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Huang W, Son MH, Ha LN, Kang L, Cai W. More than meets the eye: 2-[ 18F]FDG PET-based radiomics predicts lymph node metastasis in colorectal cancer patients to enable precision medicine. Eur J Nucl Med Mol Imaging 2024; 51:1725-1728. [PMID: 38424238 PMCID: PMC11042987 DOI: 10.1007/s00259-024-06664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, No.8 Xishiku Str, Xicheng District, Beijing, 100034, China
| | - Mai Hong Son
- Department of Nuclear Medicine, Hospital 108, Hanoi, Vietnam
| | - Le Ngoc Ha
- Department of Nuclear Medicine, Hospital 108, Hanoi, Vietnam
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, No.8 Xishiku Str, Xicheng District, Beijing, 100034, China.
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin - Madison, K6/562 Clinical Science Center, 600 Highland Ave, Madison, WI, 53705-2275, USA.
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Multidisciplinary Postoperative Validation of 18F-FDG PET/CT Scan in Nodal Staging of Resected Non-Small Cell Lung Cancer. J Clin Med 2022; 11:jcm11237215. [PMID: 36498790 PMCID: PMC9741057 DOI: 10.3390/jcm11237215] [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: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the validity of PET/CT scans in the preoperative identification of lymph node metastases (LNM) and compare them with postoperative outcomes. METHODS In this retrospective study, we included 87 patients with a solitary lung nodule or biopsy-proven non-small cell lung cancer treated in our institution from 2009 to 2015. Patients were divided into two groups and four subgroups, depending on pre- and postoperative findings. RESULTS According to our analysis, PET/CT scan has a sensitivity of 50%, a specificity of 88.89%, a positive predictive value of 63.16%, and a negative predictive value of 82.35%. Among the patients, 13.8% were downstaged in PET-CT, while 8% were upstaged. In 78.2% of cases, the PET/CT evaluation was consistent with the histology. Metastases without extracapsular invasion were seldom recognized on PET/CT. CONCLUSIONS This analysis showed the significance of extracapsular tumor invasion, which causes an inflammatory reaction, on LNM, which is probably responsible for preoperative false-positive findings. In conclusion, PET/CT scans are very effective in identifying patients without tumors. Furthermore, it is highly probable that patients with negative findings are free of disease.
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Chiappetta M, Lococo F, Sperduti I, Tabacco D, Meacci E, Curcio C, Crisci R, Margaritora S. Type of lymphadenectomy does not influence survival in pIa NSCLC patients who underwent VATS lobectomy: Results from the national VATS group database. Lung Cancer 2022; 174:104-111. [PMID: 36370468 DOI: 10.1016/j.lungcan.2022.10.008] [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: 09/27/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Stage Ia presents an optimal survival rate after surgical resection, but the type of lymphadenectomy to use in these patients is still debated. The aim of this study is evaluate if one type of lymphadenectomy adopted influences survival in patients who underwent VATS lobectomy for stage Ia NSCLC. METHODS Clinical and pathological data from pIa patients in the prospective VATS Italian nationwide registry were reviewed and analysed. Patients and tumour characteristics,type of lymphadenectomy (sampling or radical nodal dissection,MRLD), were collected and correlated to Overall Survival(OS) and Disease free Survival(DFS). The Kaplan-Meier product-limit method was used to estimate OS and DFS and the log-rank test was adopted to evaluate the differences between groups. A propensity match was performed to reduce bias due to the retrospective study design. RESULTS The final analysis was conducted on 2039 patients, 179 died during follow-up,recurrence rate was 13%. MRLD was performed in 1287(63.1%)patients. The univariable analysis identified as favourable prognostic factors for OS the female sex(p = 0.023), low ECOG-score(0.008),low SUVmax(p < 0.001), GGO appearance(p < 0.001), pT < 2 cm(p = 0.002) and low tumour grading(p = 0.002). The multivariable analysis confirmed as independent prognostic factors low ECOG-score(p = 0.012), low SUVmax(p < 0.001) and low tumour grading(p < 0.001). Analysing survival in patients with solid/sub-solid nodules and after propensity score matching for pTdimension and number of N2 resected lymphnodes, no OS differences were present comparing sampling vs MRLD. CONCLUSION Survival in pIa patients seems to be determined by patient and tumour characteristics such as performance status,grading and SUVmax. Type of lymphadnectomy did not seem to be correlated with OS in these patients.
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Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Isabella Sperduti
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Diomira Tabacco
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Meacci
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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FDG-PET/CT tumor to liver SUV ratio (TLR), tumor SUVmax, and tumor size: can this help in differentiating squamous cell carcinoma from adenocarcinoma of the lung? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00782-4] [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
PET/CT plays an essential role in the diagnosis, staging, and follow-up of lung cancer. We aimed to assess the ability of PET/CT to differentiate between adenocarcinomas (AC) and squamous cell carcinomas (SCC) of the lung using tumor size, tumor maximum standardized uptake value (SUVmax), lymph nodes SUVmax, and tumor to liver SUV ratio (TLR).
Results
A total of 60 patients pathologically proved to have non-small cell lung cancer either AC or SCC were retrospectively evaluated. The mean tumor size, SUVmax of the tumor, and TLR were significantly higher in SCC lesions compared to AC lesions. The mean SCC tumoral size was 7.96 ± 2.18 cm compared to 5.66 ± 2.57 cm in AC lesions (P = 0.008). The mean tumor SUVmax in SCC lesions was 18.95 ± 8.3 compared to 12.4 ± 7.55 in AC lesions (P = 0.04). While the mean TLR of SCC lesions was 10.32 ± 4.03 compared to 7.36 ± 4.61 in AC lesions (P = 0.028). All three parameters showed the same sensitivity (75%), while TLR showed the highest specificity (77.78%) followed by tumor size (76.47%) and then SUVmax of the tumor (72.22%).
Conclusions
SCC of the lung has a higher mean tumor size, SUVmax of the tumor, and TLR as compared to AC which can be helpful tools in differentiation between them using PET/CT.
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Nakada T, Yabe M, Ohtsuka T. Efficacy of a combined tool for stage I non‑small cell lung cancer against lymph node metastasis. Oncol Lett 2022; 24:332. [PMID: 36039061 PMCID: PMC9404702 DOI: 10.3892/ol.2022.13452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
In patients with clinical stage I non-small cell lung cancer (NSCLC), the prediction of occult lymph node metastasis (LNM) based on a combination of morphology using high-resolution computed tomography (HRCT) and metabolism using positron emission tomography (PET)-CT is unknown. The present study evaluated the use of predictive radiological tools, chest CT and PET-CT, for occult LNM in patients with clinical stage I NSCLC. The records of patients who underwent lobectomy between July 2014 and November 2021 were retrospectively reviewed. The differences in clinicopathological parameters, including CT and PET, between the LNM and non-LNM groups were assessed. Pure solid tumor was defined as a consolidation-to-tumor ratio of 1. The optimal cut-off value for predictive radiological tools for LNM was assessed according to the area under the receiver operating characteristic (ROC) curve. The present study included 288 patients, of whom 39 (13.5%) had LNM; of these 38 (97.4%) were pure solid type. Larger consolidation size (CS), higher maximal standardized uptake (SUVmax) value and histological type were statistically associated with LNM (all P<0.05). The optimal cutoff values of CS and SUVmax for predicting LNM were 19 mm and 5.5 respectively, as assessed using the area under the ROC curve. The combination of CS ≥19 mm and SUVmax ≥5.5 demonstrated a markedly higher odds ratio (9.184; 95% CI, 4.345-19.407) than each parameter individually. The minimum values of CS and SUVmax associated with LNM were 10 mm and 0.8 respectively. Pure solid formation and CS as morphology and SUVmax as metabolism were useful tools that complemented each other in predicting LNM. The combined method of evaluating SUVmax and CS may identify eligibility for LN dissection. However, considering the minimum values of CS and SUVmax in LNM, it cannot affirm the omission of LN dissection for cases that do not meet the combined criteria using HRCT and PET-CT.
