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Kandemir O, Demir F. An Investigation of the Relationship Between 18F-FDG PET/CT Parameters of Primary Tumors and Lymph Node Metastasis in Resectable Non-small Cell Lung Cancer. Curr Radiopharm 2024; 17:111-116. [PMID: 37644744 DOI: 10.2174/1874471016666230829100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Mediastinal lymph node metastasis is an important prognostic factor in non-small cell lung cancer (NSCLC) patients without distant metastases. 18F-2-fluoro-2-deoxy-Dglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) is recommended for detecting and staging lymph nodes and distant metastases in NSCLC patients. OBJECTIVE This study aims to investigate whether maximum standardized uptake (SUVmax), mean standardized uptake (SUVmean), metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG) values of the primary tumor measured by 18F-FDG PET/CT in resectable NSCLC can predict preoperative lymph node metastasis. METHODS This retrospective study included eighty NSCLC patients who underwent preoperative Positron Emission Tomography/Computed Tomography (PET/CT) for diagnosis and staging. The patients were stage I-III and had no distant metastases. Tumor metabolic parameters such as SUVmax, SUVmean, MTV, and TLG at PET/CT imaging were measured for preoperative diagnosis and staging, and the postoperative pathology results of the patients were examined. The pathology results divided patients with and without lymph node metastasis into two groups. The groups were compared with the student's t-test and chi-square test regarding 18F-FDG PET/CT tumor metabolic parameters and other parameters. RESULTS Fifteen (18.8%) patients were female, and 65 (81.3%) were male. According to the postoperative pathology results, while 30 (37.5%) patients had lymph node metastasis, 50 (62.5%) did not. There was a significant difference between the groups regarding tumor SUVmax and SUVmean values (p = 0.036, p = 0.045). Overall survival in the N0 group was significantly higher than in the N1 + N2 group (p = 0.034); median survival was 30.2 months in N0 cases and 27.3 months in N1 and N2 groups. CONCLUSION SUVmax and SUVmean values are significantly higher in patients with lymph node metastases than in patients without lymph node metastases, and this finding may provide useful information for predicting lymph node metastasis in patients with resectable NSCLC.
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Affiliation(s)
- Ozan Kandemir
- Department of Nuclear Medicine, Faculty of Medicine, Sıtkı Kocman University, Mugla, Turkey
| | - Fadime Demir
- Nuclear Medicine Department, Kayseri City Health Application and Research Center, Health Sciences University, Kayseri, Turkey
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Kidera E, Koyasu S, Hirata K, Hamaji M, Nakamoto R, Nakamoto Y. Convolutional neural network-based program to predict lymph node metastasis of non-small cell lung cancer using 18F-FDG PET. Ann Nucl Med 2024; 38:71-80. [PMID: 37755604 DOI: 10.1007/s12149-023-01866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To develop a convolutional neural network (CNN)-based program to analyze maximum intensity projection (MIP) images of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) positron emission tomography (PET) scans, aimed at predicting lymph node metastasis of non-small cell lung cancer (NSCLC), and to evaluate its effectiveness in providing diagnostic assistance to radiologists. METHODS We obtained PET images of NSCLC from public datasets, including those of 435 patients with available N-stage information, which were divided into a training set (n = 304) and a test set (n = 131). We generated 36 maximum intensity projection (MIP) images for each patient. A residual network (ResNet-50)-based CNN was trained using the MIP images of the training set to predict lymph node metastasis. Lymph node metastasis in the test set was predicted by the trained CNN as well as by seven radiologists twice: first without and second with CNN assistance. Diagnostic performance metrics, including accuracy and prediction error (the difference between the truth and the predictions), were calculated, and reading times were recorded. RESULTS In the test set, 67 (51%) patients exhibited lymph node metastases and the CNN yielded 0.748 predictive accuracy. With the assistance of the CNN, the prediction error was significantly reduced for six of the seven radiologists although the accuracy did not change significantly. The prediction time was significantly reduced for five of the seven radiologists with the median reduction ratio 38.0%. CONCLUSION The CNN-based program could potentially assist radiologists in predicting lymph node metastasis by increasing diagnostic confidence and reducing reading time without affecting diagnostic accuracy, at least in the limited situations using MIP images.
