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Li Y, Zhang Y, Guo Z, Hou P, Lv J, Ke M, Liu S, Li S, Yin W, He J, Wang X. [ 18F]FAPI adds value to [ 18F]FDG PET/CT for diagnosing lymph node metastases in stage I-IIIA non-small cell lung cancer: a prospective study. Cancer Imaging 2024; 24:68. [PMID: 38831354 PMCID: PMC11145785 DOI: 10.1186/s40644-024-00701-y] [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: 09/04/2023] [Accepted: 04/27/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND This study investigates the value of fluorine 18 ([18F])-labeled fibroblast activation protein inhibitor (FAPI) for lymph node (LN) metastases in patients with stage I-IIIA non-small cell lung cancer (NSCLC). METHODS From November 2021 to October 2022, 53 patients with stage I-IIIA NSCLC who underwent radical resection were prospectively included. [18F]-fluorodeoxyglucose (FDG) and [18F]FAPI examinations were performed within one week. LN staging was validated using surgical and pathological findings. [18F]FDG and [18F]FAPI uptake was compared using the Wilcoxon signed-ranks test. Furthermore, the diagnostic value of nodal groups was investigated. RESULTS In 53 patients (median age, 64 years, range: 31-76 years), the specificity of [18F]FAPI for detecting LN metastasis was significantly higher than that of [18F]FDG (P < 0.001). High LN risk category, greater LN short-axis dimension(≥ 1.0 cm), absence of LN calcification or high-attenuation, and higher LN FDG SUVmax (≥ 10.1) were risk factors for LN metastasis(P < 0.05). The concurrence of these four risk factors accurately predicted LN metastases (Positive Predictive Value [PPV] 100%), whereas the presence of one to three risk factors was unable to accurately discriminate the nature of LNs (PPV 21.7%). Adding [18F]FAPI in this circumstance improved the diagnostic value. LNs with an [18F]FAPI SUVmax<6.2 were diagnosed as benign (Negative Predictive Value 93.8%), and LNs with an [18F]FAPI SUVmax≥6.2 without calcification or high-attenuation were diagnosed as LN metastasis (PPV 87.5%). Ultimately, the integration of [18F]FDG and [18F]FAPI PET/CT resulted in the highest accuracy for N stage (83.0%) and clinical decision revisions for 29 patients. CONCLUSION In patients with stage I-IIIA NSCLC, [18F]FAPI contributed additional valuable information to reduce LN diagnostic uncertainties after [18F]FDG PET/CT. Integrating [18F]FDG and [18F]FAPI PET/CT resulted in more precise clinical decisions. TRIAL REGISTRATION The Chinese Clinical Trial Registry: ChiCTR2100044944 (Registered: 1 April 2021, https://www.chictr.org.cn/showprojEN.html?proj=123995 ).
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Affiliation(s)
- Youcai Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China
| | - Yin Zhang
- Nanfang PET Center, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong Province, China
| | - Zhihua Guo
- Department of Thoracic Surgery, Guangzhou Institute of Respiratory Health & China State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Peng Hou
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China
| | - Jie Lv
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China
| | - Miao Ke
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China
| | - Shaoyu Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China
| | - Siwen Li
- Guangzhou Medical University, Guangzhou, China
| | - Weiqiang Yin
- Department of Thoracic Surgery, Guangzhou Institute of Respiratory Health & China State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, Guangzhou Institute of Respiratory Health & China State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Xinlu Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China.
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Ramamoorthy E, Garg M, Singh P, Aggarwal AN, Gupta N. Role of Diffusion-Weighted Magnetic Resonance Imaging for Characterization of Mediastinal Lymphadenopathy. Diagnostics (Basel) 2023; 13:diagnostics13040706. [PMID: 36832194 PMCID: PMC9955495 DOI: 10.3390/diagnostics13040706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND To assess the diagnostic performance of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the characterization of mediastinal lymph nodes and compare them with morphological parameters. METHODS A total of 43 untreated patients with mediastinal lymphadenopathy underwent DW and T2 weighted MRI followed by pathological examination in the period from January 2015 to June 2016. The presence of diffusion restriction, apparent diffusion coefficient (ADC) value, short axis dimensions (SAD), and T2 heterogeneous signal intensity of the lymph nodes were evaluated using receiver operating characteristic curve (ROC) and forward step-wise multivariate logistic regression analysis. RESULTS The ADC of malignant lymphadenopathy was significantly lower (0.873 ± 0.109 × 10-3 mm2/s) than that of benign lymphadenopathy (1.663 ± 0.311 × 10-3 mm2/s) (p = 0.001). When an ADC of 1.0955 × 10-3 mm2/s was used as a threshold value for differentiating malignant from benign nodes, the best results were obtained with a sensitivity of 94%, a specificity of 96%, and an area under the curve (AUC) of 0.996. A model combining the other three MRI criteria showed less sensitivity (88.9%) and specificity (92%) compared to the ADC-only model. CONCLUSION The ADC was the strongest independent predictor of malignancy. The addition of other parameters failed to show any increase in sensitivity and specificity.
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Affiliation(s)
- Eniyavel Ramamoorthy
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Mandeep Garg
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
- Correspondence:
| | - Paramjeet Singh
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ashutosh N. Aggarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Nalini Gupta
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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High SUVmax Is an Independent Predictor of Higher Diagnostic Accuracy of ROSE in EBUS-TBNA for Patients with NSCLC. J Pers Med 2022; 12:jpm12030451. [PMID: 35330451 PMCID: PMC8952648 DOI: 10.3390/jpm12030451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: This study aimed to verify the predictors of the diagnostic accuracy of rapid on-site evaluation (ROSE) in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) among patients with non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed consecutive patients with NSCLC who underwent EBUS-TBNA for staging or diagnosis at our hospital from June 2016 to June 2018. The patients were divided into two groups—those with a correct diagnosis and an incorrect diagnosis after ROSE. Kaplan−Meier plots and log-rank tests were used to estimate outcomes. Results: A total of 84 patients underwent EBUS-TBNA for staging and diagnosis. Sixty patients with demonstrated malignant mediastinal lymph nodes were enrolled. In the univariate analysis, lymph nodes < 1.5 cm (HR = 3.667, p = 0.031) and a SUVmax > 5 (HR = 41, p = 0.001) were statistically significant for diagnostic accuracy of ROSE. In the multivariate Cox regression analysis, only a SUVmax > 5 (HR = 20.258, p = 0.016) was statistically significant. Conclusions: A SUVmax > 5 is an independent predictor of higher diagnostic accuracy of ROSE in EBUS-TBNA in patients with NSCLC with malignant mediastinal lymph nodes. Therefore, ROSE in patients with a SUVmax < 5 might not be reliable and requires further prudent assessment (more shots or repeated biopsies at mediastinal LNs) in clinical practice.
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Lu P, Sun Y, Liang B, Yu L. Derivation and validation of a 18F-FDG PET/CT scoring model to predict malignant pleural effusion. Nucl Med Commun 2022; 43:177-185. [PMID: 34864810 DOI: 10.1097/mnm.0000000000001505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop an 18F-fluorodeoxyglucose PET/computed tomography (CT) scoring model based on metabolic and radiologic findings of the pleura and fluid to identify malignant pleural effusion. METHODS The PET and CT findings from patients with pleural effusion in the derivation dataset were used to develop a scoring model. Then, the diagnostic accuracy of the predictive score was verified by the validation dataset. RESULTS Eight parameters independently predicting malignancy were retained in the scoring model, including pleural nodules or masses (4 points), focal pleural thickening (2 points), absence of pleural loculation (2 points), thickness of mediastinal pleura involvement ≥0.5 cm (2 points), maximum standardized uptake value (SUVmax) of mediastinal pleura involvement ≥2.3 (2 points), thickness of nonmediastinal pleura involvement ≥0.5 cm (1 point), SUVmax of nonmediastinal pleura involvement ≥3.0 (1 point) and fluid SUVmax ≥1.6 (1 point). The operating characteristics of the PET/CT score were 0.958 area under the curve (AUC), 88.6% sensitivity, 91.2% specificity, 10.09 positive likelihood ratio and 0.13 negative likelihood ratio, with 6 points as the threshold. These values in the validation dataset were 0.947, 91.7%, 88.4%, 7.91 and 0.094, respectively. No difference was found in AUCs between the derivation and validation datasets (z = 0.517, P = 0.697). The negative predictive value was 99.4% in the score from 0 to 2, and the positive predictive value was 98.3% for patients with score between 9 and 15. CONCLUSIONS The PET/CT scoring model is a valuable strategy to help physicians to distinguish malignant-benign pleural effusion and stratify patients who will benefit from invasive procedures.
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Affiliation(s)
| | - Yajuan Sun
- Department of Radiologic Diagnosis, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang
| | | | - Lijuan Yu
- Department of Nuclear Medicine
- Department of Nuclear Medicine, Affiliated Cancer Hospital of Hainan Medical College, Haikou, Hainan, China
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Small Cell Lung Cancer Staging: Prospective Comparison of Conventional Staging Tests, FDG PET/CT, Whole-Body MRI, and Coregistered FDG PET/MRI. AJR Am J Roentgenol 2021; 218:899-908. [PMID: 34877872 DOI: 10.2214/ajr.21.26868] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Whole-body MRI and FDG PET/MRI have shown encouraging results for staging of thoracic malignancy, but are poorly studied for staging of small cell lung cancer (SCLC). Objective: To compare the performance of conventional staging tests, FDG PET/CT, whole-body MRI, and FDG PET/MRI for staging of SCLC. Methods: This prospective study included 98 patients (64 men, 34 women; median age, 74 years) with SCLC who underwent conventional staging tests (brain MRI; neck, chest, and abdominopelvic CT; bone scintigraphy), FDG PET/CT, and FDG PET/MRI, within 2 weeks before treatment; coregistered FDG PET/MRI was generated. Two nuclear medicine physicians independently reviewed conventional tests and FDG PET/CT examinations in separate sessions; two chest radiologists independently reviewed whole-body MRI and FDG PET/MRI examinations in separate sessions. Readers assessed T, N, and M categories; TNM stage; and Veterans Administration Lung Cancer Study Group (VALSG) stage. Reader pairs subsequently reached consensus. Stages determined clinically during tumor board sessions served as reference. Results: Accuracy for T category was higher (p<.05) for whole-body MRI (94.9%) and FDG PET/MRI (94.9%) than for FDG PET/CT (85.7%). Accuracy for N category was higher (p<.05) for whole-body MRI (84.7%), FDG PET/MRI (83.7%), and FDG PET/CT (81.6%) than for conventional staging tests (75.5%). Accuracy for M category was higher (p<.05) for whole-body MRI (94.9%), FDG PET/MRI (94.9%), and FDG PET/CT (94.9%) than for conventional staging tests (84.7%). Accuracy for TNM stage was higher (p<.05) for whole-body MRI (88.8%) and FDG PET/MRI (86.7%) than for FDG PET/CT (77.6%) and conventional staging tests (72.4%). Accuracy for VALSG stage was higher (p<.05) for whole-body MRI (95.9%), FDG PET/MRI (95.9%), and FDG PET/CT (98.0%) than for conventional staging tests (82.7%). Interobserver agreement, expressed as kappa, ranged from 0.81 to 0.94 across imaging tests and staging endpoints. Conclusion: FDG PET/CT, whole-body MRI, and coregistered FDG PET/MRI outperformed conventional tests for various staging endpoints in patients with SCLC. Whole-body MRI and FDG PET/MRI outperformed FDG PET/CT for T category and thus TNM stage, indicating utility of MRI for assessing extent of local invasion in SCLC. Clinical Impact: Incorporation of either MRI approach may improve initial staging evaluation in SCLC.