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Affiliation(s)
- Takeo Nakada
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo 105‑8471, Japan
| | - Mitsuo Yabe
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo 105‑8471, Japan
| | - Takashi Ohtsuka
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo 105‑8471, Japan
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Nakada T, Takahashi Y, Sakakura N, Iwata H, Ohtsuka T, Kuroda H. Prognostic Radiological Tools for Clinical Stage IA Pure Solid Lung Cancer. ACTA ACUST UNITED AC 2021; 28:3846-3856. [PMID: 34677246 PMCID: PMC8534325 DOI: 10.3390/curroncol28050328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
In this study, we analyzed prognostic radiological tools and surgical outcomes for radiologically pure solid adenocarcinomas (AD) and squamous cell carcinoma (SQ) in clinical stage IA. We retrospectively investigated 130 patients who underwent surgical resections. We assessed the predictive risk factors for recurrence and pathological lymph node metastasis (LNM). There was no statistical difference in recurrence free survival (RFS) or cancer-specific survival (CSS) between AD and SQ groups (p = 0.642 and p = 0.403, respectively). In the whole cohort, tumor size on lung window and mediastinal settings, and tumor disappearance ratio using high-resolution computed tomography (HRCT) were not prognostic parameters (p = 0.127, 0.066, and 0.082, respectively). The maximal standardized uptake value (SUVmax) using positron emission tomography-CT was associated with recurrence (p = 0.016). According to the receiver operating characteristic curve, the cut-off value of SUVmax for recurrence was 4.6 (p = 0.016). The quantitative continuous variables using any radiological tools were not associated with LNM. However, tumor diameter on mediastinal setting ≥8 mm with SUVmax ≥2.4 could be a risk factor for LNM. Pure solid AD and SQ were equivalent for the RFS and CSS. SUVmax was useful to predict recurrence. The tumor diameter on a mediastinal setting and SUVmax were useful in predicting pathological LNM.
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Affiliation(s)
- Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi 464-8681, Japan; (Y.T.); (N.S.); (H.K.)
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo 105-8471, Japan;
- Correspondence: ; Tel.: +81-52-762-6111
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi 464-8681, Japan; (Y.T.); (N.S.); (H.K.)
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi 464-8681, Japan; (Y.T.); (N.S.); (H.K.)
| | - Hiroshi Iwata
- East Nagoya Radiological Diagnosis Foundation, Aichi 464-0044, Japan;
| | - Takashi Ohtsuka
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo 105-8471, Japan;
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi 464-8681, Japan; (Y.T.); (N.S.); (H.K.)
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Taralli S, Scolozzi V, Boldrini L, Lenkowicz J, Pelliccioni A, Lorusso M, Attieh O, Ricciardi S, Carleo F, Cardillo G, Calcagni ML. Application of Artificial Neural Network to Preoperative 18F-FDG PET/CT for Predicting Pathological Nodal Involvement in Non-small-cell Lung Cancer Patients. Front Med (Lausanne) 2021; 8:664529. [PMID: 33968968 PMCID: PMC8100035 DOI: 10.3389/fmed.2021.664529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/25/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose: To evaluate the performance of artificial neural networks (aNN) applied to preoperative 18F-FDG PET/CT for predicting nodal involvement in non-small-cell lung cancer (NSCLC) patients. Methods: We retrospectively analyzed data from 540 clinically resectable NSCLC patients (333 M; 67.4 ± 9 years) undergone preoperative 18F-FDG PET/CT and pulmonary resection with hilo-mediastinal lymphadenectomy. A 3-layers NN model was applied (dataset randomly splitted into 2/3 training and 1/3 testing). Using histopathological reference standard, NN performance for nodal involvement (N0/N+ patient) was calculated by ROC analysis in terms of: area under the curve (AUC), accuracy (ACC), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV, NPV). Diagnostic performance of PET visual analysis (N+ patient: at least one node with uptake ≥ mediastinal blood-pool) and of logistic regression (LR) was evaluated. Results: Histology proved 108/540 (20%) nodal-metastatic patients. Among all collected data, relevant features selected as input parameters were: patients' age, tumor parameters (size, PET visual and semiquantitative features, histotype, grading), PET visual nodal result (patient-based, as N0/N+ and N0/N1/N2). Training and testing NN performance (AUC = 0.849, 0.769): ACC = 80 and 77%; SE = 72 and 58%; SP = 81 and 81%; PPV = 50 and 44%; NPV = 92 and 89%, respectively. Visual PET performance: ACC = 82%, SE = 32%, SP = 94%; PPV = 57%, NPV = 85%. Training and testing LR performance (AUC = 0.795, 0.763): ACC = 75 and 77%; SE = 68 and 55%; SP = 77 and 82%; PPV = 43 and 43%; NPV = 90 and 88%, respectively. Conclusions: aNN application to preoperative 18F-FDG PET/CT provides overall good performance for predicting nodal involvement in NSCLC patients candidate to surgery, especially for ruling out nodal metastases, being NPV the best diagnostic result; a high NPV was also reached by PET qualitative assessment. Moreover, in such population with low a priori nodal involvement probability, aNN better identify the relatively few and unexpected nodal-metastatic patients than PET analysis, so supporting the additional aNN use in case of PET-negative images.