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Affiliation(s)
- Eitaro Kidera
- Department of Radiology, Kishiwada City Hospital, Kishiwada, Japan
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto University, Kyoto, Japan
| | - Ryusuke Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Kanou T, Funaki S, Minami M, Ose N, Kimura T, Fukui E, Watabe T, Shintani Y. Usefulness of positron-emission tomography for predicting the World Health Organization grade of thymic epithelial tumors. Thorac Cancer 2022; 13:1651-1656. [PMID: 35460177 PMCID: PMC9161332 DOI: 10.1111/1759-7714.14434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background It is often difficult to distinguish between thymoma and thymic carcinoma by preoperative radiological tests. While there have been some reports that the maximum standardized uptake value (SUVmax) in positron emission tomography‐computed tomography (PET‐CT) is useful to this end, no large‐scale analysis has been performed. We therefore analyzed the usefulness of the SUVmax and tumor size (TS) for differentiating thymic epithelial tumors. Methods From 2011 to 2019, 129 patients with thymic epithelial tumor who underwent PET‐CT before surgical treatment were enrolled. The relevance of the SUVmax to the World Health Organization (WHO) histological type was assessed. To reduce the impact of the TS, the ratio of the SUVmax to the TS was also investigated. Results A total of 99 thymoma cases and 30 thymic carcinoma cases were enrolled into the study. The SUVmax and SUVmax/TS of thymic carcinoma were significantly higher than those of thymoma (SUVmax: 7.7 ± 3.4 vs. 3.3 ± 1.3, p < 0.01; SUVmax/TS: 1.5 ± 0.7 vs. 0.6 ± 0.4, p < 0.01). Focusing on the patients with a moderate SUVmax of ≤5 (84 thymoma and 4 thymic carcinoma), the SUVmax/TS values of thymic carcinoma were still significantly higher than those of thymoma (1.6 ± 0.8 vs. 0.6 ± 0.4, p < 0.01). Conclusions PET‐CT might provide significant information for differentiating images of thymoma and thymic carcinoma. We experienced several cases of thymic carcinoma with a moderate SUVmax of ≤5, and SUVmax/TS was considered a useful parameter for differentiating such cases.
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Affiliation(s)
- Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Kimura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Watabe
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Smith DE, Fernandez Aramburu J, Da Lozzo A, Montagne JA, Beveraggi E, Dietrich A. Accuracy of positron emission tomography and computed tomography (PET/CT) in detecting nodal metastasis according to histology of non-small cell lung cancer. Updates Surg 2019; 71:741-746. [PMID: 31552569 DOI: 10.1007/s13304-019-00680-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Abstract
Positron emission tomography and computed tomography (PET-CT) is the non-invasive gold standard method for determining the oncological stage of patient with diagnosis of lung cancer. A correct preoperative staging is significant because only patients who do not have a history of regional or distant disease are those who will benefit from a surgical treatment. However, due to the different values of the PET-CT in terms of sensitivity and specificity to evaluate the mediastinal lymph node involvement, it is often necessary to perform a surgical mediastinal sampling through a cervical video mediastinoscopy (VM). Patient's risk factors which could modify the results of the PET scan, performing differences between non-invasive staging and the lymph node sampling due to VM are not yet clearly established in the literature. This knowledge will allow to identify in whom a surgical staging by sampling the mediastinal lymph nodes is needed. We included 234 patients with diagnosis of lung cancer who underwent a mediastinal lymph node staging by PET-CT images and histopathological results of mediastinal sampling by VM, analyzing the sensitivity and specificity of this non-invasive imaging study. We also analyzed variables that could modify the results of PET-CT, such as tumor type, location of the tumor and patient's history. We showed that those PET-CT presented an overall sensitivity and specificity of 93.8 and 62.7%, respectively, with negative and positive predictive values of 95.05 and 57.1%, respectively. The false-positive rate was 25% (57 of 234 patients). Analyzing risk factors involved in this false-positive rate (n = 57), we found that the only statistically significant factor that could explain these results was the histology of squamous carcinoma (p < 0.03). In this group of patients, it is essential to perform a mediastinal lymph node biopsy to know the real state of lymph node involvement.