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Lue KH, Chu SC, Wang LY, Chen YC, Li MH, Chang BS, Chan SC, Chen YH, Lin CB, Liu SH. Tumor glycolytic heterogeneity improves detection of regional nodal metastasis in patients with lung adenocarcinoma. Ann Nucl Med 2021; 36:256-266. [PMID: 34817824 DOI: 10.1007/s12149-021-01698-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The diagnostic performance of 18F-FDG PET for detecting regional lymph node metastasis in resectable lung cancer is variable, and its sensitivity for adenocarcinoma is even lower. We aimed to evaluate the value of 18F-FDG PET-derived features in predicting pathological lymph node metastasis in patients with lung adenocarcinoma. METHODS We retrospectively analyzed pretreatment 18F-FDG PET-derived features of 126 lung adenocarcinoma patients who underwent curative surgery. A logistic regression model was used to analyze the association between study variables and pathological regional lymph node status obtained from the curative surgery. Furthermore, Cox regression analysis was used to test the effect of the study variables on survival outcomes, including disease-free survival (DFS) and overall survival (OS). RESULTS The primary tumor entropy (OR = 1.7, p = 0.014) and visual interpretation of regional nodes via 18F-FDG PET (OR = 2.5, p = 0.026) independently predicted pathological regional lymph node metastasis. The areas under the receiver-operating-characteristic curves were 0.631, 0.671, and 0.711 for visual interpretation, primary tumor entropy, and their combination, respectively. Based on visual interpretation, a primary tumor entropy ≥ 3.0 improved the positive predictive value of positive visual interpretation from 51.2% to 63.0%, whereas an entropy < 3.0 improved the negative predictive value of negative visual interpretation from 75.3% to 82.6%. In cases with positive visual interpretation and low entropy, or negative visual interpretation and high entropy, the nodal metastasis rates were approximately 30%. In the survival analyses, the primary tumor entropy was also independently associated with DFS (HR = 2.7, p = 0.001) and OS (HR = 4.8, p = 0.001). CONCLUSIONS Our preliminary results show that the primary tumor entropy may improve 18F-FDG PET visual interpretation in predicting pathological nodal metastasis in lung adenocarcinoma, and may also show a survival prognostic value. This versatile biomarker may facilitate tailored therapeutic strategies for patients with resectable lung adenocarcinoma.
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Affiliation(s)
- Kun-Han Lue
- Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Sung-Chao Chu
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ling-Yi Wang
- Epidemiology and Biostatistics Consulting Center, Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Pharmacy, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yen-Chang Chen
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ming-Hsun Li
- Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Bee-Song Chang
- Department of Cardiothoracic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sheng-Chieh Chan
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Hung Chen
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan. .,Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| | - Chih-Bin Lin
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Shu-Hsin Liu
- Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan.,Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Moon SH, Cho YS, Choi JY. KSNM60 in Clinical Nuclear Oncology. Nucl Med Mol Imaging 2021; 55:210-224. [PMID: 34721714 DOI: 10.1007/s13139-021-00711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
Since the foundation of the Korean Society of Nuclear Medicine in 1961, clinical nuclear oncology has been a major part of clinical nuclear medicine in Korea. There are several important events for the development of clinical nuclear oncology in Korea. First, a scintillating type gamma camera was adopted in 1969, which enabled to perform modern oncological gamma imaging. Second, Tc-99 m generator was imported to Korea since 1979, which promoted the wide clinical use of gamma camera imaging by using various kinds of Tc-99 m labeled radiopharmaceuticals. Third, a gamma camera with single photon emission tomography (SPECT) capability was first installed in 1980, which has been used for various kinds of tumor SPECT imaging. Fourth, in 1994, clinical positron emission tomography (PET) scanner and cyclotron with a production of F-18 fluorodeoxyglucose were first installed in Korea. Fifth, Korean Board of Nuclear Medicine was established in 1995, which contributed in the education and manpower training of dedicated nuclear medicine physicians in Korea. Finally, an integrated PET/CT scanner was first installed in 2002. Since that, PET/CT imaging has been a major imaging tool in clinical nuclear oncology in Korea. In this review, a brief history of clinical nuclear oncology in Korea is described.
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Affiliation(s)
- Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351 Seoul, Republic of Korea
| | - Young Seok Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351 Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351 Seoul, Republic of Korea
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Ouyang ML, Wang YR, Deng QS, Zhu YF, Zhao ZH, Wang L, Wang LX, Tang K. Development and Validation of a 18F-FDG PET-Based Radiomic Model for Evaluating Hypermetabolic Mediastinal-Hilar Lymph Nodes in Non-Small-Cell Lung Cancer. Front Oncol 2021; 11:710909. [PMID: 34568038 PMCID: PMC8457532 DOI: 10.3389/fonc.2021.710909] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background Accurate evaluation of lymph node (LN) status is critical for determining the treatment options in patients with non-small cell lung cancer (NSCLC). This study aimed to develop and validate a 18F-FDG PET-based radiomic model for the identification of metastatic LNs from the hypermetabolic mediastinal–hilar LNs in NSCLC. Methods We retrospectively reviewed 259 patients with hypermetabolic LNs who underwent pretreatment 18F-FDG PET/CT and were pathologically confirmed as NSCLC from two centers. Two hundred twenty-eight LNs were allocated to a training cohort (LN = 159) and an internal validation cohort (LN = 69) from one center (7:3 ratio), and 60 LNs were enrolled to an external validation cohort from the other. Radiomic features were extracted from LNs of PET images. A PET radiomics signature was constructed by multivariable logistic regression after using the least absolute shrinkage and selection operator (LASSO) method with 10-fold cross-validation. The PET radiomics signature (model 1) and independent predictors from CT image features and clinical data (model 2) were incorporated into a combined model (model 3). A nomogram was plotted for the complex model, and the performance of the nomogram was assessed by its discrimination, calibration, and clinical usefulness. Results The area under the curve (AUC) values of model 1 were 0.820, 0.785, and 0.808 in the training, internal, and external validation cohorts, respectively, showing good diagnostic efficacy for lymph node metastasis (LNM). Furthermore, model 2 was able to discriminate metastatic LNs in the training (AUC 0.780), internal (AUC 0.794), and external validation cohorts (AUC 0.802), respectively. Model 3 showed optimal diagnostic performance among the three cohorts, with an AUC of 0.874, 0.845, and 0.841, respectively. The nomogram based on the model 3 showed good discrimination and calibration. Conclusions Our study revealed that PET radiomics signature, especially when integrated with CT imaging features, showed the ability to identify true and false positives of mediastinal–hilar LNM detected by PET/CT in patients with NSCLC, which would help clinicians to make individual treatment decisions.
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Affiliation(s)
- Ming-Li Ouyang
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi-Ran Wang
- Department of Medical Engineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing-Shan Deng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ye-Fei Zhu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Zhen-Hua Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Ling Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang-Xing Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kun Tang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Rogasch JMM, Frost N, Bluemel S, Michaels L, Penzkofer T, von Laffert M, Temmesfeld-Wollbrück B, Neudecker J, Rückert JC, Ochsenreither S, Böhmer D, Amthauer H, Furth C. FDG-PET/CT for pretherapeutic lymph node staging in non-small cell lung cancer: A tailored approach to the ESTS/ESMO guideline workflow. Lung Cancer 2021; 157:66-74. [PMID: 33994197 DOI: 10.1016/j.lungcan.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES In patients with NSCLC, current ESTS and ESMO guidelines recommend invasive lymph node (LN) staging with EBUS-TBNA even if FDG-PET/CT is negative for mediastinal LNs if at least one of three risk factors is present (cN1, non-peripheral primary or primary >3 cm). Modified workflows to avoid unnecessary invasive procedures were evaluated. MATERIALS AND METHODS Monocentric retrospective analysis of pretherapeutic FDG-PET/CT in 247 patients with NSCLC (62 % male; age, 68 [43-88] years) using an analog or digital PET/CT scanner. PET windowing was standardized. LNs were positive if 'LN uptake > mediastinal blood pool' or short axis >10 mm. Surgery or EBUS-TBNA served as reference for diagnostic accuracy per LN station. In all patients with negative mediastinal LNs by PET/CT, LN histology from surgery was available. RESULTS Among 700 L N stations analyzed, 180 were malignant. Sensitivity and specificity of PET/CT per LN station were 93 % and 71 %. Following current guidelines, 76 patients with mediastinal negative PET/CT required confirmatory invasive staging. Only 5/76 patients had unexpected pN2 (all had adenocarcinoma). In a modified approach, confirmatory invasive staging was confined to patients with mediastinal negative PET/CT who showed all three risk factors. Using this modification, EBUS-TBNA could have been omitted in 62 (82 %) of the 76 patients who required EBUS-TBNA based on current recommendation. Among these 62 patients, only one patient had unsuspected pN2 (single-level) while the remaining 61 of 62 omitted EBUS-TBNA were deemed unnecessary because mediastinal LNs were confirmed to be negative. No multi-level pN2 would have been missed. CONCLUSION In the current analysis, 82 % of EBUS-TBNA procedures in patients with mediastinal negative PET/CT could have been omitted by modifying the current guideline workflow as proposed (i.e., restricting EBUS-TBNA in patients with cN0/1 to those with all three risk factors). This was consistent with different PET/CT scanners. Prospective confirmation is required.