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Affiliation(s)
- Silvia Taralli
- Unità Operativa Complessa (UOC) di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Scolozzi
- Unità Operativa Complessa (UOC) di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Unità Operativa Complessa (UOC) di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jacopo Lenkowicz
- Unità Operativa Complessa (UOC) di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Armando Pelliccioni
- Department of Occupational and Environmental Medicine, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Rome, Italy
| | - Margherita Lorusso
- Unità Operativa Complessa (UOC) di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ola Attieh
- Nuclear Medicine Department, Jordanian Royal Medical Services, Amman, Jordan
| | - Sara Ricciardi
- Department of Cardiothoracic Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Carleo
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Maria Lucia Calcagni
- Unità Operativa Complessa (UOC) di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Universitario di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Noel CW, Forner D, Goldstein DP, Metser U, Ferris RL, Waldron J, de Almeida JR. Elective neck dissection versus positron emission tomography-computed tomography-guided management of the neck in clinically node-negative early oral cavity cancer: A cost-utility analysis. Cancer 2021; 127:1993-2002. [PMID: 33635537 DOI: 10.1002/cncr.33446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In early oral cavity cancer, elective neck dissection (END) for the clinically node-negative (cN0) neck improves survival compared with observation. This paradigm has been challenged recently by the use of positron emission tomography-computed tomography (PET-CT) imaging in the cN0 neck. To inform this debate, we performed an economic evaluation comparing PET-CT-guided therapy with routine END in the cN0 neck. METHODS Patients with T1-2N0 lateralized oral tongue cancer were analyzed. A Markov model over a 40-year time horizon simulated treatment, disease recurrence, and survival from a US health care payer perspective. Model parameters were derived from a review of the literature. RESULTS The END strategy was dominant, with a cost savings of $1576.30 USD, an increase of 0.055 quality-adjusted life years (QALYs), a net monetary benefit of $4303 USD, and a 0.22 life-year advantage. END was sensitive to variation in cost and utilities in deterministic and probabilistic sensitivity analyses. PET-CT became the preferred strategy when decreasing occult nodal disease to 18% and increasing the negative predictive value (NPV) of PET-CT to 89% in 1-way sensitivity analyses. In probabilistic sensitivity analysis, assuming a cost effectiveness threshold of $50,000 USD/QALY, END was dominant in 64% of simulations and cost effective in 69.8%. CONCLUSION END is a cost-effective strategy compared with PET-CT in patients who have node-negative oral cancer. Although lower PET standardized uptake value thresholds would result in fewer false negatives and improved NPV, it is still uncertain that PET-CT would be cost effective, as this would likely result in more false positive tests.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ur Metser
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert L Ferris
- University of Pittsburgh and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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A PET/CT nomogram incorporating SUVmax and CT radiomics for preoperative nodal staging in non-small cell lung cancer. Eur Radiol 2021; 31:6030-6038. [PMID: 33560457 PMCID: PMC8270849 DOI: 10.1007/s00330-020-07624-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/08/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
Objectives To develop and validate a PET/CT nomogram for preoperative estimation of lymph node (LN) staging in patients with non-small cell lung cancer (NSCLC). Methods A total of 263 pathologically confirmed LNs from 124 patients with NCSLC were retrospectively analyzed. Positron-emission tomography/computed tomography (PET/CT) examination was performed before treatment according to the clinical schedule. In the training cohort (N = 185), malignancy-related features, such as SUVmax, short-axis diameter (SAD), and CT radiomics features, were extracted from the regions of LN based on the PET/CT scan. The Minimum-Redundancy Maximum-Relevance (mRMR) algorithm and the Least Absolute Shrinkage and Selection Operator (LASSO) regression model were used for feature selection and radiomics score building. The radiomics score (Rad-Score) and SUVmax were incorporated in a PET/CT nomogram using the multivariable logistic regression analysis. The performance of the proposed model was evaluated with discrimination, calibration, and clinical application in an independent testing cohort (N = 78). Results The radiomics scores consisting of 14 selected features were significantly associated with LN status for both training cohort with AUC of 0.849 (95% confidence interval (CI), 0.796–0.903) and testing cohort with AUC of 0.828 (95% CI, 0.782–0.919). The PET/CT nomogram incorporating radiomics score and SUVmax showed moderate improvement of the efficiency with AUC of 0.881 (95% CI, 0.834–0.928) in the training cohort and AUC of 0.872 (95% CI, 0.797–0.946) in the testing cohort. The decision curve analysis indicated that the PET/CT nomogram was clinically useful. Conclusion The PET/CT nomogram, which incorporates Rad-Score and SUVmax, can improve the diagnostic performance of LN metastasis. Key Points • The PET/CT nomogram (Int-Score) based on lymph node (LN) PET/CT images can reliably predict LN status in NSCLC. • Int-Score is a relatively objective diagnostic method, which can play an auxiliary role in the process of clinicians making treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-020-07624-9.
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Lv X, Wu Z, Cao J, Hu Y, Liu K, Dai X, Yuan X, Wang Y, Zhao K, Lv W, Hu J. A nomogram for predicting the risk of lymph node metastasis in T1-2 non-small-cell lung cancer based on PET/CT and clinical characteristics. Transl Lung Cancer Res 2021; 10:430-438. [PMID: 33569324 PMCID: PMC7867781 DOI: 10.21037/tlcr-20-1026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Accurately predicting the risk level for a lymph node metastasis is critical in the treatment of non-small cell lung cancer (NSCLC). This study aimed to construct a novel nomogram to identify patients with a risk of lymph node metastasis in T1–2 NSCLC based on positron emission tomography/computed tomography (PET/CT) and clinical characteristics. Methods From January 2011 to November 2017, the records of 318 consecutive patients who had undergone PET/CT examination within 30 days before surgical resection for clinical T1–2 NSCLC were retrospectively reviewed. A nomogram to predict the risk of lymph node metastasis was constructed. The model was confirmed using bootstrap resampling, and an independent validation cohort contained 156 patients from June 2017 to February 2020 at another institution. Results Six factors [age, tumor location, histology, the lymph node maximum standardized uptake value (SUVmax), the tumor SUVmax and the carcinoembryonic antigen (CEA) value] were identified and entered into the nomogram. The nomogram developed based on the analysis showed robust discrimination, with an area under the receiver operating characteristic curve of 0.858 in the primary cohort and 0.749 in the validation cohort. The calibration curve for the probability of lymph node metastasis showed excellent concordance between the predicted and actual results. Decision curve analysis suggested that the nomogram was clinically useful. Conclusions We set up and validated a novel and effective nomogram that can predict the risk of lymph node metastasis for individual patients with T1–2 NSCLC. This model may help clinicians to make treatment recommendations for individuals.
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Affiliation(s)
- Xiayi Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhigang Wu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinlin Cao
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yeji Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kai Liu
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaona Dai
- Department of Quality Management, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoshuai Yuan
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yiqing Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kui Zhao
- Departments of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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11
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Tibdewal A, Pathak RS, Agarwal JP, Hoskote SS, Mummudi N, Iyer V, Nair AG. Nodal recurrences after stereotactic body radiotherapy for early stage non-small-cell lung cancer. Curr Probl Cancer 2020; 45:100653. [PMID: 32988628 DOI: 10.1016/j.currproblcancer.2020.100653] [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: 08/07/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
Lobectomy is considered the standard of care for early stage non-small-cell lung cancer. However, for those patients who remain unfit to undergo surgery due to advanced age, poor performance status, comorbidities, poor pulmonary reserve or a combination of these are now treated with stereotactic body radiation therapy (SBRT). Due to its noninvasive nature, lower cost, lower toxicity, reduced recovery time and equivalent efficacy, even medically operable patients are attracted to the option of SBRT despite the lack of level I evidence. Thus, studying the incidence and patterns of recurrence after SBRT help in understanding the magnitude of the problem, risk factors associated with the different patterns of recurrence, and aid in devising strategies to prevent them in future. Nodal recurrences are not uncommon after SBRT and can potentially lead to further seeding for distant metastases and ultimately poor survival. This review is aimed at reviewing the published data on the incidence of nodal recurrences after SBRT and compare it to surgery, identify potential risk factors for recurrence, salvage treatment options and prevention strategies.
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Affiliation(s)
- Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Rima S Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sumedh S Hoskote
- Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Akshay G Nair
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Aditya Jyot Eye Hospital, Mumbai, India
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Kernstine KH, Faubert B, Do QN, Rogers TJ, Hensley CT, Cai L, Torrealba J, Oliver D, Wachsmann JW, Lenkinski RE, Malloy CR, Deberardinis RJ. Does Tumor FDG-PET Avidity Represent Enhanced Glycolytic Metabolism in Non-Small Cell Lung Cancer? Ann Thorac Surg 2020; 109:1019-1025. [PMID: 31846640 PMCID: PMC7370816 DOI: 10.1016/j.athoracsur.2019.10.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/29/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND In non-small cell lung cancer (NSCLC), 18fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) assists in diagnosis, staging, and evaluating treatment response. One variable of FDG-PET, the maximum standard uptake value (SUVm), is considered an objective measure of glucose uptake. However, little is known about the fate of glucose in FDG-avid lung tumors in vivo. This study used stable glucose isotope tracing to determine whether the SUVm predicts glycolytic metabolism or other glucose fates in tumors. METHODS In this prospective Institutional Review Board-approved clinical trial, 52 untreated potentially resectable confirmed NSCLC patients underwent FDG-PET computed tomography. During the surgical procedure, the patients were infused with 13C-labeled glucose. Blood, tumor, and normal lung samples were analyzed by mass spectrometry to determine 13C enrichment in glycolytic intermediates. These values were compared with clinical variables, including SUVm, maximum tumor diameter, stage, grade, and MIB-1/Ki67 proliferation index. RESULTS For each patient, 13C enrichment in each metabolite was compared between tumor and adjacent lung. Although all tumors metabolized glucose, SUVm did not correlate with glycolytic intermediate labeling. Rather, SUVm correlated with markers indicating the use of other respiratory substrates, including lactate, and with the proliferation index. CONCLUSIONS SUVm does not correlate with glycolytic metabolism in human NSCLC but does correlate with the proliferation index, suggesting that SUVm predicts glucose use by pathways other than glycolysis. These pathways may offer alternative therapeutic targets, including biosynthetic pathways required for cell proliferation. The research techniques in this study offer the opportunity to understand the relationships between SUVm, tumor metabolism, and therapeutic vulnerabilities in human NSCLCs.