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Affiliation(s)
- David E Smith
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Julian Fernandez Aramburu
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Alejandro Da Lozzo
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Juan A Montagne
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Enrique Beveraggi
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Agustin Dietrich
- Thoracic Surgery and Lung Transplant Section, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina.
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Dejima H, Kuroda H, Oya Y, Sakakura N, Inaba Y, Tamaki T, Yatabe Y, Sakao Y. Evaluation of lobar lymph node metastasis in non-small cell lung carcinoma using modified total lesion glycolysis. J Thorac Dis 2019; 10:6932-6941. [PMID: 30746239 DOI: 10.21037/jtd.2018.11.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Hitoshi Dejima
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuko Oya
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tsuneo Tamaki
- Nagoya Radiological Diagnosis Foundation, Nagoya, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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Takahashi Y, Suzuki S, Matsutani N, Kawamura M. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of clinically node-negative non-small cell lung cancer. Thorac Cancer 2019; 10:413-420. [PMID: 30666803 PMCID: PMC6397908 DOI: 10.1111/1759-7714.12978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/24/2018] [Accepted: 12/24/2018] [Indexed: 12/21/2022] Open
Abstract
One in four non-small cell lung cancer (NSCLC) patients are diagnosed at an early-stage. Following the results of the National Lung Screening Trial that demonstrated a survival benefit for low-dose computed tomography screening in high-risk patients, the incidence of early-stage NSCLC is expected to increase. Use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography during initial diagnosis of these early-stage lesions has been increasing. Traditionally, positron emission tomography/computed tomography scans have been utilized for mediastinal nodal staging and to rule out distant metastases in suspected early-stage NSCLC. In clinically node-negative NSCLC, the use of sublobar resection and selective lymph node dissection has been increasing as a therapeutic option. The higher rate of locoregional recurrences after limited resection and the significant incidence of occult lymph node metastases underscores the need to further stratify clinically node-negative NSCLC in order to select patients for limited resection versus lobectomy with complete mediastinal lymph node dissection. In this report, we review the published data, and discuss the significance and potential role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography evaluation for clinically node-negative NSCLC. Consequently, the literature review demonstrates that maximum standardized uptake value is a predictive factor for occult nodal metastasis with an accuracy of 55-77%. In addition, maximum standardized uptake value is a predictor for worse overall, as well as disease-free, survival.
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Affiliation(s)
- Yusuke Takahashi
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Sagamihara, Japan.,Department of General Thoracic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeki Suzuki
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Noriyuki Matsutani
- Department of General Thoracic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masafumi Kawamura
- Department of General Thoracic Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Pak K, Kim K, Kim MH, Eom JS, Lee MK, Cho JS, Kim YS, Kim BS, Kim SJ, Kim IJ. A decision tree model for predicting mediastinal lymph node metastasis in non-small cell lung cancer with F-18 FDG PET/CT. PLoS One 2018; 13:e0193403. [PMID: 29486012 PMCID: PMC5828356 DOI: 10.1371/journal.pone.0193403] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 02/03/2018] [Indexed: 11/18/2022] Open
Abstract
We aimed to develop a decision tree model to improve diagnostic performance of positron emission tomography/computed tomography (PET/CT) to detect metastatic lymph nodes (LN) in non-small cell lung cancer (NSCLC). 115 patients with NSCLC were included in this study. The training dataset included 66 patients. A decision tree model was developed with 9 variables, and validated with 49 patients: short and long diameters of LNs, ratio of short and long diameters, maximum standardized uptake value (SUVmax) of LN, mean hounsfield unit, ratio of LN SUVmax and ascending aorta SUVmax (LN/AA), and ratio of LN SUVmax and superior vena cava SUVmax. A total of 301 LNs of 115 patients were evaluated in this study. Nodular calcification was applied as the initial imaging parameter, and LN SUVmax (≥3.95) was assessed as the second. LN/AA (≥2.92) was required to high LN SUVmax. Sensitivity was 50% for training dataset, and 40% for validation dataset. However, specificity was 99.28% for training dataset, and 96.23% for validation dataset. In conclusion, we have developed a new decision tree model for interpreting mediastinal LNs. All LNs with nodular calcification were benign, and LNs with high LN SUVmax and high LN/AA were metastatic Further studies are needed to incorporate subjective parameters and pathologic evaluations into a decision tree model to improve the test performance of PET/CT.