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Affiliation(s)
- Julian M M Rogasch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany.
| | - Nikolaj Frost
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Stephanie Bluemel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Liza Michaels
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Tobias Penzkofer
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Maximilian von Laffert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany.
| | - Bettina Temmesfeld-Wollbrück
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Jens Neudecker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral, Vascular and Thoracic Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Jens-Carsten Rückert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of General, Visceral, Vascular and Thoracic Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Sebastian Ochsenreither
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Hematology and Medical Oncology, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Charitéplatz 1, 10115 Berlin, Germany.
| | - Dirk Böhmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Holger Amthauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Christian Furth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
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Yoo J, Cheon M, Park YJ, Hyun SH, Zo JI, Um SW, Won HH, Lee KH, Kim BT, Choi JY. Machine learning-based diagnostic method of pre-therapeutic 18F-FDG PET/CT for evaluating mediastinal lymph nodes in non-small cell lung cancer. Eur Radiol 2020; 31:4184-4194. [PMID: 33241521 DOI: 10.1007/s00330-020-07523-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/08/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We aimed to find the best machine learning (ML) model using 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for evaluating metastatic mediastinal lymph nodes (MedLNs) in non-small cell lung cancer, and compare the diagnostic results with those of nuclear medicine physicians. METHODS A total of 1329 MedLNs were reviewed. Boosted decision tree, logistic regression, support vector machine, neural network, and decision forest models were compared. The diagnostic performance of the best ML model was compared with that of physicians. The ML method was divided into ML with quantitative variables only (MLq) and adding clinical information (MLc). We performed an analysis based on the 18F-FDG-avidity of the MedLNs. RESULTS The boosted decision tree model obtained higher sensitivity and negative predictive values but lower specificity and positive predictive values than the physicians. There was no significant difference between the accuracy of the physicians and MLq (79.8% vs. 76.8%, p = 0.067). The accuracy of MLc was significantly higher than that of the physicians (81.0% vs. 76.8%, p = 0.009). In MedLNs with low 18F-FDG-avidity, ML had significantly higher accuracy than the physicians (70.0% vs. 63.3%, p = 0.018). CONCLUSION Although there was no significant difference in accuracy between the MLq and physicians, the diagnostic performance of MLc was better than that of MLq or of the physicians. The ML method appeared to be useful for evaluating low metabolic MedLNs. Therefore, adding clinical information to the quantitative variables from 18F-FDG PET/CT can improve the diagnostic results of ML. KEY POINTS • Machine learning using two-class boosted decision tree model revealed the highest value of area under curve, and it showed higher sensitivity and negative predictive values but lower specificity and positive predictive values than nuclear medicine physicians. • The diagnostic results from machine learning method after adding clinical information to the quantitative variables improved accuracy significantly than nuclear medicine physicians. • Machine learning could improve the diagnostic significance of metastatic mediastinal lymph nodes, especially in mediastinal lymph nodes with low 18F-FDG-avidity.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, South Korea.,Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Miju Cheon
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Yong Jin Park
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Prediction of mediastinal lymph node metastasis based on 18F-FDG PET/CT imaging using support vector machine in non-small cell lung cancer. Eur Radiol 2020; 31:3983-3992. [PMID: 33201286 DOI: 10.1007/s00330-020-07466-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a classification method based on support vector machine (SVM) to improve the diagnostic performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to detect the lymph node (LN) metastasis in non-small cell lung cancer (NSCLC). METHOD Two hundred nineteen lymph nodes (37 metastatic) from 71 patients were evaluated in this study. SVM models were developed with 7 LN features. The area under the curve (AUC) and accuracy of 9 models were compared to select the best model. The best SVM model was simplified on the basis of the feature weights and value distribution to further suit the clinical application. RESULTS The maximum, minimum, and mean accuracy of the best model was 91.89% (68/74, 95% CI 83.11~96.54%), 66.22% (49/74, 95% CI 54.85~75.98%), and 80.09% (59,266/74,000, 95% CI 70.27~89.19%), respectively, with an AUC of 0.94, 0.66, and 0.81, respectively. The best SVM model was finally simplified into a score rule: LNs with scores more than 3.0 were considered as malignant ones, whereas LNs with scores less than 1.5 tended to be benign ones. For the LNs with scores within a range of 1.5-3.0, metastasis was suspected. CONCLUSION An SVM model based on 18F-FDG PET/CT images was able to predict the metastatic LNs for patients with NSCLC. The ratio of the maximum of standard uptake value of LNs to aortic arch played a major role in the model. After simplification, the model could be transferred into a scoring method which may partly help clinicians determine the clinical staging of patients with NSCLC relatively easier. KEY POINTS • The SVM model based on 18F-FDG PET/CT features may help clinicians to make a decision for metastatic mediastinal lymph nodes in patients with NSCLC. • The SURblood plays a major role in the SVM model. • The score rule based on the SVM model simplified the complexity of the model and may partly help clinicians determine the clinical staging of patients with NSCLC relatively easier.
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12
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Yun JK, Park I, Kim HR, Choi YS, Lee GD, Choi S, Kim YH, Kim DK, Park SI, Cho JH, Shin S, Kim HK, Kim J, Zo JI, Kim K, Shim YM. Long-term outcomes of video-assisted thoracoscopic lobectomy for clinical N1 non-small cell lung cancer: A propensity score-weighted comparison with open thoracotomy. Lung Cancer 2020; 150:201-208. [PMID: 33197685 DOI: 10.1016/j.lungcan.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/28/2020] [Accepted: 10/18/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Although the video-assisted thoracic surgery (VATS) approach has been accepted as a safe and effective alternative to lobectomy, its advantage remains unclear in advanced-stage lung cancer. This study is aimed to evaluate the feasibility and long-term outcomes of VATS in lung cancer with clinical N1 (cN1) disease. MATERIALS AND METHODS We retrospectively reviewed the records of 1149 consecutive patients who underwent lobectomy for cN1 disease from 2006 to 2016. Perioperative outcomes and long-term survival rates were compared using a propensity score-based inverse probability of treatment weighting (IPTW) technique. RESULTS We performed VATS and open thoracotomy for 500 and 649 patients, respectively. All preoperative characteristics became similar between the two groups after IPTW adjustment. Compared to thoracotomy, VATS was associated with shorter hospitalization (7.7 days vs. 9.2 days, p < 0.001), earlier adjuvant chemotherapy (41.7 days vs. 46.6 days, p = 0.028), similar complete resection rates (95.2 % vs. 94.0 %, p = 0.583), and equivalent dissected lymph nodes (27.5 vs. 27.8, p = 0.704). On IPTW-adjusted analysis, overall survival (OS) (59.4 % vs. 60.3 %, p = 0.588) and recurrence-free survival (RFS) (59.2 % vs. 56.9 %, p = 0.651) at 5 years were also similar between the two groups. Multivariable Cox analysis revealed that VATS was not a significant prognostic factor for cN1 disease (p = 0.764 for OS and p = 0.879 for RFS). CONCLUSIONS VATS lobectomy is feasible for patients with cN1 disease, providing comparable perioperative outcomes, oncologic efficacy, and long-term outcomes as open thoracotomy.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea.
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Bundang Hospital, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Muehe AM, Siedek F, Theruvath AJ, Seekins J, Spunt SL, Pribnow A, Hazard FK, Liang T, Daldrup-Link H. Differentiation of benign and malignant lymph nodes in pediatric patients on ferumoxytol-enhanced PET/MRI. Am J Cancer Res 2020; 10:3612-3621. [PMID: 32206111 PMCID: PMC7069081 DOI: 10.7150/thno.40606] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/30/2020] [Indexed: 12/24/2022] Open
Abstract
The composition of lymph nodes in pediatric patients is different from that in adults. Most notably, normal lymph nodes in children contain less macrophages. Therefore, previously described biodistributions of iron oxide nanoparticles in benign and malignant lymph nodes of adult patients may not apply to children. The purpose of our study was to evaluate if the iron supplement ferumoxytol improves the differentiation of benign and malignant lymph nodes in pediatric cancer patients on 18F-FDG PET/MRI. Methods: We conducted a prospective clinical trial from May 2015 to December 2018 to investigate the value of ferumoxytol nanoparticles for staging of children with cancer with 18F-FDG PET/MRI. Ferumoxytol is an FDA-approved iron supplement for the treatment of anemia and has been used "off-label" as an MRI contrast agent in this study. Forty-two children (7-18 years, 29 male, 13 female) received a 18F-FDG PET/MRI at 2 (n=20) or 24 hours (h) (n=22) after intravenous injection of ferumoxytol (dose 5 mg Fe/kg). The morphology of benign and malignant lymph nodes on ferumoxytol-enhanced T2-FSE sequences at 2 and 24 h were compared using a linear regression analysis. In addition, ADCmean-values, SUV-ratio (SUVmax lesion/SUVmean liver) and R2*-relaxation rate of benign and malignant lymph nodes were compared with a Mann-Whitney-U test. The accuracy of different criteria was assessed with a receiver operating characteristics (ROC) curve. Follow-up imaging for at least 6 months served as the standard of reference. Results: We examined a total of 613 lymph nodes, of which 464 (75.7%) were benign and 149 (24.3%) were malignant. On ferumoxytol-enhanced T2-FSE images, benign lymph nodes showed a hypointense hilum and hyperintense parenchyma, while malignant lymph nodes showed no discernible hilum. This pattern was not significantly different at 2 h and 24 h postcontrast (p=0.82). Benign and malignant lymph nodes showed significantly different ferumoxytol enhancement patterns, ADCmean values of 1578 and 852 x10-6 mm2/s, mean SUV-ratios of 0.5 and 2.8, and mean R2*-relaxation rate of 127.8 and 84.4 Hertz (Hz), respectively (all p<0.001). The accuracy of ADCmean, SUV-ratio and pattern (area under the curve (AUC): 0.99; 0.98; 0.97, respectively) was not significantly different (p=0.07). Compared to these three parameters, the accuracy of R2* was significantly lower (AUC: 0.93; p=0.001). Conclusion: Lymph nodes in children show different ferumoxytol-enhancement patterns on MRI than previously reported for adult patients. We found high accuracy (>90%) of ADCmean, SUV-ratio, pattern, and R2* measurements for the characterization of benign and malignant lymph nodes in children. Ferumoxytol nanoparticle accumulation at the hilum can be used to diagnose a benign lymph node. In the future, the delivery of clinically applicable nanoparticles to the hilum of benign lymph nodes could be harnessed to deliver theranostic drugs for immune cell priming.
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Utility of FDG PET/CT for Preoperative Staging of Non-Small Cell Lung Cancers Manifesting as Subsolid Nodules With a Solid Portion of 3 cm or Smaller. AJR Am J Roentgenol 2019; 214:514-523. [PMID: 31846374 DOI: 10.2214/ajr.19.21811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE. The objective of our study was to investigate the utility of FDG PET/CT for the preoperative staging of subsolid non-small cell lung cancers (NSCLCs) with a solid portion size of 3 cm or smaller. MATERIALS AND METHODS. We retrospectively enrolled 855 patients with pathologically proven NSCLCs manifesting as subsolid nodules with a solid portion of 3 cm or smaller on CT. We then compared the diagnostic performances of FDG PET/CT and chest CT for detecting lymph node (LN), intrathoracic, or distant metastases in patients who underwent preoperative chest CT and FDG PET/CT. After propensity score matching, we compared the diagnostic performance of FDG PET/CT in the group who underwent both chest CT and FDG PET/CT with that of chest CT in patients who did not undergo FDG PET/CT. RESULTS. There were LN metastases in 25 of 765 patients (3.3%) who underwent surgical LN dissection or biopsy and intrathoracic or distant metastasis in two of 855 patients (0.2%). For LN staging, FDG PET/CT showed a sensitivity of 44.0%, specificity of 81.5%, positive predictive value of 9.6%, negative predictive value of 97.0%, and accuracy of 79.9%, which were lower than those of chest CT for accuracy (p < 0.0001). FDG PET/CT could not accurately detect any intrathoracic or distant metastasis. After propensity score matching, the diagnostic accuracy for LN staging of FDG PET/CT in the group who underwent both CT and FDG PET/CT was lower than that of chest CT in the group who did not undergo FDG PET/CT (p = 0.002), and the diagnostic accuracy for intrathoracic and distant metastases was not different (p > 0.999). CONCLUSION. FDG PET/CT has limited utility in preoperatively detecting LN or distant metastasis in patients with subsolid NSCLCs with a solid portion size of 3 cm or smaller.