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Affiliation(s)
- Kemp H Kernstine
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Texas.
| | - Brandon Faubert
- Children's Medical Center Research Institute, University of Texas Southwestern, Dallas, Texas
| | - Quyen N Do
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Thomas J Rogers
- Children's Medical Center Research Institute, University of Texas Southwestern, Dallas, Texas
| | - Christopher T Hensley
- Children's Medical Center Research Institute, University of Texas Southwestern, Dallas, Texas
| | - Ling Cai
- Children's Medical Center Research Institute, University of Texas Southwestern, Dallas, Texas; Quantitative Biomedical Research Center, University of Texas Southwestern, Dallas, Texas
| | - Jose Torrealba
- Department of Pathology, University of Texas Southwestern, Dallas, Texas
| | - Dwight Oliver
- Department of Pathology, University of Texas Southwestern, Dallas, Texas
| | - Jason W Wachsmann
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Robert E Lenkinski
- Department of Radiology, University of Texas Southwestern, Dallas, Texas; Advanced Imaging Research Center, University of Texas Southwestern, Dallas, Texas
| | - Craig R Malloy
- Department of Radiology, University of Texas Southwestern, Dallas, Texas; Advanced Imaging Research Center, University of Texas Southwestern, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Ralph J Deberardinis
- Children's Medical Center Research Institute, University of Texas Southwestern, Dallas, Texas; Department of Pediatrics, University of Texas Southwestern, Dallas, Texas; Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern, Dallas, Texas; Howard Hughes Medical Institute, Chevy Chase, Maryland
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Is SUVmax Helpful in the Differential Diagnosis of Enlarged Mediastinal Lymph Nodes? A Pilot Study. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:3417190. [PMID: 30510493 PMCID: PMC6230427 DOI: 10.1155/2018/3417190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/02/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
Objective To explore the diagnostic value of maximum standard uptake value (SUVmax) from 18F-FDG PET/CT images in enlarged mediastinal lymph nodes of unknown etiology. Methods We performed a retrospective study of patients with enlarged mediastinal lymph nodes on 18F-FDG PET/CT scans. SUVmax and the short axis and long axis of lymph nodes were recorded. These parameters were compared among the five commonest causes of mediastinal lymphadenopathy: lymphoma, metastatic disease, sarcoidosis, tuberculosis, and lymphadenitis. Histopathologic diagnosis was recorded as the final golden standard. Results A total of 94 patients (62 men and 32 women; age range 7-85 y) were included with final diagnoses of 42 patients with benign pathology and 52 patients with malignancies. The sensitivity, specificity, and the accuracy of PET/CT in diagnosis of the benign and malignant mediastinal lymph nodes were 94.2%, 73.8%, and 85.1%, respectively. The SUVmax of benign and malignant groups were 13.10 ± 5.21 and 12.59 ± 5.50, respectively, which had no statistical difference (P > 0.05). However, the long axis and the short axis of lymph nodes in the benign and malignant groups were 2.86 ± 1.02 cm, 1.77 ± 0.60 cm and 6.04 ± 3.83 cm, 3.95 ± 2.08 cm, respectively (P < 0.05). The diagnostic values of PET/CT were higher than those of the long or short axis. However, the specificity of PET/CT was lower (73.8%) than that from the long or short axis (90.5% and 92.9%, respectively), although no statistical difference existed. Among the five common causes of mediastinal lymphadenopathy, significant differences could be seen in SUVmax and in the long axis and the short axis of lymph nodes (P < 0.05). Conclusions SUVmax, a commonly used semiquantitative measurement, was not helpful for differentiation between benign and malignant lesions in patients with enlarged mediastinal lymph nodes in this study. Many benign lesions, such as sarcoidosis and tuberculosis, had high FDG uptake, possibly a trend that the size of the lymph nodes seems to have some diagnostic value.
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Verma V, Schonewolf CA, Cushman TR, Post CM, Doms A, Berman AT, DeVries M, Katz SI, Simone CB. Impact of Enlarged Nonhypermetabolic Lymph Nodes on Outcomes After Stereotactic Body Radiotherapy for Early-Stage Non-Small-Cell Lung Cancer. Clin Lung Cancer 2018; 19:502-510. [PMID: 30111509 DOI: 10.1016/j.cllc.2018.07.005] [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] [Received: 05/29/2018] [Revised: 07/04/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Up to 15% of patients undergoing positron emission tomography (PET)/computed tomography (CT) before stereotactic body radiotherapy (SBRT) harbor occult nodal disease. In the absence of invasive mediastinal staging, the clinical significance of enlarged nonhypermetabolic lymph nodes (LNs) remains unclear. We performed what is to our knowledge the first study to address whether enlarged nonhypermetabolic LNs were associated with higher post-SBRT failure rates. PATIENTS AND METHODS Two academic centers assessed 157 consecutive patients treated with SBRT for cT1-2aN0M0 non-small-cell lung cancer who underwent PET/CT without pathologic nodal staging. The cutoff of an enlarged node was ≥ 1.0 cm, although a 7 mm threshold was also evaluated. Local recurrence-free survival (RFS), regional RFS, distant metastasis-free survival, RFS, and overall survival (OS) were calculated by Kaplan-Meier methodology. Multivariate Cox modeling addressed factors associated with RFS and OS. RESULTS There were 120 patients (76%) with LNs < 1 cm and 37 (24%) with nodes ≥ 1 cm. Most patients had peripheral and/or T1 tumors. Median follow-up was 25.5 months. There were no differences between cohorts in actuarial local RFS, regional RFS, distant metastasis-free survival, RFS, or OS (P > .05 for all). Thirteen percent of patients experienced any nodal relapse, 15% of which occurred in the same station as that of the largest pre-SBRT LN. Stratification by largest LN location in an N1 versus N2 station showed no differences in RFS or OS (P > .05 for both). A 7 mm cutoff also showed no differences in outcomes (P > .05 for all). LN size was not correlated with RFS/OS on multivariable analysis (P > .05 for both). CONCLUSION The presence of enlarged nonhypermetabolic LNs on PET/CT is not associated with increased post-SBRT failure rates.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA
| | - Caitlin A Schonewolf
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Carl M Post
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA
| | - Alexandra Doms
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Abigail T Berman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Matthew DeVries
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE
| | - Sharyn I Katz
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
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Okizaki A, Nakayama M, Nakajima K, Takahashi K. A novel iterative modified bicubic interpolation method enables high-contrast and high-resolution image generation for F-18 FDG-PET. Medicine (Baltimore) 2017; 96:e9472. [PMID: 29384938 PMCID: PMC6393029 DOI: 10.1097/md.0000000000009472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Positron emission tomography (PET) has become a useful and important technique in oncology. However, spatial resolution of PET is not high; therefore, small abnormalities can sometimes be overlooked with PET. To address this problem, we devised a novel algorithm, iterative modified bicubic interpolation method (IMBIM). IMBIM generates high resolution and -contrast image. The purpose of this study was to investigate the utility of IMBIM for clinical FDG positron emission tomography/X-ray computed tomography (PET/CT) imaging.We evaluated PET images from 1435 patients with malignant tumor and compared the contrast (uptake ratio of abnormal lesions to background) in high resolution image with the standard bicubic interpolation method (SBIM) and IMBIM. In addition to the contrast analysis, 340 out of 1435 patients were selected for visual evaluation by nuclear medicine physicians to investigate lesion detectability. Abnormal uptakes on the images were categorized as either absolutely abnormal or equivocal finding.The average of contrast with IMBIM was significantly higher than that with SBIM (P < .001). The improvements were prominent with large matrix sizes and small lesions. SBIM images showed abnormalities in 198 of 340 lesions (58.2%), while IMBIM indicated abnormalities in 312 (91.8%). There was statistically significant improvement in lesion detectability with IMBIM (P < .001).In conclusion, IMBIM generates high-resolution images with improved contrast and, therefore, may facilitate more accurate diagnoses in clinical practice.