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Affiliation(s)
- Kyoungjune Pak
- Department of Nuclear Medicine of Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute of Pusan National University Hospital, Busan, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine of Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute of Pusan National University Hospital, Busan, Republic of Korea
| | - Mi-Hyun Kim
- Biomedical Research Institute of Pusan National University Hospital, Busan, Republic of Korea
- Department of Internal Medicine of Pusan National University Hospital, Busan, Republic of Korea
| | - Jung Seop Eom
- Biomedical Research Institute of Pusan National University Hospital, Busan, Republic of Korea
- Department of Internal Medicine of Pusan National University Hospital, Busan, Republic of Korea
| | - Min Ki Lee
- Biomedical Research Institute of Pusan National University Hospital, Busan, Republic of Korea
- Department of Internal Medicine of Pusan National University Hospital, Busan, Republic of Korea
| | - Jeong Su Cho
- Biomedical Research Institute of Pusan National University Hospital, Busan, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery of Pusan National University Hospital, Busan, Republic of Korea
| | - Yun Seong Kim
- Department of Internal Medicine of Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology of of Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Bum Soo Kim
- Research Institute for Convergence of Biomedical Science and Technology of of Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Nuclear Medicine of Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seong Jang Kim
- Research Institute for Convergence of Biomedical Science and Technology of of Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Nuclear Medicine of Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - In Joo Kim
- Department of Nuclear Medicine of Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute of Pusan National University Hospital, Busan, Republic of Korea
- * E-mail:
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邵 亭, 于 丽, 李 迎, 陈 暮. [Density and SUV ratios from PET/CT in the detection of mediastinal lymph node metastasis in non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:155-60. [PMID: 25800571 PMCID: PMC6000007 DOI: 10.3779/j.issn.1009-3419.2015.03.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/16/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Mediastinal involvement in lung cancer is a highly significant prognostic factor for survival, and accurate staging of the mediastinum will correctly identify patients who will benefit the most from surgery. Positron emission tomography/computed tomography (PET/CT) has become the standard imaging modality for the staging of patients with lung cancer. The aim of this study is to investigate 18-fluoro-2-deoxy-glucose (18F-FDG) PET/CT imaging in the detection of mediastinal disease in lung cancer. METHODS A total of 72 patients newly diagnosed with non-small cell lung cancer (NSCLC) who underwent preoperative whole-body 18F-FDG PET/CT were retrospectively included. All patients underwent radical surgery and mediastinal lymph node dissection. Mediastinal disease was histologically confirmed in 45 of 413 lymph nodes. PET/CT doctors analyzed patients' visual images and evaluated lymph node's short axis, lymph node's maximum standardized uptake value (SUVmax), node/aorta density ratio, node/aorta SUV ratio, and other parameters using the histopathological results as the reference standard. The optimal cutoff value for each ratio was determined by receiver operator characteristic curve analysis. RESULTS Using a threshold of 0.9 for density ratio and 1.2 for SUV ratio yielded high accuracy for the detection of mediastinal disease. The lymph node's short axis, lymph node's SUVmax, density ratio, and SUV ratio of integrated PET/CT for the accuracy of diagnosing mediastinal lymph node was 95.2%. The diagnostic accuracy of mediastinal lymph node with conventional PET/CT was 89.8%, whereas that of PET/CT comprehensive analysis was 90.8%. CONCLUSIONS Node/aorta density ratio and SUV ratio may be complimentary to conventional visual interpretation and SUVmax measurement. The use of lymph node's short axis, lymph node's SUVmax, and both ratios in combination is better than either conventional PET/CT analysis or PET/CT comprehensive analysis in the assessment of mediastinal disease in NSCLC patients.