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Sheha AS, Elia RZ, Ghoneim NMFH. The added value of18F-FDG PET/CT in staging non-small cell lung cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Non-small cell lung cancer (NSCLC) accounts for about 80% of all lung cancers. The current criteria for its staging are based on the TNM system that determines treatment options and predicts survival rate in patients. The aim of the study was to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography PET/CT in staging of NSCLC patients.
Methods
A retrospective study was conducted. We reviewed the CT and PET/CT examinations done in our institution on pathologically proven patients of NSCLC, in the period between October 2018 and end of July 2019.
Results
A total of 40 patients were evaluated with the age ranging from 37 to 77 years old, and the mean was 55.63 years (SD ± 10.29). There were 31 male cases and 9 female cases. When we compared contrast enhanced CT (CECT) to PET-CT for staging, PET-CT helped upstage disease in 10 of 40 patients (25%) and downstage in 3 of 40 patients (7.5%).
Conclusion
PET/CT is a useful imaging tool in initial staging of the newly diagnosed patients with NSCLC. It is better thаn СT alone fоr detection of malignant lesions for accurate staging. It can change the strategy of treatment according to its findings.
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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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Chen B, Xia W, Wang Z, Zhao H, Li X, Liu L, Liu Y, Hu J, Fu X, Li Y, Xu Y, Liu D, Yang H, Xu L, Jiang F. Risk analyses of N2 lymph-node metastases in patients with T1 non-small cell lung cancer: a multi-center real-world observational study in China. J Cancer Res Clin Oncol 2019; 145:2771-2777. [PMID: 31428933 DOI: 10.1007/s00432-019-03006-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE N2 lymph-node metastases occur in approximately 6-17% of the patients with T1-2 non-small cell lung cancer (NSCLC). However, the clinical characteristics of N2 patients are not fully understood. METHODS This retrospective, multi-center analysis included T1 NSCLC patients receiving surgical resection during a period from Jan 2nd, 2014 to Dec 27th, 2017. The diagnosis was pathologically verified in all cases. Univariate and multivariate logistic regression analyses were conducted to analyze the factors that are associated with pN2 lymph-node metastases. RESULTS A total of 10,885 patients (48.4% men; 84.7% adenocarcinoma) were included in the analysis. The mean age was 59.0 ± 9.9 years. The mean tumor size was 1.8 ± 0.8 cm. Of the patients, 3260 (29.9%) were smokers or ex-smokers. Lymph-node metastases were verified in 1808 (16.6%) patients, and 1167 (10.7%) patients had N2 lymph-node metastases. The multivariate analyses indicated that larger tumor size, lower differentiation, CEA level ≥ 5 ng/mL, vascular invasion (+), and pleural involvement (+) were associated with higher percentages of N2 lymph-node metastases (p < 0.001 for all). CONCLUSIONS This study demonstrated the significant association between N2 lymph-node metastases and tumor size and differentiation, CEA levels, and status of vascular invasion and pleural involvement.
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Affiliation(s)
- Bing Chen
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, No.42, Baiziting, Xuanwu District, Nanjing, 210009, Jiangsu, China
- Department of Thoracic Surgery, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, 210009, China
- Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, 210009, China
| | - Wenjie Xia
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, No.42, Baiziting, Xuanwu District, Nanjing, 210009, Jiangsu, China
- Department of Thoracic Surgery, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, 210009, China
- Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, 210009, China
| | - Zhongqiu Wang
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, No.42, Baiziting, Xuanwu District, Nanjing, 210009, Jiangsu, China
- Department of Thoracic Surgery, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, 210009, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, 200030, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing, 1000853, China
| | - Jian Hu
- Department of Thoracic Surgery, First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, 310000, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yijun Xu
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300051, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Haiying Yang
- Medical Affairs, Linkdoc Technology Co, Ltd, Beijing, 100080, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, No.42, Baiziting, Xuanwu District, Nanjing, 210009, Jiangsu, China.
- Department of Thoracic Surgery, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, 210009, China.
- Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, 210009, China.
| | - Feng Jiang
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, No.42, Baiziting, Xuanwu District, Nanjing, 210009, Jiangsu, China.
- Department of Thoracic Surgery, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, 210009, China.
- Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, 210009, China.
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Lee JY, Kim YH, Park YJ, Park SB, Chung HW, Zo JI, Shim YM, Lee KS, Choi JY. Improved detection of metastatic lymph nodes in oesophageal squamous cell carcinoma by combined interpretation of fluorine-18-fluorodeoxyglucose positron-emission tomography/computed tomography. Cancer Imaging 2019; 19:40. [PMID: 31227017 PMCID: PMC6588863 DOI: 10.1186/s40644-019-0225-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/13/2019] [Indexed: 12/19/2022] Open
Abstract
Background We sought to evaluate the diagnostic performance of fluorine-18-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in the detection of metastatic lymph nodes by combined interpretation of PET/CT images in patients with oesophageal squamous cell carcinoma. Methods Two hundred three patients with oesophageal squamous cell carcinoma underwent 18F-FDG PET/CT before oesophagectomy and lymph node dissection. Maximum standardized uptake value (SUVmax), mean Hounsfield unit (HU), short axis diameter (size), and visual CT attenuation (high, iso-, low) were evaluated on noncontrast CT and PET images following PET/CT scan. In this combined interpretation protocol, the high attenuated lymph nodes were considered benign, even if the SUVmax value was high. The diagnostic accuracy of each method was compared using the postoperative histologic result as a reference standard. Results A total of 1099 nodal stations were dissected and 949 nodal stations were proven to demonstrate metastasis. SUVmax and size of the malignant lymph nodes were higher than those of the benign nodes, and visual CT attenuation was significantly different among the two groups (P < 0.001). Using cutoff values of 2.6 for SUVmax and 10.2 mm for size, the combined interpretation of an SUVmax of more than 2.6 with iso- or low CT attenuation [area under the curve (AUC): 0.846, 95% confidence interval (CI): 0.824–0.867] showed significantly better diagnostic performance for detecting malignant lymph nodes than SUVmax only (AUC: 0.791, 95% CI: 0.766–0.815) and size (AUC: 0.693, 95% CI: 0.665–0.720) methods (P < 0.001) in a receiver operating characteristic curve analysis. Conclusions The diagnostic accuracy of PET/CT for nodal metastasis in oesophageal squamous cell carcinoma was improved by the combined interpretation of 18F-FDG uptake and visual CT attenuation pattern.
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Affiliation(s)
- Ji Young Lee
- Department of Nuclear Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Young Hwan Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Jin Park
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Soo Bin Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Woo Chung
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Ouyang ML, Xia HW, Xu MM, Lin J, Wang LL, Zheng XW, Tang K. Prediction of occult lymph node metastasis using SUV, volumetric parameters and intratumoral heterogeneity of the primary tumor in T1-2N0M0 lung cancer patients staged by PET/CT. Ann Nucl Med 2019; 33:671-680. [PMID: 31190182 DOI: 10.1007/s12149-019-01375-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to identify whether PET/CT-related metabolic parameters of the primary tumor could predict occult lymph node metastasis (OLM) in patients with T1-2N0M0 NSCLC staged by 18F-FDG PET/CT. METHODS 215 patients with clinical T1-2N0M0 (cT1-2N0M0) NSCLC who underwent both preoperative FDG PET/CT and surgical resection with the systematic lymph node dissection were included in the retrospective study. Heterogeneity factor (HF) was obtained by finding the derivative of the volume-threshold function from 40 to 80% of the maximum standardized uptake value (SUVmax). Univariate and multivariate stepwise logistic regression analyses were used to identify these PET parameters and clinicopathological variables associated with OLM. RESULTS Statistically significant differences were detected in sex, tumor site, SUVmax, mean SUV (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis and HF between patients with adenocarcinoma (ADC) and squamous cell carcinoma (SQCC). OLM was detected in 36 (16.7%) of 215 patients (ADC, 27/152 = 17.8% vs. SQCC, 9/63 = 14.3%). In multivariate analysis, MTV (OR = 1.671, P = 0.044) in ADC and HF (OR = 8.799, P = 0.023) in SQCC were potent associated factors for the prediction of OLM. The optimal cutoff values of 5.12 cm3 for MTV in ADC, and 0.198 for HF in SQCC were determined using receiver operating characteristic curve analysis. CONCLUSIONS In conclusion, MTV was an independent predictor of OLM in cT1-2N0M0 ADC patients, while HF might be the most powerful predictor for OLM in SQCC. These findings would be helpful in selecting patients who might be considered as candidates for sublobar resection or new stereotactic ablative radiotherapy.
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Affiliation(s)
- Ming-Li Ouyang
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Hu-Wei Xia
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Man-Man Xu
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Jie Lin
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Li-Li Wang
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Xiang-Wu Zheng
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, Zhejiang, 325000, People's Republic of China
| | - Kun Tang
- Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, Zhejiang, 325000, People's Republic of China.
