The Additional Value of FDG PET Imaging for Distinguishing N0 or N1 From N2 Stage in Preoperative Staging of Non-small Cell Lung Cancer in Region Where the Prevalence of Inflammatory Lung Disease Is High

Türkmen, Cüneyt; Sönmezoğlu, Kerim; Toker, Alper; Yılmazbayhan, Dilek; Dilege, Şükrü; Halaç, Metin; Erelel, Mustafa; Ece, Turhan; Mudun, Ayşe

doi:10.1097/rlu.0b013e3180a1ac87

Cited by 38 publications

(32 citation statements)

References 27 publications

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“…The sensitivity and specificity for lymph node staging of lung cancer in one tuberculosis-endemic country were 92.3 and 95%, respectively, which were comparable to those of previous meta-analyses [24], whereas the sensitivity in another tuberculosis-endemic country, in which lymph nodes with high attenuation on CT or calcification were considered benign, decreased to 61% (specificity = 96%) [18]. In other region with a high prevalence of inflammatory lung disease, both sensitivity and specificity decreased to 79 and 76% for N0 and N1 lymph nodes and 76 and 79% for N2 lymph nodes [17]. However, because those previous studies did not show the incidence of inflammatory lung disease in their countries or the proportion of inflammatory lung disease among their patients, a direct effect of pulmonary inflammation on the diagnostic ability of PET could not be evaluated accurately.…”

Section: Discussionsupporting

confidence: 74%

“…False-positive 18 F-FDG uptake could be caused by granulation tissue, inflammatory condition, physiologic uptake, or artifact (Fig. 3) [5,12,[20][21][22], whereas false-negative 18 F-FDG uptake could be caused by by small size, micrometastasis, or proximity of the lymph node to widespread pleural metastasis and huge primary mass [10,17,23].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies suggest that the diagnostic performance of 18 F-FDG PET/CT in lung cancer was lower in patients with inflammatory lung disease [17][18][19]24]. The sensitivity and specificity for lymph node staging of lung cancer in one tuberculosis-endemic country were 92.3 and 95%, respectively, which were comparable to those of previous meta-analyses [24], whereas the sensitivity in another tuberculosis-endemic country, in which lymph nodes with high attenuation on CT or calcification were considered benign, decreased to 61% (specificity = 96%) [18].…”

Section: Discussionmentioning

confidence: 99%

“…Since Korea is an endemic area of tuberculosis, diagnostic accuracy of 18 F-FDG PET/CT in lung cancer staging would be lower than expected. In a recent study it has been suggested that the diagnostic accuracy of 18 F-FDG PET for mediastinal lymph node staging is not enough to replace mediastinoscopy in regions with high prevalence of inflammatory lung disease [17]. Moreover, a clinical study showed somewhat low sensitivity (61%) of 18 F-FDG PET/CT for mediastinal lymph node staging in a tuberculosis-endemic country [18].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of 18F-FDG PET/CT for Lymph Node Staging in Patients with Operable Non-small-cell Lung Cancer and Inflammatory Lung Disease

Sun

Park

et al. 2008

Lung

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As 18 F-fluorodeoxyglucose (FDG) is taken up by inflammatory lymph nodes, it could be falsely interpreted as metastasis. Therefore, we evaluated the diagnostic ability of positron emission tomography/computed tomography (PET/CT) for lymph node staging of lung cancer when inflammatory lung disease coexisted. Patients with operable non-small-cell lung cancer and FDG-avid lymph nodes were retrospectively classified into two groups; those with inflammatory lung disease (ILD) and those without it (NILD). Receiver operating characteristic (ROC) curve analysis was performed for maximum standardized uptake value (SUVmax), pattern of FDG uptake, maximum Hounsfield unit, and size, and then the areas under the ROC curves (AUCs) were compared between subgroups. There were 124 patients (ILD/ NILD = 38/86) and 396 FDG-avid lymph nodes (ILD/ NILD = 140/256). The average number of FDG-avid lymph nodes was greater in ILD (3.7 vs. 2.9, p = 0.039), whereas the proportion of metastasis was higher in NILD (25.4% vs. 11.4%, p = 0.002). With all N1-N3 lymph nodes and the NILD group, the AUC values of all four parameters were significantly greater than 0.5 (p \ 0.05), and SUVmax was the most valuable parameter for lymph node metastasis. However, in the ILD group, only the AUC value of SUVmax was significantly greater than 0.5. These results were reproduced when analyses were performed with N1-N2 lymph nodes. In conclusion, SUVmax was the most valuable PET/CT parameter for assessment of lymph node metastasis in patients with operable non-small-cell lung cancer. In addition, it was the only valuable parameter when inflammatory lung disease coexisted.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of 18F-FDG PET/CT for Lymph Node Staging in Patients with Operable Non-small-cell Lung Cancer and Inflammatory Lung Disease