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Affiliation(s)
- 亭亭 邵
- />150081 哈尔滨,哈尔滨医科大学附属肿瘤医院PET/CT-MRI中心Department of PET/CT-MRI, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - 丽娟 于
- />150081 哈尔滨,哈尔滨医科大学附属肿瘤医院PET/CT-MRI中心Department of PET/CT-MRI, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - 迎辞 李
- />150081 哈尔滨,哈尔滨医科大学附属肿瘤医院PET/CT-MRI中心Department of PET/CT-MRI, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - 暮楠 陈
- />150081 哈尔滨,哈尔滨医科大学附属肿瘤医院PET/CT-MRI中心Department of PET/CT-MRI, Harbin Medical University Cancer Hospital, Harbin 150081, China
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Update on nodal staging in non-small cell lung cancer with integrated positron emission tomography/computed tomography: a meta-analysis. Ann Nucl Med 2015; 29:409-19. [DOI: 10.1007/s12149-015-0958-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 02/01/2015] [Indexed: 11/26/2022]
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Kim MP, Correa AM, Hofstetter W, Mehran R, Rice DC, Roth JA, Vaporciyan AA, Walsh GL, Erasmus JJ, Swisher SG. Limitations of 18F-2-Deoxy-d-Glucose Positron Emission Tomography in N1 Detection in Patients With Pathologic Stage II-N1 and Implications for Management. Ann Thorac Surg 2015; 99:414-20. [DOI: 10.1016/j.athoracsur.2014.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/27/2014] [Accepted: 09/09/2014] [Indexed: 11/30/2022]
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Schmidt‐Hansen M, Baldwin DR, Hasler E, Zamora J, Abraira V, Roqué i Figuls M. PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Database Syst Rev 2014; 2014:CD009519. [PMID: 25393718 PMCID: PMC6472607 DOI: 10.1002/14651858.cd009519.pub2] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND A major determinant of treatment offered to patients with non-small cell lung cancer (NSCLC) is their intrathoracic (mediastinal) nodal status. If the disease has not spread to the ipsilateral mediastinal nodes, subcarinal (N2) nodes, or both, and the patient is otherwise considered fit for surgery, resection is often the treatment of choice. Planning the optimal treatment is therefore critically dependent on accurate staging of the disease. PET-CT (positron emission tomography-computed tomography) is a non-invasive staging method of the mediastinum, which is increasingly available and used by lung cancer multidisciplinary teams. Although the non-invasive nature of PET-CT constitutes one of its major advantages, PET-CT may be suboptimal in detecting malignancy in normal-sized lymph nodes and in ruling out malignancy in patients with coexisting inflammatory or infectious diseases. OBJECTIVES To determine the diagnostic accuracy of integrated PET-CT for mediastinal staging of patients with suspected or confirmed NSCLC that is potentially suitable for treatment with curative intent. SEARCH METHODS We searched the following databases up to 30 April 2013: The Cochrane Library, MEDLINE via OvidSP (from 1946), Embase via OvidSP (from 1974), PreMEDLINE via OvidSP, OpenGrey, ProQuest Dissertations & Theses, and the trials register www.clinicaltrials.gov. There were no language or publication status restrictions on the search. We also contacted researchers in the field, checked reference lists, and conducted citation searches (with an end-date of 9 July 2013) of relevant studies. SELECTION CRITERIA Prospective or retrospective cross-sectional studies that assessed the diagnostic accuracy of integrated PET-CT for diagnosing N2 disease in patients with suspected resectable NSCLC. The studies must have used pathology as the reference standard and reported participants as the unit of analysis. DATA COLLECTION AND ANALYSIS Two authors independently extracted data pertaining to the study characteristics and the number of true and false positives and true and false negatives for the index test, and they independently assessed the quality of the included studies using QUADAS-2. We calculated sensitivity and specificity with 95% confidence intervals (CI) for each