Paul Flechsig1,2,3, Philipp Frank1, Clemens Kratochwil1, Gerald Antoch4, Daniel Rath1, Jan Moltz5, Michael Rieser6, Arne Warth3,7, Hans-Ulrich Kauczor2,3, Lawrence H Schwartz8, Uwe Haberkorn1,9, Frederik L Giesel10,11. 1. Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany. 2. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany. 3. Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany. 4. Department of Diagnostic and Interventional Radiology, University Dusseldorf, 40225, Dusseldorf, Germany. 5. Fraunhofer MEVIS, Institute for Medical Imaging Computing, Bremen, Germany. 6. Department of Nuclear Medicine and Endocrinology, Klinikum Klagenfurt, Klagenfurt, Austria. 7. Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany. 8. Department of Radiology, Columbia University Medical Centre, New York, NY, USA. 9. Clinical Cooperation Unit, Department of Nuclear Medicine, DKFZ, Heidelberg, Germany. 10. Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany. frederik@egiesel.com. 11. Clinical Cooperation Unit, Department of Nuclear Medicine, DKFZ, Heidelberg, Germany. frederik@egiesel.com.
Abstract
PURPOSE: Mediastinal nodal (N)-staging done by integrated 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/x-ray computed tomography (PET/CT) in lung cancer patients is not always accurate. In order to reduce the need for invasive staging procedures, additional surrogate parameters for the detection of malignant lymph node infiltration would be helpful. The purpose of this study was to evaluate if radiomic semi-automated density profiling in mediastinal lymph nodes can improve preclinical N-staging, irrespective of the specific lung cancer entity. PROCEDURES: This retrospective study was approved by the institutional review board. Two hundred forty-eight histologically proven lymph nodes in 122 lung cancer patients were investigated. In malignantly infiltrated lymph nodes, the specific lung cancer entity was histologically classified; benign lymph nodes were histologically classified as benign. Non-contrast enhanced [18F]FDG-PET/CT was performed before surgery/biopsy. Lymph node analyses were performed on the basis of FDG uptake and volumetric CT histogram analysis for metric lymph node sampling. RESULTS: Of the 248 lymph nodes, 118 were benign, 130 malignant. Malignant lymph nodes had a significantly higher median CT density (32.4 Hounsfield units (HU) (min 5.4/max 77.5 HU)) compared to benign lymph nodes (9.3 HU (min -49.5/max 60.4 HU, p < 0.05), irrespective of the histological subtype. The discrimination between different malignant tumour subtypes by means of volumetric density analysis failed. Irrespective of the malignant subtype, a possible cutoff value of 20 HU may help differentiate between benign and malignant lymph nodes. CONCLUSION: Density measurements in unclear mediastinal and hilar lymph nodes with equivocal FDG uptake in PET might serve as a possible surrogate parameter for N-staging in lung cancer patients, irrespective of the specific lung cancer subtype. This could also help to find possible high yield targets in cases where invasive lymph node staging is necessary.
PURPOSE: Mediastinal nodal (N)-staging done by integrated 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/x-ray computed tomography (PET/CT) in lung cancerpatients is not always accurate. In order to reduce the need for invasive staging procedures, additional surrogate parameters for the detection of malignant lymph node infiltration would be helpful. The purpose of this study was to evaluate if radiomic semi-automated density profiling in mediastinal lymph nodes can improve preclinical N-staging, irrespective of the specific lung cancer entity. PROCEDURES: This retrospective study was approved by the institutional review board. Two hundred forty-eight histologically proven lymph nodes in 122 lung cancerpatients were investigated. In malignantly infiltrated lymph nodes, the specific lung cancer entity was histologically classified; benign lymph nodes were histologically classified as benign. Non-contrast enhanced [18F]FDG-PET/CT was performed before surgery/biopsy. Lymph node analyses were performed on the basis of FDG uptake and volumetric CT histogram analysis for metric lymph node sampling. RESULTS: Of the 248 lymph nodes, 118 were benign, 130 malignant. Malignant lymph nodes had a significantly higher median CT density (32.4 Hounsfield units (HU) (min 5.4/max 77.5 HU)) compared to benign lymph nodes (9.3 HU (min -49.5/max 60.4 HU, p < 0.05), irrespective of the histological subtype. The discrimination between different malignant tumour subtypes by means of volumetric density analysis failed. Irrespective of the malignant subtype, a possible cutoff value of 20 HU may help differentiate between benign and malignant lymph nodes. CONCLUSION: Density measurements in unclear mediastinal and hilar lymph nodes with equivocal FDG uptake in PET might serve as a possible surrogate parameter for N-staging in lung cancerpatients, irrespective of the specific lung cancer subtype. This could also help to find possible high yield targets in cases where invasive lymph node staging is necessary.
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