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Kaseda K, Asakura K, Kazama A, Ozawa Y. Risk Factors for Predicting Occult Lymph Node Metastasis in Patients with Clinical Stage I Non-small Cell Lung Cancer Staged by Integrated Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. World J Surg 2017; 40:2976-2983. [PMID: 27456499 DOI: 10.1007/s00268-016-3652-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lymph nodes in patients with non-small cell lung cancer (NSCLC) are often staged using integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). However, this modality has limited ability to detect micrometastases. We aimed to define risk factors for occult lymph node metastasis in patients with clinical stage I NSCLC diagnosed by preoperative integrated FDG-PET/CT. METHODS We retrospectively reviewed the records of 246 patients diagnosed with clinical stage I NSCLC based on integrated FDG-PET/CT between April 2007 and May 2015. All patients were treated by complete surgical resection. The prevalence of occult lymph node metastasis in patients with clinical stage I NSCLC was analysed according to clinicopathological factors. Risk factors for occult lymph node metastasis were defined using univariate and multivariate analyses. RESULTS Occult lymph node metastasis was detected in 31 patients (12.6 %). Univariate analysis revealed CEA (P = 0.04), SUVmax of the primary tumour (P = 0.031), adenocarcinoma (P = 0.023), tumour size (P = 0.002) and pleural invasion (P = 0.046) as significant predictors of occult lymph node metastasis. Multivariate analysis selected SUVmax of the primary tumour (P = 0.049), adenocarcinoma (P = 0.003) and tumour size (P = 0.019) as independent predictors of occult lymph node metastasis. CONCLUSIONS The SUVmax of the primary tumour, adenocarcinoma and tumour size were risk factors for occult lymph node metastasis in patients with NSCLC diagnosed as clinical stage I by preoperative integrated FDG-PET/CT. These findings would be helpful in selecting candidates for mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.
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Affiliation(s)
- Kaoru Kaseda
- Department of Thoracic Surgery, Sagamihara Kyodo Hospital, 2-8-18 Hashimoto, Midori-ku, Sagamihara, Kanagawa, 252-5188, Japan.
| | - Keisuke Asakura
- Department of Thoracic Surgery, Sagamihara Kyodo Hospital, 2-8-18 Hashimoto, Midori-ku, Sagamihara, Kanagawa, 252-5188, Japan
| | - Akio Kazama
- Department of Pathology, Sagamihara Kyodo Hospital, Kanagawa, Japan
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Jin F, Qu B, Fu Z, Zhang Y, Han A, Kong L, Yu J. Prognostic Value of Metabolic Parameters of Metastatic Lymph Nodes on 18F-FDG PET/CT in Patients With Limited-stage Small-cell Lung Cancer With Lymph Node Involvement. Clin Lung Cancer 2017; 19:e101-e108. [PMID: 28690012 DOI: 10.1016/j.cllc.2017.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/03/2017] [Accepted: 06/13/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We assessed the prognostic value of the metabolic parameters of different lesions, including primary tumors and metastatic lymph nodes (LNs), measured by fluorine-18 fluorodeoxyglucose positron emission tomography (PET)/computed tomography in patients with limited-stage small-cell lung cancer (LS-SCLC) with LN metastasis. MATERIALS AND METHODS The present retrospective study included 46 patients with clinical stage II-III N1-N2 LS-SCLC who had undergone pretreatment fluorine-18 fluorodeoxyglucose PET/computed tomography scanning from January 2011 to December 2014. All patients underwent complete first-line therapy (concurrent chemoradiotherapy and prophylactic cranial irradiation). The metabolic parameters, including maximal standardized uptake value, mean standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) values of the PTs and metastatic LNs were measured on PET. Kaplan-Meier survival curves were used for evaluation of progression-free survival (PFS) and overall survival (OS). Univariate and multivariate Cox proportional hazards models were used to analyze the prognostic factors. RESULTS The median OS and PFS were 25.9 months (range, 8.2-63.5 months) and 21 months (range, 6.4-55.3 months), respectively. Univariate analysis demonstrated that the Eastern Cooperative Oncology Group performance status, N1 station involvement, subcarinal LN metastasis, LN MTV, LN TLG, sum of the MTV, and summary of the TLG were significant predictive factors (P < .05). The Eastern Cooperative Oncology Group performance status, subcarinal nodal metastasis, LN MTV, and LN TLG were independent predictive factors of PFS and OS on multivariate analysis. CONCLUSION The metabolic parameters of metastatic LNs, other than lung lesions, are independent prognostic factors in patients with LS-SCLC with LN metastasis. These parameters could further stratify the prognosis of these patients, and these findings might provide functional imaging evidence for the future study of the mechanisms of metastasis.
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Affiliation(s)
- Feng Jin
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Bo Qu
- Department of Nuclear Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zheng Fu
- PET/CT Center, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yan Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Anqin Han
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China.
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SUV navigator enables rapid [ 18F]-FDG PET/CT image interpretation compared with 2D ROI and 3D VOI evaluations. Jpn J Radiol 2017; 35:398-403. [PMID: 28497349 DOI: 10.1007/s11604-017-0645-8] [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: 02/06/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Positron emission tomography (PET) and the maximum standardized uptake value (SUVmax) is a useful technique for assessing malignant tumors. Measurements of SUVmax in multiple lesions per patient frequently require many time-consuming procedures. To address this issue, we designed a novel interface named SUV Navigator (SUVnavi), and the purpose of this study was to investigate its utility. MATERIALS AND METHODS We measured SUVmax in 661 lesions from 100 patients with malignant tumors. Diagnoses and SUVmax measurements were made with SUVnavi, 2D, and 3D measurements. SUV measurement accuracy in each method were also evaluated. RESULTS The average reduction in time with SUVnavi versus 2D was 53.8% and 3D was 37.5%; time required with SUVnavi was significantly shorter than with 2D and 3D (P < 0.001 and P < 0.001, respectively). The time reduction and lesion number had a positive correlation (P < 0.001 and P < 0.001, respectively). SUVmax agreed with precise SUVmax in all lesions measured with SUVnavi and 3D but in only 466 of 661 lesions (70.5%) measured with 2D. CONCLUSION SUVnavi may be useful for rapid [18F]-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) image interpretation without reducing the accuracy of SUVmax measurement.