study and performed two main analyses based on the criteria for test positivity employed: Activity > background or SUVmax ≥ 2.5 (SUVmax = maximum standardised uptake value), where we fitted a summary receiver operating characteristic (ROC) curve using a hierarchical summary ROC (HSROC) model for each subset of studies. We identified the average operating point on the SROC curve and computed the average sensitivities and specificities. We checked for heterogeneity and examined the robustness of the meta-analyses through sensitivity analyses. MAIN RESULTS We included 45 studies, and based on the criteria for PET-CT positivity, we categorised the included studies into three groups: Activity > background (18 studies, N = 2823, prevalence of N2 and N3 nodes = 679/2328), SUVmax ≥ 2.5 (12 studies, N = 1656, prevalence of N2 and N3 nodes = 465/1656), and Other/mixed (15 studies, N = 1616, prevalence of N2 to N3 nodes = 400/1616). None of the studies reported (any) adverse events. Under-reporting generally hampered the quality assessment of the studies, and in 30/45 studies, the applicability of the study populations was of high or unclear concern.The summary sensitivity and specificity estimates for the 'Activity > background PET-CT positivity criterion were 77.4% (95% CI 65.3 to 86.1) and 90.1% (95% CI 85.3 to 93.5), respectively, but the accuracy estimates of these studies in ROC space showed a wide prediction region. This indicated high between-study heterogeneity and a relatively large 95% confidence region around the summary value of sensitivity and specificity, denoting a lack of precision. Sensitivity analyses suggested that the overall estimate of sensitivity was especially susceptible to selection bias; reference standard bias; clear definition of test positivity; and to a lesser extent, index test bias and commercial funding bias, with lower combined estimates of sensitivity observed for all the low 'Risk of bias' studies compared with the full analysis.The summary sensitivity and specificity estimates for the SUVmax ≥ 2.5 PET-CT positivity criterion were 81.3% (95% CI 70.2 to 88.9) and 79.4% (95% CI 70 to 86.5), respectively.In this group, the accuracy estimates of these studies in ROC space also showed a very wide prediction region. This indicated very high between-study heterogeneity, and there was a relatively large 95% confidence region around the summary value of sensitivity and specificity, denoting a clear lack of precision. Sensitivity analyses suggested that both overall accuracy estimates were marginally sensitive to flow and timing bias and commercial funding bias, which both lead to slightly lower estimates of sensitivity and specificity.Heterogeneity analyses showed that the accuracy estimates were significantly influenced by country of study origin, percentage of participants with adenocarcinoma, (¹⁸F)-2-fluoro-deoxy-D-glucose (FDG) dose, type of PET-CT scanner, and study size, but not by study design, consecutive recruitment, attenuation correction, year of publication, or tuberculosis incidence rate per 100,000 population. AUTHORS' CONCLUSIONS This review has shown that accuracy of PET-CT is insufficient to allow management based on PET-CT alone. The findings therefore support National Institute for Health and Care (formally 'clinical') Excellence (NICE) guidance on this topic, where PET-CT is used to guide clinicians in the next step: either a biopsy or where negative and nodes are small, directly to surgery. The apparent difference between the two main makes of PET-CT scanner is important and may influence the treatment decision in some circumstances. The differences in PET-CT accuracy estimates between scanner makes, NSCLC subtypes, FDG dose, and country of study origin, along with the general variability of results, suggest that all large centres should actively monitor their accuracy. This is so that they can make reliable decisions based on their own results and identify the populations in which PET-CT is of most use or potentially little value.
