUV delayed , and RI for LN staging in patients with NSCLC, SUV delayed was the most accurate variable for LN staging. DTP PET/CT could provide improved diagnostic accuracy for the LN staging of NSCLC.

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Section: Discussionsupporting

confidence: 58%

Dual-time-point FDG PET/CT: Is It Useful for Lymph Node Staging in Patients with Non-Small-Cell Lung Cancer?

Kim

2012

Nucl Med Mol Imaging

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“…I ntegrated positron emission tomography/x-ray computed tomography (PET/CT) imaging is widely used for the diagnosis and staging of patients with various types of thoracic lesions [1][2][3]. However, PET data acquisition occurs over many respiratory cycles and as such, accurate evaluation of thoracic lesions on PET/CT may prove challenging due to respiratory motion during imaging.…”

Section: Introductionmentioning

confidence: 99%

Application of Partial Volume Effect Correction and 4D PET in the Quantification of FDG Avid Lung Lesions

et al. 2014

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Purpose: The aim of this study is to assess a software-based method with semiautomated correction for partial volume effect (PVE) to quantify the metabolic activity of pulmonary malignancies in patients who underwent non-gated and respiratory-gated 2-deoxy-2-[ 18 F]fluoro-D-glucose (FDG)-positron emission tomography (PET)/x-ray computed tomography(CT). Procedures: The study included 106 lesions of 55 lung cancer patients who underwent respiratory-gated FDG-PET/CT for radiation therapy treatment planning. Volumetric PET/CT parameters were determined by using 4D PET/CT and non-gated PET/CT images. We used a semiautomated program employing an adaptive contrast-oriented thresholding algorithm for lesion delineation as well as a lesion-based partial volume effect correction algorithm. We compared respiratory-gated parameters with non-gated parameters by using pairwise comparison and interclass correlation coefficient assessment. In a multivariable regression analysis, we also examined factors, which can affect quantification accuracy, including the size of lesion and the location of tumor. Results: This study showed that quantification of volumetric parameters of 4D PET/CT images using an adaptive contrast-oriented thresholding algorithm and 3D lesion-based partial volume correction is feasible. We observed slight increase in FDG uptake by using PET/CT volumetric parameters in comparison of highest respiratory-gated values with non-gated values. After correction for partial volume effect, the mean standardized uptake value (SUVmean) and total lesion glycolysis (TLG) increased substantially (p value G0.001). However, we did not observe a clinically significant difference between partial volume corrected parameters of respiratory-gated and non-gated PET/CT scans. Regression analysis showed that tumor volume was the main predictor of quantification inaccuracy caused by partial volume effect.Electronic supplementary material The online version of this article (doi:10.1007/s11307-014-0776-6) contains supplementary material, which is available to authorized users.Correspondence to: Abass Alavi; e-mail: abass.alavi@uphs.upenn.edu Conclusions: Based on this study, assessment of volumetric PET/CT parameters and partial volume effect correction for accurate quantification of lung malignant lesions by using respiratory non-gated PET images are feasible and it is comparable to gated measurements. Partial volume correction increased both the respiratory-gated and non-gated values significantly and appears to be the dominant source of quantification error of lung lesions.

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“…Mediastinoscopic (McNeill and Chamberlain, 1966) or VATS approaches are usually reserved for cases when other measures cannot yield the diagnosis. There have been still very limited reports about the application of VATS in the diagnosis of sarcoidosis in (Massone et al, 2003;Ohmichi, 2002;Nakayama et al, 2000;Gould et al, 2003). In TB high prevalence area, patients with hilar or mediastinal lymphadenopathy should be differentiated pathologically between sarcoidosis and tubeculosis (Nakayama et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Experiences and benefits of positron emitted tomography-computed tomography (PET-CT) combined with video-assisted thoracoscopic surgery (VATS) in the diagnosis of Stage 1 sarcoidosis

Luh

Wang

et al. 2007

J. Zhejiang Univ. - Sci. B

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Abstract:Background: The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery (VATS) combined with positron emitted tomography (PET)-computed tomography (CT) in the diagnosis of patients with early (Stage 1) sarcoidosis. Methods: From 1995 to 2006, seven patients (two males, five females), with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis (mediastinal or hilar lymph nodes involvements without lung involvement) by histological examination of intrathoracic lymph nodes (LNs) and/or lung parenchyma taken from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results: All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satisfactory results. Conclusion: VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic alternative of transbronchial lung biopsy (TBLB), and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.

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Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non–Small-Cell Lung Cancer

Abstract: Positron emission tomography with 18-fluorodeoxyglucose is more accurate than CT for mediastinal staging. Positron emission tomography with 18-fluorodeoxyglucose is more sensitive but less specific when CT shows enlarged mediastinal lymph nodes.

Cited by 645 publications

References 82 publications

Dual-time-point FDG PET/CT: Is It Useful for Lymph Node Staging in Patients with Non-Small-Cell Lung Cancer?

Dual-time-point FDG PET/CT: Is It Useful for Lymph Node Staging in Patients with Non-Small-Cell Lung Cancer?

Application of Partial Volume Effect Correction and 4D PET in the Quantification of FDG Avid Lung Lesions

Experiences and benefits of positron emitted tomography-computed tomography (PET-CT) combined with video-assisted thoracoscopic surgery (VATS) in the diagnosis of Stage 1 sarcoidosis

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