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Kaseda K, Watanabe KI, Asakura K, Kazama A, Ozawa Y. Identification of false-negative and false-positive diagnoses of lymph node metastases in non-small cell lung cancer patients staged by integrated (18F-)fluorodeoxyglucose-positron emission tomography/computed tomography: A retrospective cohort study. Thorac Cancer 2016; 7:473-80. [PMID: 27385991 PMCID: PMC4930968 DOI: 10.1111/1759-7714.12358] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/03/2016] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to evaluate the diagnostic accuracy of integrated 18
F‐fluorodeoxyglucose positron emission tomography/computed tomography (FDG‐PET/CT) in hilar and mediastinal lymph node (HMLN) staging of non‐small cell lung cancer (NSCLC), and to investigate potential risk factors for false‐negative and false‐positive HMLN metastases. Methods We examined the data of 388 surgically resected NSCLC patients preoperatively staged by integrated FDG‐PET/CT. Risk factors for false‐negative and false‐positive HMLN metastases were analyzed using univariate and multivariate analyses of clinicopathological factors. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of integrated FDG‐PET/CT in detecting HMLN metastases were 47.4%, 91.0%, 56.3%, 87.7%, and 82.5%, respectively. On multivariate analysis, the maximum standardized uptake value (SUVmax) of the tumor (P = 0.042), adenocarcinoma (P = 0.003), and tumor size (P = 0.017) were risk factors for false‐negative HMLN metastases, and history of lung disease (P = 0.006) and tumor location (central; P = 0.025) were risk factors for false‐positive HMLN metastases. Conclusions The present study identified risk factors for false‐negative and false‐positive HMLN metastases in NSCLC patients staged by preoperative integrated FDG‐PET/CT. These findings would be helpful in selecting appropriate candidates for mediastinoscopy or endobronchial ultrasound‐guided transbronchial needle aspiration.
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Affiliation(s)
- Kaoru Kaseda
- Department of Thoracic Surgery Sagamihara Kyodo Hospital Sagamihara Japan
| | - Ken-Ichi Watanabe
- Department of Thoracic Surgery Sagamihara Kyodo Hospital Sagamihara Japan
| | - Keisuke Asakura
- Department of Thoracic Surgery Sagamihara Kyodo Hospital Sagamihara Japan
| | - Akio Kazama
- Department of Pathology Sagamihara Kyodo Hospital Sagamihara Japan
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Wang Y, Ma S, Dong M, Yao Y, Liu K, Zhou J. Evaluation of the factors affecting the maximum standardized uptake value of metastatic lymph nodes in different histological types of non-small cell lung cancer on PET-CT. BMC Pulm Med 2015; 15:20. [PMID: 25880540 PMCID: PMC4372315 DOI: 10.1186/s12890-015-0014-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the factors affecting the maximum standardized uptake value (SUVmax) of metastatic lymph nodes in different histological types of non-small cell lung cancer (NSCLC) on integrated positron emission tomography and computed tomography (PET-CT). Methods This was a retrospective, single-institution review of 122 patients with pathologically proven NSCLC who had PET-CT scanning at the same center. Lymph node metastases were pathologically confirmed in tissue specimens from surgical patients. Statistical evaluation of PET-CT results was performed on a per-nodal-station basis. Results The tumor SUVmax of squamous cell carcinoma (SCC) (11.0 ± 4.1) was higher than that of adenocarcinoma (AC) (7.4 ± 4.4) (P < 0.01), however, the SUVmax of the metastatic lymph nodes did not differ between the SCC (4.6 ± 3.1) and AC groups(3.6 ± 2.5) (P = 0.221). The SUVmax of metastatic lymph nodes was positively correlated with lymph node size but not with the primary tumor SUVmax, primary tumor size, tumor location and tumor differentiation. The frequency of a SUVmax of lymph nodes ≥2.5 was 44%, 80%,100% in SCC group and 39%, 59%, 90% in AC group when the short-axis diameter of metastatic lymph node was <10 mm, 10–15 mm, and > 15 mm, respectively. The low sensitivity for metastatic lymph nodes on PET-CT was increased when the SUVmax cut-off for malignancy was considered to be above the normal background compared with that when the SUVmax cut-off was above 2.5. Conclusions There was no difference in the SUVmax of metastatic lymph nodes in the SCC and AC groups. The SUVmax of metastatic lymph nodes was positively correlated with metastatic lymph node size. There was a high false negative rate if lymph nodes with a short-axis diameter less than 10 mm and a extremely low false negative rate if lymph nodes with a short-axis diameter higher than 15 mm. Although an increased sensitivity may be achieved by decreasing the SUVmax cut-off, invasive staging may still be required for negative lymph nodes due to the lower sensitivity of PET-CT in both SCC and AC.
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Affiliation(s)
- Yuehong Wang
- Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Shanni Ma
- Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Mengjie Dong
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Yake Yao
- Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Kanfeng Liu
- Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
| | - Jianying Zhou
- Department of Respiratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, China.
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Armstrong IS, Kelly MD, Williams HA, Matthews JC. Impact of point spread function modelling and time of flight on FDG uptake measurements in lung lesions using alternative filtering strategies. EJNMMI Phys 2014; 1:99. [PMID: 26501457 PMCID: PMC4545221 DOI: 10.1186/s40658-014-0099-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/02/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The use of maximum standardised uptake value (SUVmax) is commonplace in oncology positron emission tomography (PET). Point spread function (PSF) modelling and time-of-flight (TOF) reconstructions have a significant impact on SUVmax, presenting a challenge for centres with defined protocols for lesion classification based on SUVmax thresholds. This has perhaps led to the slow adoption of these reconstructions. This work evaluated the impact of PSF and/or TOF reconstructions on SUVmax, SUVpeak and total lesion glycolysis (TLG) under two different schemes of post-filtering. METHODS Post-filters to match voxel variance or SUVmax were determined using a NEMA NU-2 phantom. Images from 68 consecutive lung cancer patients were reconstructed with the standard iterative algorithm along with TOF; PSF modelling - Siemens HD·PET (HD); and combined PSF modelling and TOF - Siemens ultraHD·PET (UHD) with the two post-filter sets. SUVmax, SUVpeak, TLG and signal-to-noise ratio of tumour relative to liver (SNR(T-L)) were measured in 74 lesions for each reconstruction. Relative differences in uptake measures were calculated, and the clinical impact of any changes was assessed using published guidelines and local practice. RESULTS When matching voxel variance, SUVmax increased substantially (mean increase +32% and +49% for HD and UHD, respectively), potentially impacting outcome in the majority of patients. Increases in SUVpeak were less notable (mean increase +17% and +23% for HD and UHD, respectively). Increases with TOF alone were far less for both measures. Mean changes to TLG were <10% for all algorithms for either set of post-filters. SNR(T-L) were greater than ordered subset expectation maximisation (OSEM) in all reconstructions using both post-filtering sets. CONCLUSIONS Matching image voxel variance with PSF and/or TOF reconstructions, particularly with PSF modelling and in small lesions, resulted in considerable increases in SUVmax, inhibiting the use of defined protocols for lesion classification based on SUVmax. However, reduced partial volume effects may increase lesion detectability. Matching SUVmax in phantoms translated well to patient studies for PSF reconstruction but less well with TOF, where a small positive bias was observed in patient images. Matching SUVmax significantly reduced voxel variance and potential variability of uptake measures. Finally, TLG may be less sensitive to reconstruction methods compared with either SUVmax or SUVpeak.
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Affiliation(s)
- Ian S Armstrong
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, UK. .,Institute of Population Health, MAHSC, University of Manchester, Manchester, UK.
| | - Matthew D Kelly
- Molecular Imaging, Healthcare Sector, Siemens PLC, Oxford, UK.
| | - Heather A Williams
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, UK.
| | - Julian C Matthews
- Institute of Population Health, MAHSC, University of Manchester, Manchester, UK.