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Affiliation(s)
- Mia Schmidt‐Hansen
- Royal College of Obstetricians and GynaecologistsNational Guideline Alliance27 Sussex PlRegent's ParkLondonUKNW1 4RG
| | - David R Baldwin
- Nottingham University Hospitals, NHS Trust, Nottingham City HospitalDepartment of Respiratory MedicineHucknall RoadNottinghamUKNG5 1PB
| | - Elise Hasler
- Royal College of Obstetricians and GynaecologistsNational Guideline Alliance27 Sussex PlRegent's ParkLondonUKNW1 4RG
| | - Javier Zamora
- Ramon y Cajal Institute for Health Research (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP), Madrid (Spain) and Queen Mary University of LondonClinical Biostatistics UnitCtra. Colmenar km 9,100MadridMadridSpain28034
| | - Víctor Abraira
- Ramon y Cajal Institute for Health Research (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP) and Cochrane Collaborating CentreClinical Biostatistics UnitCrta Colmenar Km 9.1MadridMadridSpain28034
| | - Marta Roqué i Figuls
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 171Edifici Casa de ConvalescènciaBarcelonaCatalunyaSpain08041
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Nakanishi R, Fujino Y, Yamashita T, Shinohara S, Oyama T. Thoracoscopic Anatomic Pulmonary Resection for Locally Advanced Non-Small Cell Lung Cancer. Ann Thorac Surg 2014; 97:980-5. [DOI: 10.1016/j.athoracsur.2013.10.082] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/23/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
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Moloney F, Ryan D, McCarthy L, McCarthy J, Burke L, Henry MT, Kennedy MP, Hinchion J, McSweeney S, Maher MM, O'Regan K. Increasing the accuracy of 18F-FDG PET/CT interpretation of "mildly positive" mediastinal nodes in the staging of non-small cell lung cancer. Eur J Radiol 2014; 83:843-7. [PMID: 24581594 DOI: 10.1016/j.ejrad.2014.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 01/20/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to identify radiological factors that may reduce false-positive results and increase diagnostic accuracy when staging the mediastinum of patients with non-small cell lung carcinoma (NSCLC). METHODS This was a retrospective, interdisciplinary, per-node analysis study. We included patients with NSCLC and mediastinal nodes with an SUV max in the range of 2.5-4.0 on PET-CT. We hypothesized that the greatest number of false positive cases would occur in this cohort of patients. RESULTS A total of 92 mediastinal lymph nodes were analyzed in 44 patients. Mediastinal disease (N2/N3) was histologically confirmed in 15 of 44 patients and in 34 of 92 lymph nodes; positive predictive value of 37% and false positive rate of 63%. Lymph node SUV max, tumor size, ratio of node SUV max to tumor SUV max (SUVn/SUVp), and ratio of node SUV max to node size (SUV n/SADn) were significantly higher in true positive cases. Using a threshold of 0.3 for SUV node/tumor and 3 for SUV node/size yielded sensitivities of 91% and 71% and specificities of 71% and 69% respectively for the detection of mediastinal disease. Using both ratios in combination resulted in a sensitivity of 65% and a specificity of 88%. Concurrent benign lung disease was observed significantly more frequently in false-positive cases. CONCLUSION SUVn/SUVpt and SUVn/SADn may be complimentary to conventional visual interpretation and SUV max measurement in the assessment of mediastinal disease in patients with NSCLC.
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Affiliation(s)
- F Moloney
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - D Ryan
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - L McCarthy
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - J McCarthy
- Department of Pathology, Cork University Hospital, Cork - 0214922000, Ireland.
| | - L Burke
- Department of Pathology, Cork University Hospital, Cork - 0214922000, Ireland.
| | - M T Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - M P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - J Hinchion
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - S McSweeney
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - M M Maher
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
| | - K O'Regan
- Department of Radiology, Cork University Hospital, Cork - 00353214922000, Ireland.
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Russo VC, Higgins S, Werther GA, Cameron FJ. Effects of Fluctuating Glucose Levels on Neuronal Cells In Vitro. Neurochem Res 2012; 37:1768-82. [DOI: 10.1007/s11064-012-0789-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 04/12/2012] [Accepted: 04/24/2012] [Indexed: 12/29/2022]
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