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AlRasheedi M, Han S, Thygesen H, Neilson M, Hendry F, Alkarn A, Maclay JD, Leung HY. A Comparative Evaluation of Mediastinal Nodal SUVmax and Derived Ratios from 18F-FDG PET/CT Imaging to Predict Nodal Metastases in Non-Small Cell Lung Cancer. Diagnostics (Basel) 2023; 13:1209. [PMID: 37046427 PMCID: PMC10093125 DOI: 10.3390/diagnostics13071209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023] Open
Abstract
18F-FDG positron emission tomography with computed tomography (PET/CT) is a standard imaging modality for the nodal staging of non-small cell lung cancer (NSCLC). To improve the accuracy of pre-operative staging, we compare the staging accuracy of mediastinal lymph node (LN) standard uptake values (SUV) with four derived SUV ratios based on the SUV values of primary tumours (TR), the mediastinal blood pool (MR), liver (LR), and nodal size (SR). In 2015-2017, 53 patients (29 women and 24 men, mean age 67.4 years, range 53-87) receiving surgical resection have pre-operative evidence of mediastinal nodal involvement (cN2). Among these, 114 mediastinal nodes are resected and available for correlative PET/CT analysis. cN2 status accuracy is low, with only 32.5% of the cN2 cases confirmed pathologically. Using receiver operating characteristic (ROC) curve analyses, a SUVmax of N2 LN performs well in predicting the presence of N2 disease (AUC, 0.822). Based on the respective selected thresholds for each ROC curve, normalisation of LN SUVmax to that for mediastinum, liver and tumour improved sensitivities of LN SUVmax from 68% to 81.1-89.2% while maintaining acceptable specificity (68-70.1%). In conclusion, normalised SUV ratios (particularly LR) improve current pre-operative staging performance in detecting mediastinal nodal involvement.
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Affiliation(s)
- Maha AlRasheedi
- School of Cancer Sciences, University of Glasgow, Glasgow G61 1QH, UK; (M.A.)
- West of Scotland PET Centre, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Sai Han
- West of Scotland PET Centre, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Helene Thygesen
- School of Cancer Sciences, University of Glasgow, Glasgow G61 1QH, UK; (M.A.)
| | - Matt Neilson
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
| | - Fraser Hendry
- West of Scotland PET Centre, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Ahmed Alkarn
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow G4 0SF, UK
| | - John D. Maclay
- Department of Respiratory Medicine, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow G4 0SF, UK
| | - Hing Y. Leung
- School of Cancer Sciences, University of Glasgow, Glasgow G61 1QH, UK; (M.A.)
- Cancer Research UK Beatson Institute, Garscube Estate, Switchback Road, Glasgow G61 1BD, UK
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Divisi D, Rinaldi M, Necozione S, Curcio C, Rea F, Zaraca F, De Vico A, Zaccagna G, Di Leonardo G, Crisci R. Is It Possible to Establish a Reliable Correlation between Maximum Standardized Uptake Value of 18-Fluorine Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Histological Types of Non-Small Cell Lung Cancer? Analysis of the Italian VATS Group Database. Diagnostics (Basel) 2021; 11:diagnostics11101901. [PMID: 34679600 PMCID: PMC8534503 DOI: 10.3390/diagnostics11101901] [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: 09/22/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although positron emission tomography/computed tomography, often integrated with 2-deoxy-2-[fluorine-18] fluorine-D-glucose (18F-FDG-PET/CT), is fundamental in the assessment of lung cancer, the relationship between metabolic avidity of different histotypes and maximum standardized uptake value (SUVmax) has not yet been thoroughly investigated. The aim of the study is to establish a reliable correlation between Suvmax and histology in non-small cell lung cancer (NSCLC), in order to facilitate patient management. METHODS We retrospectively assessed the data about lung cancer patients entered in the Italian Registry of VATS Group from January 2014 to October 2019, after establishing the eligibility criteria of the study. In total, 8139 patients undergoing VATS lobectomy were enrolled: 3260 females and 4879 males. The relationship between SUVmax and tumor size was also analyzed. RESULTS The mean values of SUVmax in the most frequent