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Lee H, Hwang KH, Kim SG, Koh G, Kim JH. Can Initial (18)F-FDG PET-CT Imaging Give Information on Metastasis in Patients with Primary Renal Cell Carcinoma? Nucl Med Mol Imaging 2013; 48:144-52. [PMID: 24900155 PMCID: PMC4028476 DOI: 10.1007/s13139-013-0245-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 10/10/2013] [Accepted: 10/15/2013] [Indexed: 12/22/2022] Open
Abstract
Purpose The aim of this study was to investigate the relationship between the maximum standardized uptake values (SUVmax) of primary renal cancers with and without metastatic lesions, if any. We also studied the relationship between the size of primary renal cancers and their SUVmax, and tried to find a clinical value of 18F-FDG PET-CT for the initial evaluation of renal cell carcinoma (RCC). Methods The cases of 23 patients, 16 men and 7 women, who underwent PET-CT examination before operation were retrospectively reviewed. We measured the SUVmax of the primary renal cancers and those of any existing metastatic lesions, and the size of the primary renal cancers. We compared the SUVmax of primary RCCs with metastases and those without metastases, SUVmax of primary RCC and those of metastases, and studied the correlation between the size and SUVmax of primary RCCs. Results The SUVmax of primary RCC of the 16 patients without metastasis ranged from 1.1 to 5.6 with a median value of 2.6. Those of the patients with metastasis ranged from 2.9 to 7.6 with a median of 5.0. The size of the all 23 primary renal cancers ranged from 1.7 cm to 13.5 cm, with a median of 4.5 cm, and their SUVmax ranged from 1.1 to 7.6, with a median of 2.9. There was a statistically significant difference between the SUVmax of the primary RCC with metastasis (5.3 ± 1.7) and those without metastasis (2.9 ± 1.0). There was a moderate positive correlation between the sizes and SUVmax of all 23 primary RCCs. However, there was no statistically significant correlation between the sizes and SUVmax of primary RCCs with metastatic lesions and the same for RCCs without metastasis. The cutoff value of SUVmax for predicting extra-renal lesion was 4.4 and that for size was 5.8 cm according to the receiver operating characteristic curves. Conclusions Those who have primary RCC with high SUVmax are suggested to have a likelihood of metastasis. Also, there was a moderate trend of increasing value of SUVmax of primary RCC as their size increases. Physicians should beware of missing extra-renal lesions elsewhere.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Kyung Hoon Hwang
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Seog Gyun Kim
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Geon Koh
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Ji Hyun Kim
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
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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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Clinicopathological determinants of positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value in head and neck carcinoma. The Journal of Laryngology & Otology 2013; 127:676-80. [PMID: 23790108 DOI: 10.1017/s002221511300128x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although positron emission tomography computed tomography has proven diagnostic and staging value in head and neck carcinoma, it does not have optimal sensitivity or specificity. The positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value has been shown to be associated with carcinoma stage. This study evaluated the impact of major clinicopathological factors on the standardised uptake value at the primary site and at neck lymph node metastases. SUBJECTS AND METHODS Two hundred and forty-three oral cavity and laryngopharyngeal carcinoma patients who underwent positron emission tomography computed tomography were included. Correlation between the positron emission tomography computed tomography standardised uptake value and various clinicopathological factors was analysed. RESULTS A positive correlation was found between the standardised uptake value and the size and depth of tumour infiltration, and lymph node positivity. Higher standardised uptake values were seen for more advanced tumour stages. The presence of perineural invasion, lymphatic invasion and extracapsular spread were all associated with increased standardised uptake values. CONCLUSION Most of the clinicopathological features of head and neck carcinoma which are well known to be poor prognostic factors have a significant impact on positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value.
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Zhu SH, Zhang Y, Yu YH, Fu Z, Kong L, Han DL, Fu L, Yu JM, Li J. FDG PET-CT in Non-small Cell Lung Cancer: Relationship between Primary Tumor FDG Uptake and Extensional or Metastatic Potential. Asian Pac J Cancer Prev 2013; 14:2925-9. [DOI: 10.7314/apjcp.2013.14.5.2925] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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Koksal D, Demirag F, Bayiz H, Ozmen O, Tatci E, Berktas B, Aydoğdu K, Yekeler E. The correlation of SUVmax with pathological characteristics of primary tumor and the value of Tumor/ Lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients. J Cardiothorac Surg 2013; 8:63. [PMID: 23557204 PMCID: PMC3622559 DOI: 10.1186/1749-8090-8-63] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 03/26/2013] [Indexed: 12/25/2022] Open
Abstract
Background We aimed to investigate the correlation of maximum standardized uptake value (SUVmax) with pathological characteristics of primary tumor and to determine a Tumor/ Lymph node (T/LN) SUVmax ratio predicting metastasis to lymph nodes in NSCLC patients. Methods Eighty-one NSCLC patients who had PET/CT examination at initial staging and subsequently underwent surgical resection were retrospectively evaluated. There were 100 PET/CT positive mediastinal or hilar lymph node stations. Pathological characteristics of the tumor such as largest tumor diameter, tumor histology, differentiation, number of mitosis, degree of stromal inflammation, necrosis; etiology of PET/CT positive lymph node stations; SUVmax of primary tumor and positive lymph node stations were recorded. A T/LN SUVmax ratio was calculated for each lymph node station. Results SUVmax of the primary tumor was positively correlated with the largest tumor diameter (p = 0.001, r = 0.374), number of mitosis (p < 0.001, r = 0.405), and postoperative pathological stage (p = 0.007, r = 0.298). Patients with squamous cell carcinoma had a statistically significant higher mean SUVmax, number of mitosis and advanced N stages compared to adenocarcinoma. The etiology of 100 PET/CT positive lymph node stations were metastasis in 14, anthracosis in 40, reactive in 39, granulomatous in 4, and silicosis in 3 patients. A T/LN SUVmax ratio of 5 or lower was suggestive for a malignant lymph node with a sensitivity of 92.8% and specificity of 47%. Conclusions SUVmax of a primary tumor is related to certain pathological characteristics, such as largest diameter, histology, and number of mitosis. A T/LN SUVmax ratio lower than 5 predicts the metastasis to lymph nodes with a high sensitivity.
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Affiliation(s)
- Deniz Koksal
- Chest Diseases Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey.
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Su M, Li L. [Correlation between regional node metastasis and imageological characteristics in non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2012; 15:730-4. [PMID: 23249719 PMCID: PMC6000044 DOI: 10.3779/j.issn.1009-3419.2012.12.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
非小细胞肺癌(non-small cell lung cancer, NSCLC)局部淋巴结(N)分期是影响患者治疗方案选择的关键因素之一。目前临床所使用的无创和有创性N分期方法均有其局限性。研究发现NSCLC的某些影像学特点可预测淋巴结转移的危险性,包括大小、CT密度和氟代脱氧葡萄糖(fluorodeoxyglucose, FDG)标准化摄取值(standardized uptake value, SUV)等。期待系统性多因素分析,以发现影响肺癌淋巴结转移的关键因素。
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Affiliation(s)
- Minggang Su
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Cistaro A, Lopci E, Gastaldo L, Fania P, Brach Del Prever A, Fagioli F. The role of 18F-FDG PET/CT in the metabolic characterization of lung nodules in pediatric patients with bone sarcoma. Pediatr Blood Cancer 2012; 59:1206-10. [PMID: 22745027 DOI: 10.1002/pbc.24242] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 05/29/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The principal aim of this study was to identify the lowest nodule diameter and the SUV(max) capable of characterizing lung nodules in pediatric patients with bone sarcoma. PROCEDURE Eighteen consecutive bone sarcoma patients (M/F = 11:7; mean age 14 years) with suspicious lung lesions at CT were enrolled. Overall, 63 lung nodules with a mean diameter of 3.35 mm (range 1.2-39.8 mm) were investigated. (18) F-FDG PET was performed according to standard procedure using a hybrid PET/CT system and results were compared with histology and/or clinical/radiological follow-up. For each lesion, we evaluated SUV(max) , SUV(ratio) to the mediastinal blood pool and maximum nodule diameter. RESULTS Of the 63 nodules, 32 proved to be benign and 31 malignant. On a visual basis, (18) F-FDG PET had an accuracy of 88.9%, a sensitivity of 90.3%, a specificity of 87.5%, a PPV of 87.5%, and a NPV of 90.3%. ROC curve analysis of SUV(max) for all nodules showed a value around 1 (>1.09) to be capable of differentiating metastases from benign lesions: sensitivity and specificity were 90.3% and 93.8%, respectively (accuracy 92.1%). Similar analysis revealed a cut-off value around 1 (>0.83) for SUV(ratio) (sensitivity and specificity were 90.3% and 90.6%, respectively) and a cut-off value of ca. 6 mm (>5.8 mm) for nodule diameter (sensitivity and specificity of 90.3% and 81.3%, respectively). CONCLUSIONS (18) F-FDG PET/CT is an accurate modality for the metabolic characterization of lung nodules in the pediatric population with bone sarcoma, and a SUV(max) (or SUV(ratio) ) >1 is capable of discriminating malignant from benign lesions.