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Shin SY, Hong IK, Jo YS. Quantitative computed tomography texture analysis: can it improve diagnostic accuracy to differentiate malignant lymph nodes? Cancer Imaging 2019; 19:25. [PMID: 31113494 PMCID: PMC6530003 DOI: 10.1186/s40644-019-0214-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/13/2019] [Indexed: 12/25/2022] Open
Abstract
Background and objective Mediastinal lymph node (LN) staging in individuals with non-small-cell lung cancer plays an important role in staging and treatment planning. This study aimed to assess the accuracy of computed tomography (CT) texture analysis (CTTA) in differentiating benign and malignant mediastinal LNs. Methods Pathologically confirmed malignant and benign mediastinal LN samples, obtained using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), were retrospectively reviewed, in addition to chest CT and 18-fluorodeoxyglucose (FDG) uptake positron emission tomography (PET) data. For each LN, CTTA was performed using “AVIEW” software (Coreline Soft, Republic of Korea) by drawing a region of interest. Results A total of 132 LNs from 80 patients were included and classified into two groups according to pathology results: malignant (n = 61) and benign (n = 71). In EBUS, size > 1 cm, round shape, heterogeneous echogenicity, and presence of coagulation necrosis sign were more prevalent in malignant than in benign LNs; length was the only feature that distinguished the two groups. Among CTTA features, compactness and normalized standard deviation (SD) showed differences between the two groups. The ability to distinguish malignant LNs was higher using high standard uptake value (SUV) on FDG PET/CT (SUVmax ≥ 5) and normalized SD on CTTA (area under the receiver operating characteristic curve 0.739 versus 0.742, respectively); however, normalized SD demonstrated very low sensitivity despite high specificity. Conclusions CTTA may be helpful in distinguishing between benign and malignant LNs; however, the diagnostic value was not high. Therefore, integrated evaluation with other imaging modalities is needed. Electronic supplementary material The online version of this article (10.1186/s40644-019-0214-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- So Youn Shin
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Il Ki Hong
- Department of Nuclear Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, KyungHee University Hospital, Seoul, Republic of Korea. .,Department of Internal Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
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Lim CH, Hyun SH, Moon SH, Cho YS, Choi JY, Lee KH. Comparison of prognostic values of primary tumor and nodal 18F-fluorodeoxyglucose uptake in non-small cell lung cancer with N1 disease. Eur Radiol 2019; 29:5288-5297. [PMID: 30899978 DOI: 10.1007/s00330-019-06128-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/23/2019] [Accepted: 02/25/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We hypothesized that, in non-small cell lung cancer (NSCLC) with N1 metastasis, N1 nodal 18F-fluorodeoxyglucose (FDG) status offers independent and incremental prognostic value. METHODS We enrolled 106 NSCLC patients with pathology-confirmed N1 metastasis. N1 node FDG positivity, primary tumor maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured. Kaplan-Meier method and Cox regression analyses were performed for cancer-specific survival (CSS) and disease-free survival (DFS). RESULTS Subjects were 67 males and 39 females (61.9 ± 9.4 years). Eighty-one (76.4%) and 25 (23.6%) had pathologic stage IIB and IIIA NSCLC, respectively. All underwent complete tumor resection. FDG-positive N1 nodes were larger and had higher primary tumor SUVmax. During a follow-up of 42 months, there were 56 recurrences and 31 cancer deaths. Significant univariate predictors were stage, no adjuvant therapy, and FDG-positive nodes for DFS, and stage, no adjuvant therapy, node size, tumor MTV, TLG, and SUVmax, and FDG-positive nodes for CSS. Independent predictors on multivariate analyses were FDG-positive nodes (HR = 3.071, p = 0.003), greater tumor TLG (HR = 3.224, p = 0.002), and no adjuvant therapy (HR = 3.631, p < 0.001) for poor CSS, and FDG-positive nodes (HR = 1.771, p = 0.040) and no adjuvant therapy (HR = 2.666, p = 0.002) for poor DFS. Harrell's concordance and net reclassification improvement tests showed that CSS prediction was significantly improved by the addition of N1 FDG status to a model containing tumor TLG. CONCLUSION N1 node FDG status can be useful for predicting the outcome of NSCLC patients with N1 metastasis beyond that provided by other prognostic variables. KEY POINTS • In NSCLC with N1 disease, N1 node FDG status is useful as a prognostic predictor. • FDG-positive N1 nodes provide additional prognostic value beyond TLG of primary tumor. • Combining TLG of primary tumor and N1 node uptake can stratify the survival of patients.
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Affiliation(s)
- Chae Hong Lim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Young Seok Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Is Calcification in the Regional Lymph Nodes a Benign Feature in Patients with Lung Cancer? World J Surg 2019; 43:1850-1856. [DOI: 10.1007/s00268-019-04937-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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An Unusual Presentation of Cervical Carcinoma Metastasis as Mediastinal Adenopathy. J Bronchology Interv Pulmonol 2019; 24:e61-e63. [PMID: 28957900 DOI: 10.1097/lbr.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Performance Comparison Between 18F-FDG PET/CT Plus Brain MRI and Conventional Staging Plus Brain MRI in Staging of Small Cell Lung Carcinoma. AJR Am J Roentgenol 2018; 211:185-192. [PMID: 29667886 DOI: 10.2214/ajr.17.18935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to prospectively compare the capabilities of integrated FDG PET/CT and conventional staging for identification of TNM factors, evaluation of the TNM and Veterans Administration Lung Study Group (VALSG) stages, and selection of patients with stage I small cell lung carcinoma (SCLC). SUBJECTS AND METHODS Fifty-nine patients (mean age, 69.6 ± 7.8 [SD] years; range, 40-84 years) with pathologically diagnosed SCLC underwent integrated 18F-FDG PET/CT and conventional staging with enhanced brain MRI. TNM and VALSG stages were evaluated by two different reader groups. Kappa statistics and chi-square test result were determined for evaluations of interobserver agreement of all factors and for each clinical stage for both methods. Diagnostic accuracy of identification of each factor and clinical stage was statistically compared by McNemar test. RESULTS Interobserver agreements for all factors and each clinical stage were assessed as almost perfect for PET/CT (0.83 ≤ κ ≤ 0.93; p < 0.001) and substantial and almost perfect (0.63 ≤ κ ≤ 0.96; p < 0.001) for conventional staging plus enhanced brain MRI. The diagnostic accuracy of PET/CT for N factor and TNM stage (N, 89.8% [53/59]; TNM stage, 88.1% [52/59]) was significantly higher than that of conventional staging plus enhanced brain MRI (N, 67.8% [40/59], p = 0.0002; TNM stage, 72.9% [43/59], p = 0.004). CONCLUSION Integrated FDG PET/CT with contrast-enhanced brain MRI is potentially equal to or more effective than conventional staging plus enhanced brain MRI for T, N, and M assessment and TNM and VALSG staging of SCLC.
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Dual-time point 18F-FDG PET/CT for the staging of oesophageal cancer: the best diagnostic performance by retention index for N-staging in non-calcified lymph nodes. Eur J Nucl Med Mol Imaging 2018; 45:1317-1328. [DOI: 10.1007/s00259-018-3981-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/15/2018] [Indexed: 12/11/2022]
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Wang H, Li QK, Auster M, Gong G. PET and CT features differentiating infectious/inflammatory from malignant mediastinal lymphadenopathy: A correlated study with endobronchial ultrasound-guided transbronchial needle aspiration. ACTA ACUST UNITED AC 2018; 5:7-13. [PMID: 31692939 PMCID: PMC6831101 DOI: 10.1016/j.jrid.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Purpose: To explore the advantages of differentiating inflammatory from malignant thoracic lymph nodes by integrating their features on positron emission tomography (PET) and computed tomography (CT). Material and method: Following institutional review board approval, PET and CT parameters of thoracic lymph nodes were examined based on their pathologic diagnosis via endobronchial ultrasound-guided transbronchial needle aspiration. The standardized uptake value (SUV) of PET and CT findings of the long- and short-axis diameters, axial short to long diameter ratios (S/L), and measured nodal CT values of the lymph nodes were compared and analyzed statistically. Results: A total of 124 lymph nodes from 70 patients were studied. The inflammatory and malignant lymph nodes differed significantly in their SUV (P = 0.008), short-axis diameters (SAD, p < 0.001), long-axis diameters (LAD, p = 0.002) and S/L ratios (p < 0.001). They did not differ significantly in non-contrast enhanced CT values (p = 0.304). The sensitivities, specificities, positive predictive values, negative predictive values, diagnostic accuracies and diagnostic odds ratios (DOR) were: 1) elevated SUV alone - 95.31% (61/64), 20% (12/60), 55.96% (61/109), 80% (12/15), 58.87% (73/124), and 5; 2) combined SUV + SAD - 89.06%, 53.33%, 67.06%, 82.05%, 71.77%, and 9.31; 3) combined SUV + S/L ratio - 87.5%, 93.33%, 93.33%, 87.5%, 90.32%, and 98, respectively. Conclusion: Increased SUV, SAD, LAD, and S/L ratio are accurate PET/CT parameters to characterize inflammatory or malignant lymph nodes. SUV has high sensitivity but low specificity, low positive and negative predictive values, and low DOR. The SUV + SAD and SUV + S/L ratios have higher specificity, positive and negative predictive values, diagnostic accuracy and DOR.
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Affiliation(s)
- Haiyan Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jingwu Road No.324, Jinan, Shandong 250021, China
| | - Qing Kay Li
- Department of Pathology, The Johns Hopkins University Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224-2780, USA
| | - Martin Auster
- Imaging Department, The Johns Hopkins University Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224-2780, USA
| | - Gary Gong
- Department of Radiology & Radiological Sciences, The Johns Hopkins University Hospital, Phipps B-125, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Shen G, Lan Y, Zhang K, Ren P, Jia Z. Comparison of 18F-FDG PET/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis. PLoS One 2017; 12:e0173104. [PMID: 28253364 PMCID: PMC5333854 DOI: 10.1371/journal.pone.0173104] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 02/15/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Accurate clinical staging of mediastinal lymph nodes of patients with lung cancer is important in determining therapeutic options and prognoses. We aimed to compare the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting mediastinal nodal metastasis of lung cancer. METHODS Relevant studies were systematically searched in the MEDLINE, EMBASE, PUBMED, and Cochrane Library databases. Based on extracted data, the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR) with individual 95% confidence intervals were calculated. In addition, the publication bias was assessed by Deek's funnel plot of the asymmetry test. The potential heterogeneity was explored by threshold effect analysis and subgroup analyses. RESULTS Forty-three studies were finally included. For PET/CT, the pooled sensitivity and specificity were 0.65 (0.63-0.67) and 0.93 (0.93-0.94), respectively. The corresponding values of DWI were 0.72 (0.68-0.76) and 0.97 (0.96-0.98), respectively. The overall PLR and NLR of DWI were 13.15 (5.98-28.89) and 0.32 (0.27-0.39), respectively. For PET/CT, the corresponding values were 8.46 (6.54-10.96) and 0.38 (0.33-0.45), respectively. The Deek's test revealed no significant publication bias. Study design and patient enrollment were potential causes for the heterogeneity of DWI studies and the threshold was a potential source for PET/CT studies. CONCLUSION Both modalities are beneficial in detecting lymph nodes metastases in lung cancer without significant differences between them. DWI might be an alternative modality for evaluating nodal status of NSCLC.
