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Accuracy and predictive features of FDG-PET/CT and CT for diagnosis of lymph node metastasis of T1 non-small-cell lung cancer manifesting as a subsolid nodule

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Abstract

Objectives

To retrospectively evaluate the diagnostic accuracy and predictive features of F-18 fluorodeoxyglucose positron emission tomography/ computed tomography (FDG-PET/CT) and CT in lymph node (LN) staging of T1 non-small-cell lung cancers (NSCLCs) manifesting as subsolid nodules.

Methods

From January 2005 to May 2011, 160 patients with pathologically proven T1 subsolid NSCLCs with LN staging were included in this study. Diagnostic accuracies of FDG-PET/CT and CT for LN staging were evaluated. Maximum standardised uptake value (SUVmax) and CT features of primary tumours were evaluated to investigate predictive factors for LN metastasis.

Results

LN metastases were found in nine of the 160 patients (5.6%). No LN metastasis was present in patients with a solid proportion ≤50%. Sensitivity, specificity and accuracy of FDG-PET/CT for LN staging on a per-patient basis were 11.1%, 86.1% and 81.9%; those of CT were 11.1%, 96.7% and 91.9%. Among patients with a solid proportion >50%, there were significant differences in SUVmax, solid portion size, solid proportion and lesion location between patients with and without LN metastasis. Multivariate analysis revealed that higher SUVmax, a larger solid proportion and central location were independent predictors of LN metastasis.

Conclusions

FDG-PET/CT adds little value to CT in the lymph node staging of T1 subsolid NSCLCs.

Key Points

Lymph node (LN) metastases are important in non-small-cell lung cancer (NSCLC).

Positron emission tomography (PET) helps to stage solid NSCLCs.

FDG-PET/CT adds little to the LN staging of T1 subsolid NSCLCs.

No LN metastasis in patients with a solid proportion ≤50%.

LN metastasis is more common in solid and/or centrally sited tumours.

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References

  1. Felip E, Stahel RA, Pavlidis N (2005) ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of non-small-cell lung cancer (NSCLC). Ann Oncol 16(Suppl 1):i28–i29

    Article  PubMed  Google Scholar 

  2. Detterbeck FC, Boffa DJ, Tanoue LT (2009) The new lung cancer staging system. Chest 136:260–271

    Article  PubMed  Google Scholar 

  3. Lardinois D, Weder W, Hany TF et al (2003) Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 348:2500–2507

    Article  PubMed  Google Scholar 

  4. Shim SS, Lee KS, Kim BT et al (2005) Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology 236:1011–1019

    Article  PubMed  Google Scholar 

  5. Kim BT, Lee KS, Shim SS et al (2006) Stage T1 non-small cell lung cancer: preoperative mediastinal nodal staging with integrated FDG PET/CT—a prospective study. Radiology 241:501–509

    Article  PubMed  Google Scholar 

  6. Yi CA, Lee KS, Kim BT et al (2007) Efficacy of helical dynamic CT versus integrated PET/CT for detection of mediastinal nodal metastasis in non-small cell lung cancer. Am J Roentgenol 188:318–325

    Article  Google Scholar 

  7. Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS (2002) CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 178:1053–1057

    PubMed  Google Scholar 

  8. Nakata M, Saeki H, Takata I et al (2002) Focal ground-glass opacity detected by low-dose helical CT. Chest 121:1464–1467

    Article  PubMed  Google Scholar 

  9. Park CM, Goo JM, Lee HJ, Lee CH, Chun EJ, Im JG (2007) Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. RadioGraphics 27:391–408

    Article  PubMed  Google Scholar 

  10. Kim HY, Shim YM, Lee KS, Han J, Yi CA, Kim YK (2007) Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology 245:267–275

    Article  PubMed  Google Scholar 

  11. Godoy MC, Naidich DP (2009) Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology 253:606–622

    Article  PubMed  Google Scholar 

  12. Goo JM, Park CM, Lee HJ (2011) Ground-glass nodules on chest CT as imaging biomarkers in the management of lung adenocarcinoma. AJR Am J Roentgenol 196:533–543

    Article  PubMed  Google Scholar 

  13. Lee HJ, Goo JM, Lee CH, Yoo CG, Kim YT, Im JG (2007) Nodular ground-glass opacities on thin-section CT: size change during follow-up and pathological results. Korean J Radiol 8:22–31

    Article  PubMed  Google Scholar 

  14. Hasegawa M, Sone S, Takashima S et al (2000) Growth rate of small lung cancers detected on mass CT screening. Br J Radiol 73:1252–1259