types of lung cancer were as follows: (a) 4.88 ± 3.82 for preinvasive adenocarcinoma; (b) 5.49 ± 4.10 for minimally invasive adenocarcinoma; (c) 5.87 ± 4.18 for invasive adenocarcinoma; and (d) 8.85 ± 6.70 for squamous cell carcinoma. Processing these data, we displayed a statistically difference (p < 0.000001) of FDG avidity between adenocarcinoma and squamous cell carcinoma. Moreover, by classifying patients into five groups based on tumor diameter and after evaluating the SUVmax value for each group, we noted a statistical correlation (p < 0.000001) between size and FDG uptake, also confirmed by the post hoc analysis. CONCLUSIONS There is a correlation between SUVmax, histopathology outcomes and tumor size in NSCLC. Further clinical trials should be performed in order to confirm our data.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
- Correspondence: or ; Tel.: +39-0861-42-94-82; Fax: +39-0861-42-94-78
| | - Marta Rinaldi
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Stefano Necozione
- Department of Internal Medicine and Public Health, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Carlo Curcio
- Division of Thoracic Surgery, Monaldi Hospital, 80131 Naples, Italy;
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova City Hospital, 35100 Padova, Italy;
| | - Francesco Zaraca
- Department of Vascular and Thoracic Surgery, Central Hospital, 39100 Bolzano, Italy;
| | - Andrea De Vico
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Gino Zaccagna
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Gabriella Di Leonardo
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Roberto Crisci
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
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Tumor-to-liver standard uptake ratio using fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography effectively predict occult lymph node metastasis of non-small cell lung cancer patients. Nucl Med Commun 2021; 41:459-468. [PMID: 32187163 DOI: 10.1097/mnm.0000000000001173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We aimed to investigate predictive factors of occult lymph node metastasis and to explore the diagnostic value of various standardized uptake value (SUV) parameters using fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography computed tomography (PET/CT) in predicting occult lymph node metastasis of clinical N0 non-small cell lung cancer patients. METHODS We retrospectively analyzed PET/computed tomography parameters of tumor and clinical data of 124 clinical N0 non-small cell lung cancer patients who underwent both preoperative F-FDG PET/computed tomography and anatomical pulmonary resection with systematic lymph node dissections. The SUVmax, SUVmean, metabolic total volume, and total lesion glycolysis of the primary tumor was automatically measured on the PET/computed tomography workstation. Standardized uptake ratio (SUR) were derived from tumor standardized uptake value divided by blood SUVmean (B-SUR) or liver SUVmean (L-SUR), respectively. RESULTS According to postoperative pathology, 19 (15%) were diagnosed as occult lymph node metastasis among 124 clinical N0 non-small cell lung cancer patients. On univariate analysis, carcinoembryonic antigen, cytokeratin 19 fragment, lobulation, and all PET parameters were associated with occult lymph node metastasis. The area under the receiver operating characteristic curve, sensitivity, and negative predictive value of L-SURmax were the highest among all PET parameters (0.778, 94.7%, and 98.4%, respectively). On multivariate analysis, carcinoembryonic antigen, cytokeratin 19 fragment, and L-SURmax were independent risk factors for predicting occult lymph node metastasis. Compared to L-SURmax alone and the combination of carcinoembryonic antigen and cytokeratin 19 fragment, the model consisting of three independent risk factors achieved a greater area under the receiver operating characteristic curve (0.901 vs. 0.778 vs. 0.780, P = 0.021 and 0.0141). CONCLUSIONS L-SURmax showed the most powerful predictive performance than the other PET parameters in predicting occult lymph node metastasis. The combination of three independent risk factors (carcinoembryonic antigen, cytokeratin 19 fragment, and L-SURmax) can effectively predict occult lymph node metastasis in clinical N0 non-small cell lung cancer patients.
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