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Affiliation(s)
- Guohua Shen
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - You Lan
- Division of Laboratory Medicine, West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Kan Zhang
- Division of Laboratory Medicine, West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Pengwei Ren
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zhiyun Jia
- Division of Laboratory Medicine, West China School of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Comparison between solid component size on thin-section CT and pathologic lymph node metastasis and local invasion in T1 lung adenocarcinoma. Jpn J Radiol 2017; 35:109-115. [DOI: 10.1007/s11604-017-0610-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
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Abstract
Precision medicine allows tailoring of preventive or therapeutic interventions to avoid the expense and toxicity of futile treatment given to those who will not respond. Lung cancer is a heterogeneous disease functionally and morphologically. PET is a sensitive molecular imaging technique with a major role in the precision medicine algorithm of patients with lung cancer. It contributes to the precision medicine of lung neoplasia by interrogating tumor heterogeneity throughout the body. It provides anatomofunctional insight during diagnosis, staging, and restaging of the disease. It is a biomarker of tumoral heterogeneity that helps direct selection of the most appropriate treatment, the prediction of early response to cytotoxic and cytostatic therapies, and is a prognostic biomarker in patients with lung cancer.
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Affiliation(s)
- Katherine A Zukotynski
- Division of Nuclear Medicine and Molecular Imaging, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, Ontario L9G 4X5, Canada; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, McMaster University, 1200 Main Street West, Hamilton, Ontario L9G 4X5, Canada
| | - Victor H Gerbaudo
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Cerra-Franco A, Diab K, Lautenschlaeger T. Undetected lymph node metastases in presumed early stage NSCLC SABR patients. Expert Rev Anticancer Ther 2016; 16:869-75. [PMID: 27279087 DOI: 10.1080/14737140.2016.1199279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Stereotactic body radiation therapy (SBRT, also called stereotactic ablative body radiation SABR) is the treatment of choice for many patients with early-stage non-small cell lung cancer (NSCLC), including those who are unfit for surgery or refuse surgery. AREAS COVERED In an effort to develop optimal staging for the evaluation of SBRT candidates, we review the performance of available lymph node staging methods, as well as risk factors for lymph node involvement. Pubmed was searched to identify relevant literature. Current staging methods for NSCLC, including Positron Emission Tomography/Computed Tomography(PET/CT) and endobronchial ultra sound (EBUS), have limited sensitivities. Expert commentary: There are several factors, including primary tumor location, tumor size, and histology that are possibly associated with the sensitivity of PET/CT to detect mediastinal lymph node metastasis. Small lymph node metastases typically remain undetected by PET/CT. Therefore invasive nodal staging procedures are indicated for most presumed early-stage NSCLC patients, but these also have limited sensitivity. Occult lymph node metastasis is associated with adverse outcome in NSCLC. Moreover, there is overwhelming evidence that certain patients who have lymph node metastases detected at the time of surgery derive an overall survival benefit from adjuvant therapies. It remains to be determined if improved detection of lymph node metastases in SABR candidates can indeed improve prognosis.
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Affiliation(s)
- Alberto Cerra-Franco
- a Department of Radiation Oncology , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Khalil Diab
- b Department of Pulmonary Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Tim Lautenschlaeger
- a Department of Radiation Oncology , Indiana University School of Medicine , Indianapolis , IN , USA
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Lee JW, Kim EY, Kim DJ, Lee JH, Kang WJ, Lee JD, Yun M. The diagnostic ability of 18F-FDG PET/CT for mediastinal lymph node staging using 18F-FDG uptake and volumetric CT histogram analysis in non-small cell lung cancer. Eur Radiol 2016; 26:4515-4523. [PMID: 26943133 DOI: 10.1007/s00330-016-4292-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 01/17/2016] [Accepted: 02/17/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the clinical implications of lymph node (LN) density on 18F-FDG PET/CT for mediastinal LN characterization in non-small cell lung cancer (NSCLC). METHODS One hundred and fifty-two patients with 271 mediastinal LNs who underwent PET/CT and endobronchial ultrasound-guided transbronchial needle aspiration for staging were enrolled. Maximum standardized uptake value (SUVmax), short axis diameter, LN-to-primary cancer ratio of SUVmax, and median Hounsfield unit (HU) based on CT histogram were correlated to histopathology. RESULTS Of 271 nodes, 162 (59.8 %) were malignant. SUVmax, short axis diameter, and LPR of malignant LNs were higher than those of benign nodes. Among malignant LNs, 71.0 % had median HU between 25 and 45, while 78.9 % of benign LNs had values <25 HU or >45 HU. Using a cutoff value of 4.0, SUVmax showed the highest diagnostic ability for detecting malignant LNs with a specificity of 94.5 %, but showing a sensitivity of 70.4 %. Using additional density criteria (median HU 25-45) in LNs with 2.0< SUVmax ≤4.0, the sensitivity increased to 88.3 % with the specificity of 82.6 %. CONCLUSIONS LN density is useful for the characterization of LNs with mild 18F-FDG uptake. The risk of mediastinal LN metastasis in NSCLC patients could be further stratified using both 18F-FDG uptake and LN density. KEY POINTS • SUVmax showed the highest diagnostic ability for detecting malignant LNs. • LN density was useful in characterization of LNs with mild FDG uptake. • SUVmax and LN density together could stratify the risk of LN metastasis.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Eun Young Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hoon Lee
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea. .,Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, Korea.
| | - Won Jun Kang
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Doo Lee
- Department of Radiology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
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Cho H, Lee HY, Kim J, Kim HK, Choi JY, Um SW, Lee KS. Pure ground glass nodular adenocarcinomas: Are preoperative positron emission tomography/computed tomography and brain magnetic resonance imaging useful or necessary? J Thorac Cardiovasc Surg 2015; 150:514-20. [DOI: 10.1016/j.jtcvs.2015.06.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 03/10/2015] [Accepted: 03/25/2015] [Indexed: 12/25/2022]
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Rubin GD. Computed tomography: revolutionizing the practice of medicine for 40 years. Radiology 2015; 273:S45-74. [PMID: 25340438 DOI: 10.1148/radiol.14141356] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computed tomography (CT) has had a profound effect on the practice of medicine. Both the spectrum of clinical applications and the role that CT has played in enhancing the depth of our understanding of disease have been profound. Although almost 90 000 articles on CT have been published in peer-reviewed journals over the past 40 years, fewer than 5% of these have been published in Radiology. Nevertheless, these almost 4000 articles have provided a basis for many important medical advances. By enabling a deepened understanding of anatomy, physiology, and pathology, CT has facilitated key advances in the detection and management of disease. This article celebrates this breadth of scientific discovery and development by examining the impact that CT has had on the diagnosis, characterization, and management of a sampling of major health challenges, including stroke, vascular diseases, cancer, trauma, acute abdominal pain, and diffuse lung diseases, as related to key technical advances in CT and manifested in Radiology.
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Affiliation(s)
- Geoffrey D Rubin
- From the Duke Clinical Research Institute and Department of Radiology, Duke University School of Medicine, PO Box 17969, 2400 Pratt St, Durham, NC 27715
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Fraioli F, Screaton NJ, Janes SM, Win T, Menezes L, Kayani I, Syed R, Zaccagna F, O'Meara C, Barnes A, Bomanji JB, Punwani S, Groves AM. Non-small-cell lung cancer resectability: diagnostic value of PET/MR. Eur J Nucl Med Mol Imaging 2015; 42:49-55. [PMID: 25120040 PMCID: PMC4244545 DOI: 10.1007/s00259-014-2873-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/20/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the diagnostic performance of PET/MR in patients with non-small-cell lung cancer. METHODS Fifty consecutive consenting patients who underwent routine (18)F-FDG PET/CT for potentially radically treatable lung cancer following a staging CT scan were recruited for PET/MR imaging on the same day. Two experienced readers, unaware of the results with the other modalities, interpreted the PET/MR images independently. Discordances were resolved in consensus. PET/MR TNM staging was compared to surgical staging from thoracotomy as the reference standard in 33 patients. In the remaining 17 nonsurgical patients, TNM was determined based on histology from biopsy, imaging results (CT and PET/CT) and follow-up. ROC curve analysis was used to assess accuracy, sensitivity and specificity of the PET/MR in assessing the surgical resectability of primary tumour. The kappa statistic was used to assess interobserver agreement in the PET/MR TNM staging. Two different readers, without knowledge of the PET/MR findings, subsequently separately reviewed the PET/CT images for TNM staging. The generalized kappa statistic was used to determine intermodality agreement between PET/CT and PET/MR for TNM staging. RESULTS ROC curve analysis showed that PET/MR had a specificity of 92.3 % and a sensitivity of 97.3 % in the determination of resectability with an AUC of 0.95. Interobserver agreement in PET/MR reading ranged from substantial to perfect between the two readers (Cohen's kappa 0.646 - 1) for T stage, N stage and M stage. Intermodality agreement between PET/CT and PET/MR ranged from substantial to almost perfect for T stage, N stage and M stage (Cohen's kappa 0.627 - 0.823). CONCLUSION In lung cancer patients PET/MR appears to be a robust technique for preoperative staging.
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Affiliation(s)
- Francesco Fraioli
- Department of Nuclear Medicine and Radiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK,
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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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Fernandez FG, Kozower BD, Crabtree TD, Force SD, Lau C, Pickens A, Krupnick AS, Veeramachaneni N, Patterson GA, Jones DR, Meyers BF. Utility of mediastinoscopy in clinical stage I lung cancers at risk for occult mediastinal nodal metastases. J Thorac Cardiovasc Surg 2014; 149:35-41, 42.e1. [PMID: 25439769 DOI: 10.1016/j.jtcvs.2014.08.075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/15/2014] [Accepted: 08/20/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The prevalence of mediastinal lymph node metastases is unknown for patients with clinical N0 lung cancer who are thought to be at high risk for occult nodal metastases. Further, the utility of mediastinoscopy in these patients is unknown. We performed a prospective trial to evaluate the utility of routine cervical mediastinoscopy for patients who may be at high risk of occult nodal metastases. METHODS From January 1, 2008, July 31, 2013, 90 patients with lung cancer with clinical stage T2N0 or T1N0 with standardized uptake value greater than 10 by positron emission tomography/computed tomography underwent routine cervical mediastinoscopy before lung resection. Biopsy of a minimum of 3 nodal stations at mediastinoscopy and a minimum of 4 nodal stations with lung resection was advised. The prevalence of nodal metastases at mediastinoscopy and lung resection was recorded. RESULTS Some 64% of patients with lung cancer were male with a mean age of 67.3 years. A total of 81 patients had clinical T2N0 and 9 patients had T1N0 with standardized uptake value greater than 10. Mean tumor size was 4.3 ± 1.7 cm, and mean standardized uptake value was 13.5 ± 6.8. One patient (1.1%) had occult metastases detected at mediastinoscopy. A total of 86 patients underwent surgical resection; 4 patients (4.6%) were upstaged to pN2, and 18 patients (21%) were upstaged to pN1. Of 90 patients with clinically staged N0 lung cancer by positron emission tomography/computed tomography, 5.6% (5) were upstaged to pN2 and 20% (18) were upstaged to pN1 (total nodal upstaging = 25.6%). CONCLUSIONS Mediastinoscopy seems to have limited utility in these patients with T1 and T2 clinically staged N0 by positron emission tomography/computed tomography. Selective use of mediastinoscopy is recommended, along with thorough mediastinal lymph node evaluation in all patients at the time of lung cancer resection.