    PubMed  CAS  Google Scholar 

  15. Aoki T, Nakata H, Watanabe H et al (2000) Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time. Am J Roentgenol 174:763–768

    CAS  Google Scholar 

  16. Aoki T, Tomoda Y, Watanabe H et al (2001) Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology 220:803–809

    Article  PubMed  CAS  Google Scholar 

  17. Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K (2004) Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. Lung Cancer 45:19–27

    Article  PubMed  Google Scholar 

  18. New York Early Lung Cancer Action Project Investigators (2007) CT screening for lung cancer: diagnoses resulting from the New York Early Lung Cancer Action Project. Radiology 243:239–249

    Article  Google Scholar 

  19. Greene FL, Page DL, Fleming ID (2002) AJCC cancer staging manual. Springer, New York

    Google Scholar 

  20. Mountain CF, Dresler CM (1997) Regional lymph node classification for lung cancer staging. Chest 111:1718–1723

    Article  PubMed  CAS  Google Scholar 

  21. Kim YK, Lee KS, Kim BT et al (2007) Mediastinal nodal staging of nonsmall cell lung cancer using integrated 18F-FDG PET/CT in a tuberculosis-endemic country: diagnostic efficacy in 674 patients. Cancer 109:1068–1077

    Article  PubMed  Google Scholar 

  22. Glazer GM, Gross BH, Aisen AM, Quint LE, Francis IR, Orringer MB (1985) Imaging of the pulmonary hilum: a prospective comparative study in patients with lung cancer. Am J Roentgenol 145:245–248

    CAS  Google Scholar 

  23. Choi YS, Shim YM, Kim J, Kim K (2003) Mediastinoscopy in patients with clinical stage I non-small cell lung cancer. Ann Thorac Surg 75:364–366

    Article  PubMed  Google Scholar 

  24. Tahara RW, Lackner RP, Graver LM (2000) Is there a role for routine mediastinoscopy in patients with peripheral T1 lung cancers? Am J Surg 180:488–491, discussion 491-482

    Article  PubMed  CAS  Google Scholar 

  25. Seely JM, Mayo JR, Miller RR, Muller NL (1993) T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. Radiology 186:129–132

    PubMed  CAS  Google Scholar 

  26. Matsuguma H, Yokoi K, Anraku M et al (2002) Proportion of ground-glass opacity on high-resolution computed tomography in clinical T1 N0 M0 adenocarcinoma of the lung: a predictor of lymph node metastasis. J Thorac Cardiovasc Surg 124:278–284

    Article  PubMed  Google Scholar 

  27. Pieterman RM, van Putten JW, Meuzelaar JJ et al (2000) Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med 343:254–261

    Article  PubMed  CAS  Google Scholar 

  28. Chun EJ, Lee HJ, Kang WJ et al (2009) Differentiation between malignancy and inflammation in pulmonary ground-glass nodules: the feasibility of integrated (18)F-FDG PET/CT. Lung Cancer 65:180–186

    Article  PubMed  Google Scholar 

  29. Chou HH, Chang TC, Yen TC et al (2006) Low value of [18F]-fluoro-2-deoxy-D-glucose positron emission tomography in primary staging of early-stage cervical cancer before radical hysterectomy. J Clin Oncol 24:123–128

    Article  PubMed  Google Scholar 

  30. Lee JW, Kim BS, Lee DS et al (2009) 18F-FDG PET/CT in mediastinal lymph node staging of non-small-cell lung cancer in a tuberculosis-endemic country: consideration of lymph node calcification and distribution pattern to improve specificity. Eur J Nucl Med Mol Imaging 36:1794–1802

    Article  PubMed  Google Scholar 

  31. Higashi K, Ito K, Hiramatsu Y et al (2005) 18F-FDG uptake by primary tumour as a predictor of intratumoral lymphatic vessel invasion and lymph node involvement in non-small cell lung cancer: analysis of a multicenter study. J Nucl Med 46:267–273

    PubMed  Google Scholar 

  32. Bille A, Pelosi E, Skanjeti A et al (2009) Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography. Eur J Cardiothorac Surg 36:440–445

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the Research Grant of the Korean Foundation for Cancer Research (grant number: CB-2011-02-01) and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (grant number: 2011-0022379).

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Correspondence to Chang Min Park.

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Lee, S.M., Park, C.M., Paeng, J.C. et al. Accuracy and predictive features of FDG-PET/CT and CT for diagnosis of lymph node metastasis of T1 non-small-cell lung cancer manifesting as a subsolid nodule. Eur Radiol 22, 1556–1563 (2012). https://doi.org/10.1007/s00330-012-2395-4

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  • DOI: https://doi.org/10.1007/s00330-012-2395-4

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