Sun

Park

et al. 2008

Lung

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“…He pointed out that the causes of PET false negative cases were micro-metastases, necrosis and PET limited spatial resolution [36].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of PET/CT with FDG in mediastinal lymph node staging of patients with NSCLC

Pelosi¹,

Billè²,

Skanjeti³

et al. 2010

Health

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PET/CT and contrast enhancement CT (CECT) are the two fundamental non-invasive exams in the preoperative staging of patients with non small cell lung cancer (NSCLC). In the staging of the mediastinum, recent studies show that PET is more accurate than CECT, with an average sensitivity and specificity of 85 vs. 61% and 90 vs. 79%, respectively. However, thanks to its specificity value of 100%, the gold standard remains the mediastinoscopy. The aim of this study was to evaluate the PET/CT accuracy in the intrathoracic lymph node staging. Three hundred and five consecutive patients with proven or suspected non-small cell lung cancer who had an integrated PET/CT study were retrospectively evaluated. Lymph node staging was pathologically confirmed on tissue specimens obtained at surgery. A med-line research of papers on accuracy of integrated PET/CT in lymph node staging was also carried out. In this population of patients, a total of 1972 lymph node stations were evaluated. Integrated PET/CT correctly staged 247 out of 305 patients: 188 of 214 (87.8%) N0 patients, 34 of 40 (85.0%) N1 patients and 25 of 51 (49.0%) N2/N3 patients. PET/CT understaged 32 patients (10.5%) and overstaged 26 patients (8.5%). One hundred and forty-three lymph nodes were proved positive for malignancy. PET/CT correctly identified 89 metastatic lymph node stations. The overall sensitivity, specificity, positive and negative predictive value and accuracy of PET/CT were 64.8%, 87.9%, 69.4%, 85.5%, and 81.0% on a per-patient basis and 62.2%, 97.9%, 69.5%, 97.1%, and 95.3%, on a per-nodal-station basis, respectively. According to nodal size, PET/CT correctly identified 67 out of 77 (87.0%) metastatic lymph node stations with a short-axis diameter ≥ 10 mm, and 22 out of 66 (33.3%) metastatic lymph node stations with a short-axis diameter < 10 mm (p<0.001). The incidence of false negative lymph node metastases at PET/CT was higher in patients with adenocarcinoma (42 out of 54). These data are in agreement with the published literature and confirm that integrated PET/CT is more accurate than CT in detecting nodal metastases; however, the PET/CT exam is not enough accurate to substitute mediastinoscopy.

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Initial experience of MR/PET in a clinical cancer center

Partovi

Robbin

Steinbach

et al. 2013

Magnetic Resonance Imaging

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Magentic Resonance/positron emission tomography (PET) has been introduced recently for imaging of clinical patients. This hybrid imaging technology combines the inherent strengths of MRI with its high soft-tissue contrast and biological sequences with the inherent strengths of PET, enabling imaging of metabolism with a high sensitivity. In this article, we describe the initial experience of MR/PET in a clinical cancer center along with a review of the literature. For establishing MR/PET in a clinical setting, technical challenges, such as attenuation correction and organizational challenges, such as workflow and reimbursement, have to be overcome. The most promising initial results of MR/PET have been achieved in anatomical areas where high soft-tissue and contrast resolution is of benefit. Head and neck cancer and pelvic imaging are potential applications of this hybrid imaging technology. In the pediatric population, MR/PET can decrease the lifetime radiation dose. MR/PET protocols tailored to different types of malignancies need to be developed. After the initial exploration phase, large multicenter trials are warranted to determine clinical indications for this exciting hybrid imaging technology and thereby opening new horizons in molecular imaging.

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The Additional Value of FDG PET Imaging for Distinguishing N0 or N1 From N2 Stage in Preoperative Staging of Non-small Cell Lung Cancer in Region Where the Prevalence of Inflammatory Lung Disease Is High

Cited by 38 publications

References 27 publications

Diagnostic Performance of 18F-FDG PET/CT for Lymph Node Staging in Patients with Operable Non-small-cell Lung Cancer and Inflammatory Lung Disease

Diagnostic Performance of 18F-FDG PET/CT for Lymph Node Staging in Patients with Operable Non-small-cell Lung Cancer and Inflammatory Lung Disease

Accuracy of PET/CT with FDG in mediastinal lymph node staging of patients with NSCLC

Initial experience of MR/PET in a clinical cancer center

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