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Affiliation(s)
- Felix G Fernandez
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga; Atlanta Veterans Affairs Medical Center, Decatur, Ga.
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Traves D Crabtree
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | - Seth D Force
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Christine Lau
- Division of Cardiothoracic Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Allan Pickens
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Alexander S Krupnick
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | | | - G Alexander Patterson
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | - David R Jones
- Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bryan F Meyers
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
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Metabolic parameters using ¹⁸F-FDG PET/CT correlate with occult lymph node metastasis in squamous cell lung carcinoma. Eur J Nucl Med Mol Imaging 2014; 41:2051-7. [PMID: 24990401 DOI: 10.1007/s00259-014-2831-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/02/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to investigate predictability of occult lymph node metastasis (OLM) using metabolic parameters on pretreatment (18)F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/CT in squamous cell non-small cell lung carcinoma (SC-NSCLC) patients who were clinically node negative (cN0) before surgery. METHODS A total of 63 cN0 SC-NSCLC patients (M/F = 61/2, mean age 64.1 ± 8.0) who underwent curative surgery with lymph node dissection were enrolled in this study. Metabolic tumor volume (MTV) of the primary tumor was obtained with a standardized uptake value (SUV) threshold of 2.5. Total lesion glycolysis (TLG) was calculated by multiplication of the MTV and its SUVmean. Metabolic parameters (SUVmax, MTV, and TLG) and clinicopathological factors were analyzed for OLM. RESULTS Of 63 patients, 12 (19.0 %) had OLM. Significantly higher SUVmax, MTV, TLG, and pathological tumor size were observed in patients with OLM. The optimal cutoff values for prediction of OLM determined using a receiver-operating characteristic (ROC) curve were 8.8 for SUVmax, 18.9 cm(3) for MTV, 88.4 for TLG, and 2.8 cm for pathological tumor size. Univariate analysis showed correlation of SUVmax, MTV, and TLG with the rate of OLM. In multivariate analyses, high SUVmax and MTV showed an association with an increased risk of OLM, after adjusting for age, sex, pathological tumor size, T stage, and location. CONCLUSION Metabolic parameters on pretreatment (18)F-FDG PET/CT were significant predictors for OLM in cN0 SC-NSCLC patients. Surgical planning can be tailored based on the parameters in order to reduce the risk of hidden residual lymph node metastases in patients.
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The role of 18F-FDG PET/CT for evaluation of metastatic mediastinal lymph nodes in patients with lung squamous-cell carcinoma or adenocarcinoma. Lung Cancer 2014; 85:53-8. [DOI: 10.1016/j.lungcan.2014.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/26/2014] [Accepted: 04/08/2014] [Indexed: 11/20/2022]
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Harders SW, Madsen HH, Hjorthaug K, Arveschoug AK, Rasmussen TR, Meldgaard P, Hoejbjerg JA, Pilegaard HK, Hager H, Rehling M, Rasmussen F. Mediastinal staging in Non-Small-Cell Lung Carcinoma: computed tomography versus F-18-fluorodeoxyglucose positron-emission tomography and computed tomography. Cancer Imaging 2014; 14:23. [PMID: 25608616 PMCID: PMC4331828 DOI: 10.1186/1470-7330-14-23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 01/12/2023] Open
Abstract
Background After the diagnosis Non-Small-Cell Lung Carcinoma (NSCLC) has been established, consideration must turn toward the stage of disease, because this will impact directly on management and prognosis. Staging is used to predict survival and to guide the patient toward the most appropriate treatment regimen or clinical trial. Distinguishing malignant involvement of the mediastinal lymph nodes (N2 or N3) from the hilar lymph nodes, or no lymph nodes (N0 or N1) is critical, because malignant involvement of N2 or N3 lymph nodes usually indicates non–surgically resectable disease. The purpose of this study was to examine and compare CT versus integrated F18-FDG PET/low dose CT (FDG PET/CT) for mediastinal staging in NSCLC, and the desire was to safely distinguish between malignant and benign lesions without the need for invasive procedures. All results were controlled for reproducibility. Methods 114 participants with NSCLC were included in a prospective cohort study. Blinded CT and FDG PET/CT images were reviewed. The participants’ mediastinums were staged based on lymph node sizes (CT), or on FDG uptake (FDG PET/CT). Reference standard was tissue sampling. Results We found that there was no measureable difference between CT and FDG PET/CT mediastinal staging results; overall two-thirds of the participants in the study were correctly staged, and almost one-third of the participants were falsely staged. Conclusion Neither CT nor FDG PET/CT could obviate the need for further invasive staging prior to thoracotomy in patients with NSCLC; for that purpose, the results of both modalities were too meagre. Therefore, these patients still depend on invasive staging methods. In our study, invasive staging was accomplished by mediastinoscopy. However, today this is increasingly replaced by EBUS or EUS.
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Role of lymphatic invasion in the prognosis of patients with clinical node-negative and pathologic node-positive lung adenocarcinoma. J Thorac Cardiovasc Surg 2014; 147:1820-6. [DOI: 10.1016/j.jtcvs.2013.11.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/22/2013] [Accepted: 11/22/2013] [Indexed: 11/21/2022]
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Minamimoto R, Toyohara J, Ito H, Seike A, Miyata Y, Morooka M, Okasaki M, Nakajima K, Ito K, Ishiwata K, Kubota K. A pilot study of 4'-[methyl-11C]-thiothymidine PET/CT for detection of regional lymph node metastasis in non-small cell lung cancer. EJNMMI Res 2014; 4:10. [PMID: 24593883 PMCID: PMC3976537 DOI: 10.1186/2191-219x-4-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/25/2014] [Indexed: 01/10/2023] Open
Abstract
Background 4′-[methyl-11C]-thiothymidine (4DST) is a novel positron emission tomography (PET) tracer to assess proliferation of malignancy. The diagnostic abilities of 4DST and 2-deoxy-2-18 F-fluoro-d-glucose (FDG) for detecting regional lymph node (LN) metastases of non-small cell lung cancer (NSCLC) were prospectively compared. In addition, the relationship between the PET result and the patient's prognosis was evaluated. Methods A total of 31 patients with NSCLC underwent 4DST PET/computed tomography (CT) and FDG PET/CT. The PET/CT images were evaluated qualitatively and quantitatively for focal uptake of each PET tracer, according to the staging system of the American Joint Committee on Cancer. Surgical and histological results provided the reference standards. Patients were followed for up to two years to assess disease-free survival. Results On a per-lesion basis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for LN staging were 82%, 72%, 32%, 96%, and 73%, respectively, for 4DST, and 29%, 86%, 25%, 88%, and 78%, respectively, for FDG. The sensitivity of 4DST was significantly higher than that of FDG (P < 0.001). The disease-free survival rate with positive 4DST uptake in nodal lesions was 0.35, which was considerably lower than the rate of 0.83 with negative findings (P = 0.04). Among the factors tested, nodal staging by 4DST was the most influential prognostic factor (P = 0.05) in predicting the presence of a previously existing spread lesion or of a recurrence over the course of 2 years. Conclusion 4DST PET/CT is sensitive for detecting mediastinal lymph node metastasis in NSCLC, but its low specificity is a limitation. However, it may be helpful in predicting the prognosis of NSCLC.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo 162-8655, Japan.
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Heusch P, Buchbender C, Köhler J, Nensa F, Gauler T, Gomez B, Reis H, Stamatis G, Kühl H, Hartung V, Heusner TA. Thoracic Staging in Lung Cancer: Prospective Comparison of 18F-FDG PET/MR Imaging and 18F-FDG PET/CT. J Nucl Med 2014; 55:373-8. [DOI: 10.2967/jnumed.113.129825] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Xu N, Wang M, Zhu Z, Zhang Y, Jiao Y, Fang W. Integrated positron emission tomography and computed tomography in preoperative lymph node staging of non-small cell lung cancer. Chin Med J (Engl) 2014; 127:607-613. [PMID: 24534208 DOI: 10.3760/cma.j.issn.0366-6999.20131691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Integrated positron emission tomography and computed tomography (PET/CT) is increasingly used for the preoperative nodal staging of non-small cell lung cancer (NSCLC). The aim of this study was to evaluate the accuracy of PET/CT in comparison with CT in detection of nodal metastasis and preoperative nodal staging in patients with NSCLC, and to analyze the causes of the PET/CT false-negative and false-positive results. METHODS Consecutive patients with pathologically proven NSCLC who underwent staging using PET/CT from July 2008 to February 2012 were evaluated retrospectively. Nodal staging was pathologically confirmed on tissue specimens obtained at thoracotomy. The accuracy of PET/CT and CT in the assessment of intrathoracic nodal involvement was determined using histological results as the reference standard. Logistic regression was used to define the causes of the false-negative and false-positive results. RESULTS A total of 528 lymph node stations were evaluated in 101 patients. Lymph nodes were positive for malignancy in 43 out of 101 patients (42.6%), and 101 out of 528 nodal stations (19.2%). PET/CT was significantly more accurate for nodal staging than CT. The sensitivity, specificity, positive and negative predictive values, and accuracy of PET/CT for detecting nodal metastasis were 51.5%, 95.8%, 74.3%, 89.3%, and 87.3% and the corresponding data by CT were 45.5%, 87.1%, 45.5%, 87.1%, and 79.2%, respectively. PET/CT confers significantly higher specificity, positive predictive value, and accuracy than CT in detecting nodal metastasis. False-negative results by PET/CT are significantly associated with smaller lymph node size, whereas false-positive results are related to a combination of inflammatory disorders and larger lymph node size. CONCLUSION PET/CT confers significantly higher accuracy than CT in nodal staging, and is more specific and accurate than CT in detecting nodal metastasis but has a low sensitivity and high false-negative rate.
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Affiliation(s)
- Na Xu
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Mengzhao Wang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhaohui Zhu
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yingqiang Zhang
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yang Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Weigang Fang
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Ozgül MA, Kirkil G, Seyhan EC, Cetinkaya E, Ozgül G, Yüksel M. The maximum standardized FDG uptake on PET-CT in patients with non-small cell lung cancer. Multidiscip Respir Med 2013; 8:69. [PMID: 24148271 PMCID: PMC3816207 DOI: 10.1186/2049-6958-8-69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/17/2013] [Indexed: 12/20/2022] Open
Abstract
Background Non-small cell lung cancer (NSCLC) accounts for approximately 80% of new diagnoses of pulmonary carcinoma. This study investigated the correlation between 18 F-fluorodeoxyglucose uptake in computerized tomography integrated positron emission tomography and tumor size, lymph node metastasis, and distant metastasis in patients with NSCLC. Methods The records of 151 NSCLC patients (139 male, 12 female; mean age 59.60 years) were evaluated retrospectively. Results Forty-one cases were adenocarcinomas; 45 squamous cell carcinomas; and 65 unspecified NSCLC. When the cases were categorized according to tumor size (group 1, ≤ 3 cm; group 2, > 3 and ≤ 5 cm; group 3, > 5 cm), the maximum standardized uptake value (SUVmax) was significantly lower in groups 1 and 2 compared with group 3 (p = 0.006 for each). Considering all cases, tumor SUVmax was not correlated with age, gender, or histopathological type. Lymph node metastases were pathologically proven in 24 cases: 24% of these were adenocarcinomas, 6% squamous cell carcinomas, and 16% unspecified NSCLC. Neither lymph node involvement nor distant metastases were correlated with tumor SUVmax, although lymph node size was positively correlated with lymph node SUVmax (r = 0.775; p < 0.001). Conclusions SUVmax was significantly associated with tumor size, but not with distant metastases or lymph node involvement. Therefore, SUVmax on positron emission tomography is not predictive of the presence of metastases.
