Hitoshi Dejima1,2, Hiroaki Kuroda1, Yuko Oya3, Noriaki Sakakura1, Yoshitaka Inaba4, Tsuneo Tamaki5, Yasushi Yatabe2, Yukinori Sakao1. 1. Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 2. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan. 3. Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan. 4. Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan. 5. Nagoya Radiological Diagnosis Foundation, Nagoya, Japan.
Abstract
BACKGROUND: Volumetric parameters based on 3-dimensional reconstruction have recently been introduced for cancer staging. We aimed to improve the ability to diagnose hilar lymph node metastasis in patients with non-small cell lung cancer. METHODS: We evaluated 142 patients with non-small cell lung cancer who underwent right upper lobectomy and radical lymph node dissection. Metastatic involvement of right upper lobar lymph nodes was assessed using high-resolution computed tomography (HRCT) and 18F-2-floro-2-deoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). RESULTS: On receiver operating characteristic (ROC) curve analysis, the area under the curves (AUC) for short axis, maximum of standardized uptake value (SUVmax), total lesion glycolysis (TLG) and modified TLG (mTLG) were 0.79, 0.77, 0.76, and 0.87, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mTLG, using the optimal cut off value (2.45), for diagnosis of lobar lymph node metastasis were 71%, 88%, 44%, and 96%, respectively. Hilar asymmetric uptake (HAU) of FDG was larger in true-positive cases than in false-negative cases (P<0.01). Furthermore, the size of metastatic foci in the lymph node was smaller in false-negative cases (P=0.012). CONCLUSIONS: Modified TLG is a good parameter to diagnose metastatic right upper lobar lymph nodes. Micrometastasis in the lymph node is difficult to predict using the current diagnostic method. However, more careful evaluation is required in patients with symmetric FDG accumulation at hilar region because hilar lymph nodes respond to various causes such as benign pulmonary diseases.
BACKGROUND: Volumetric parameters based on 3-dimensional reconstruction have recently been introduced for cancer staging. We aimed to improve the ability to diagnose hilar lymph node metastasis in patients with non-small cell lung cancer. METHODS: We evaluated 142 patients with non-small cell lung cancer who underwent right upper lobectomy and radical lymph node dissection. Metastatic involvement of right upper lobar lymph nodes was assessed using high-resolution computed tomography (HRCT) and 18F-2-floro-2-deoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). RESULTS: On receiver operating characteristic (ROC) curve analysis, the area under the curves (AUC) for short axis, maximum of standardized uptake value (SUVmax), total lesion glycolysis (TLG) and modified TLG (mTLG) were 0.79, 0.77, 0.76, and 0.87, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mTLG, using the optimal cut off value (2.45), for diagnosis of lobar lymph node metastasis were 71%, 88%, 44%, and 96%, respectively. Hilar asymmetric uptake (HAU) of FDG was larger in true-positive cases than in false-negative cases (P<0.01). Furthermore, the size of metastatic foci in the lymph node was smaller in false-negative cases (P=0.012). CONCLUSIONS: Modified TLG is a good parameter to diagnose metastatic right upper lobar lymph nodes. Micrometastasis in the lymph node is difficult to predict using the current diagnostic method. However, more careful evaluation is required in patients with symmetric FDG accumulation at hilar region because hilar lymph nodes respond to various causes such as benign pulmonary diseases.
Authors: Christophe Van de Wiele; Vibeke Kruse; Peter Smeets; Mike Sathekge; Alex Maes Journal: Eur J Nucl Med Mol Imaging Date: 2012-11-14 Impact factor: 9.236