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Affiliation(s)
- Angela Cistaro
- Positron Emission Tomography IRMET S.p.A., Turin, Italy.
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Zhang H, Wroblewski K, Pu Y. Prognostic value of tumor burden measurement using the number of tumors in non-surgical patients with non-small cell lung cancer. Acta Radiol 2012; 53:561-8. [PMID: 22661603 DOI: 10.1258/ar.2012.120080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND No study to test the feasibility and prognostic value of the number of primary tumors, the number of positive lymph nodes, and the total number of tumors in the whole body as tumor burden measurements on FDG PET/CT imaging has been reported. PURPOSE To determine whether the number of tumors seen in 18F-FDG PET scans can be a prognostic factor in non-surgical patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS One hundred and forty patients with histologically proven NSCLC and baseline 18F-FDG PET scan before therapy were identified in this retrospective analysis. The total number of tumors (TTn) in the whole body, the number of primary tumors (Tn), positive lymph nodes (Nn), and distant metastases (Mn), along with the maximum standardized uptake values (SUV(max)) of the tumors were measured. Inter-observer variability of the total number of tumors, counted by two radiologists, was assessed. Survival analyses were performed to determine the prognostic value of the number of tumors. RESULTS Concordance correlation coefficients for the TTn, Tn, Nn, and Mn were all greater than 0.85. TTn and Nn were strong prognostic factors of NSCLC patients' overall survival (OS). In univariate Cox regression models, gender, stage, TTn, Nn, and Mn were statistically significant factors (P = 0.016, 0.032, <0.001, <0.001, and 0.006, respectively). In multivariate Cox regression models, TTn and Nn remained as statistically significant predictors for survival with hazard ratios (HR) of 1.06 (P = 0.001) and 1.11 (P = 0.002), respectively, after adjusting for clinical stage based 7th edition of TNM staging system, age, gender, and SUV(max). Patients with a TTn ≤4 (cutpoint based on median value) had a median OS of 15.2 months compared with 9.0 months for those with TTn >4. CONCLUSION Measuring the number of tumors on FDG PET imaging is easy to perform with minimal inter-observer variability. The total number of tumors and number of nodal metastases, as metabolic tumor burden measurements in 18F-FDG PET/CT, are prognostic markers independent of clinical stage, age, gender, and SUV measurement in non-surgical patients with NSCLC.
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Affiliation(s)
- Hao Zhang
- Department of Radiology, First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Department of Health Studies, University of Chicago, Chicago, Illinois, USA
| | | | - Yonglin Pu
- Department of Health Studies, University of Chicago, Chicago, Illinois, USA
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Zhang H, Wroblewski K, Appelbaum D, Pu Y. Independent prognostic value of whole-body metabolic tumor burden from FDG-PET in non-small cell lung cancer. Int J Comput Assist Radiol Surg 2012; 8:181-91. [PMID: 22644386 DOI: 10.1007/s11548-012-0749-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 05/07/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether whole-body metabolic tumor burden, measured as either metabolic tumor volume (MTVWB) or total lesion glycolysis (TLGWB), using FDG-PET/CT is an independent prognostic marker in non-small cell lung cancer (NSCLC). METHODS 328 patients with histologically proven NSCLC were identified for this retrospective analysis. This study was approved by our Institutional Review Board. All patients underwent baseline (18)F-FDG-PET/CT scan imaging before therapy. The MTVWB, TLGWB, maximum standardized uptake value (SUVmaxWB) and mean standardized uptake value (SUVmeanWB) of tumors throughout the whole body were measured from FDG-PET images with semi-automated 3D contouring software. RESULTS In univariate analysis, there was a statistically significant association of overall survival (OS) with the MTVWB (hazard ratio (HR) = 1.62, p < 0.001), TLGWB (HR = 1.47, p < 0.001). The patients with a MTVWB ≤ median of 65.7 ml and TLGWB ≤ median of 205.11 SUVmean * ml had a median OS of 41.1 and 35.4 months compared with 9.5 and 9.7 months for those with a MTVWB > 65.7 ml and TLGWB > 205.11 SUVmean * ml, respectively. From a series of multivariate Cox regression models, the MTVWB and TLGWB were significantly better than SUVmaxWB and SUVmeanWB at prognostication and significantly associated with patients' OS with HRs of 1.50 (p < 0.001) and 1.42 (p < 0.001), respectively, after adjustment for patient's age, gender and treatment intent as well as the tumor SUVmaxWB, histology and stage. CONCLUSIONS MTVWB and TLGWB as metabolic tumor burden measurements in (18)F-FDG-PET/CT are independent prognostic markers and are significantly better than SUVmaxWB and SUVmeanWB at prognostication.
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Affiliation(s)
- Hao Zhang
- Department of Radiology, First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China
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FDG PET-CT in cervical cancer: relationship between primary tumor FDG uptake and metastatic potential. Nucl Med Commun 2010; 31:526-31. [DOI: 10.1097/mnm.0b013e32833800e7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Bruzzi JF. Lung-cancer staging with PET-CT. N Engl J Med 2009; 361:1606; author reply 1608. [PMID: 19828539 DOI: 10.1056/nejmc091578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ning XH, Meng QL, Wang YZ, Bai CM. Application of 18F-fluorodeoxyglucose positron emission tomography in diagnosis of malignant diseases. ACTA ACUST UNITED AC 2009; 24:117-21. [PMID: 19618610 DOI: 10.1016/s1001-9294(09)60073-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To testify the efficacy of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in the diagnosis of cancer. METHODS A total of 170 patients with diagnosed cancer or suspicious cancer were enrolled in this study, and underwent 18F-FDG PET. The standard uptake value (SUV) and diameter for each abnormal region in PET images were analyzed. All data were analyzed by SPSS 11.5. RESULTS PET scan identified a primary cancer in 45.8% (11/24) patients. The sensitivity and specificity of PET scan in differentiating malignant lesions from benign ones were 78.8% (52/66) and 77.1% (27/35) respectively. Twenty-nine out of 68 (42.6%) lesions were detected earlier by PET than by computed tomography. The SUV of primary cancer was significantly higher than that of metastatic lymph nodes (5.84 +/- 3.12 vs. 3.14 +/- 2.24, P<0.001). And SUV of primary lung cancer was also significantly higher than that of metastatic lung cancer (6.30 +/- 3.01 vs. 2.86 +/- 2.37, P<0.01). CONCLUSION 18F-FDG PET plays a very important role in cancer diagnosis.
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Affiliation(s)
- Xiao-hong Ning
- Department of Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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