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Affiliation(s)
| | | | - Ekrem Cengiz Seyhan
- Department of Chest Diseases, Istanbul Medipol University Hospital, Istanbul, Turkey.
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Patel VK, Naik SK, Naidich DP, Travis WD, Weingarten JA, Lazzaro R, Gutterman DD, Wentowski C, Grosu HB, Raoof S. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 1: radiologic characteristics and imaging modalities. Chest 2013; 143:825-839. [PMID: 23460160 DOI: 10.1378/chest.12-0960] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The solitary pulmonary nodule (SPN) is frequently encountered on chest imaging and poses an important diagnostic challenge to clinicians. The differential diagnosis is broad, ranging from benign granulomata and infectious processes to malignancy. Important concepts in the evaluation of SPNs include the definition, morphologic characteristics via appropriate imaging modalities, and the calculation of pretest probability of malignancy. Morphologic differentiation of SPN into solid or subsolid types is important in the choice of follow-up and further management. In this first part of a two-part series, we describe the morphologic characteristics and various imaging modalities available to further characterize SPN. In Part 2, we will describe the determination of pretest probability of malignancy and an algorithmic approach to the diagnosis of SPN.
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Li X, Zhang H, Xing L, Xu X, Xie P, Ma H, Zhang L, Chen M, Sun X, Xu W, Chen L, Yu J. Predictive value of primary fluorine-18 fluorodeoxyglucose standard uptake value for a better choice of systematic nodal dissection or sampling in clinical stage ia non--small-cell lung cancer. Clin Lung Cancer 2013; 14:568-73. [PMID: 23835164 DOI: 10.1016/j.cllc.2013.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/23/2012] [Accepted: 02/12/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine whether the standard uptake value (SUV) of the primary lesion can predict mediastinal lymph node metastasis in clinical stage IA non--small-cell lung cancer (NSCLC). MATERIALS AND METHODS At 5 centers, patients with clinical stage IA NSCLC from February 2004 to August 2010 were analyzed retrospectively. Data from Shandong Cancer Hospital and from the Cancer Hospital Affiliated to Harbin Medical University were used as a testing set, and data from the other 3 institutions were used as the validation set. Final diagnosis was established based on the histopathologic examination. RESULTS Data from 144 patients were collected for the study. The primary results in our study showed that maximal SUV (SUVmax) of primary tumor might be a predictor of lymph node metastasis (χ(2) = 10.424; P = .001) and the best cutoff value was 7.25 (P = .029). For the testing set, lymph node metastasis rates in low-grade group (SUVmax < 7.25) and high-grade group (SUVmax > 7.25) were 5% (2/43) and 36% (9/25) (P = .001) For the total data set, lymph node metastasis rate was 7% (6/93) in low-grade group (SUVmax < 7.25) and 26% (13/51) in high-grade group (SUVmax > 7.25) (χ(2)= 10.424; P = .001). A multivariate analysis revealed that no factors were applied to predict the probability of metastasis. But the analysis showed a weak correlation between SUVmax and nodal status (r = 0.21; P = .011) with bivariate correlation. CONCLUSION Analysis of our data suggested that fluorine-18 fluorodeoxyglucose SUVmax of the primary tumor might be a predictor of lymph node involvement in stage IA NSCLC. The rate of mediastinal lymph node metastasis of patients with a lower fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography SUVmax might be relatively low, which provides more evidence for clinical procedures of clinical stage IA NSCLC.
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Affiliation(s)
- Xiaolin Li
- Department of Radiation Oncology and Key Laboratory of Radiation Oncology of Shandong Province, Department of Radiation Oncology of Shandong Cancer Hospital and Institute, Jinan, Shandong, China
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Li L, Ren S, Zhang Y, Guan Y, Zhao J, Liu J, Wang Q, Chen G, Chen H, Xiang J, Fu X. Risk factors for predicting the occult nodal metastasis in T1-2N0M0 NSCLC patients staged by PET/CT: potential value in the clinic. Lung Cancer 2013; 81:213-7. [PMID: 23664030 DOI: 10.1016/j.lungcan.2013.04.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/03/2013] [Accepted: 04/09/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE The aims of our study were to evaluate the occult nodal metastasis in clinical stage I patients by PET/CT, further investigate the potential risk factors for nodal involvement, since a successful prediction could be helpful in selection appropriate candidates for SABR or limited surgery. METHODS We retrospectively reviewed the records of 189 patients who diagnosed as clinical stage I NSCLC by (18)F-FDG PET/CT from January 2004 to July 2011. All patients underwent lobectomy and systematic lymph node dissection and preoperative (18)F-FDG PET/CT scanning. The prevalence of occult nodal metastasis in patients as clinical N0 was analyzed according to clinicopathological factors such as tumor location, tumor size, tumor subtype, grade of differentiation and primary tumor SUV(max). Risk factors for occult nodal metastasis were defined by univariate and multivariate analysis. RESULTS Occult nodal metastasis was detected in 18.0% (34/189) of the patients. SUV(max) of the primary tumor and tumor size were independent predictors of occult nodal metastasis for patients with clinical N(0)NSCLC by FDG PET/CT. Accordingly we divided our patients into three groups: group 1 (low-risk group) ∼T ≤ 3 cm and SUV(max) ≤ 4.3; group 2 (moderate-risk group) ∼T ≤ 3 cm and SUV(max) > 4.3 or SUV(max) ≤ 4.3 and T > 3 cm; group 3 (high-risk group) ∼T > 3 cm and SUV(max) > 4.3. The occult lymph node metastasis rate in groups 1, 2, 3 was 1/82 (1.2%), 19/75 (25.3%) and 14/32 (43%) respectively. CONCLUSIONS T(1-2N0M0) NSCLC patients by PET/CT showing larger tumor size and high SUV(max) constitute a high-risk group for occult nodal metastasis. The combined information of primary tumor SUV(max) and tumor size before treatment have potential values in the clinic. These findings would be helpful in selection of SABR or limited surgery candidates.
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Affiliation(s)
- Ling Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Zhou H, Xiong Z, Liu JK, Chen SX, Zhou ML, Zhou JH, Chen W, Liu YTY, Fan F. Low tumor blood flow assessed with perfusion CT correlates with lymphatic involvement in patients with stage T1b non-small cell lung cancer. Thorac Cancer 2013; 4:131-137. [PMID: 28920205 DOI: 10.1111/j.1759-7714.2012.00142.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To investigate the correlation of computed tomography (CT) perfusion parameters and lymphatic involvement in patients with stage T1b non-small cell lung cancer (NSCLC). METHODS Forty-six patients (30 men and 16 women; age range, 36-73 years; mean age, 57 years), with stage T1b non-small cell lung cancer, underwent perfusion CT before surgery. The correlations between CT perfusion parameters (blood flow, blood volume, peak enhancement intensity), tumor angiogenesis (microvessel density and maturity of microvessels of surgical specimens) and lymphatic involvement were retrospectively investigated. Receiver operator curve (ROC) analysis was used to identify the parameter threshold at which tumors had or did not have lymph node metastasis, and the corresponding sensitivity and specificity were calculated. RESULTS A significant tendency for tumors with low blood flow and high density of immature microvessels to show lymphatic involvement was found (all P < 0.001). High correlation (r =-0.769, P < 0.001) was observed between tumor blood flow and immature microvessels. The area under ROC curves (AUC) for blood flow to detect lymph node metastasis was 0.866 (95% confidence interval, 0.766-0.966). For blood flow, the sensitivity, specificity, and accuracy of predicting lymph node metastasis were 88.9, 64.3, and 73.9% respectively, if the cutoff point was set at 43.05 mL/100 g/minute. CONCLUSIONS Blood flow may be useful to predict lymphatic involvement before surgery in stage T1b NSCLC.
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Affiliation(s)
- Hui Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Zeng Xiong
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Jin-Kang Liu
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Shen-Xi Chen
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Mo-Ling Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Jian-Hua Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Chen
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Yang-Teng-Yu Liu
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Fan Fan
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
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Role of 2-[18F]fluoro-2-deoxyglucose positron emission tomography in preoperative management of solid-type small-sized lung cancer. Ann Nucl Med 2013; 27:515-22. [DOI: 10.1007/s12149-013-0715-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
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Li M, Wu N, Zheng R, Liang Y, Liu Y, Zhang W, Li N, Zhao P. Primary tumor PET/CT [¹⁸F]FDG uptake is an independent predictive factor for regional lymph node metastasis in patients with non-small cell lung cancer. Cancer Imaging 2013; 12:566-72. [PMID: 23399986 PMCID: PMC3569669 DOI: 10.1102/1470-7330.2012.0040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: To investigate the correlation between [18F]fluorodeoxyglucose (FDG) uptake in a primary tumor and pathologic N stages, and to further analyze the possible risk factors contributing to the regional lymph node metastasis. Patients and methods: Eighty patients with non-small cell lung cancer (NSCLC) who underwent positron emission tomography/computed tomography were enrolled in the study. The FDG uptake in the primary tumor was compared for the different N staging groups and further correlation was performed. The degree of FDG uptake in the primary tumor and other possible variables related to the incidence of lymph node metastasis were examined by univariate and logistic multivariate analysis. FDG uptake was quantitated using the maximum standardized uptake value (SUVmax). Results: Statistically significant differences were found in the SUVmax of the primary tumors among different N staging groups (F = 4.124, P = 0.023), and the correlation between them was also statistically significant (r = 0.438, P = 0.000). Univariate analysis showed that blood tumor markers, primary tumor size, histologic grade, and SUVmax of the primary tumor were significantly associated with lymph node involvement. Logistic multivariate analysis showed that blood tumor makers and SUVmax of primary tumor might be considered as significant predictive factors for lymph node metastasis in patients with NSCLC. Conclusion: Our results show that there is a significant relationship between the SUVmax of the primary tumor and the pathologic N stage of NSCLC. FDG uptake by the primary tumor may be an independent predictor of regional lymph node metastasis in patients with NSCLC.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, Peoples Republic of China
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