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Szablewski L. Glucose transporters as markers of diagnosis and prognosis in cancer diseases. Oncol Rev 2022; 16:561. [PMID: 35340885 PMCID: PMC8941341 DOI: 10.4081/oncol.2022.561] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
The primary metabolic substrate for cells is glucose, which acts as both a source of energy and a substrate in several processes. However, being lipophilic, the cell membrane is impermeable to glucose and specific carrier proteins are needed to allow transport. In contrast to normal cells, cancer cells are more likely to generate energy by glycolysis; as this process generates fewer molecules of adenosine triphosphate (ATP) than complete oxidative breakdown, more glucose molecules are needed. The increased demand for glucose in cancer cells is satisfied by overexpression of a number of glucose transporters, and decreased levels of others. As specific correlations have been observed between the occurrence of cancer and the expression of glucose carrier proteins, the presence of changes in expression of glucose transporters may be treated as a marker of diagnosis and/or prognosis for cancer patients.
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Meyer HJ, Wienke A, Surov A. Associations between GLUT expression and SUV values derived from FDG-PET in different tumors-A systematic review and meta analysis. PLoS One 2019; 14:e0217781. [PMID: 31206524 PMCID: PMC6576787 DOI: 10.1371/journal.pone.0217781] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/19/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose Fluorodeoxyglucose-Positron-emission tomography (FDG-PET), quantified by standardized uptake values (SUV), is one of the most used functional imaging modality in clinical routine. It is widely acknowledged to be strongly associated with Glucose-transporter family (GLUT)-expression in tumors, which mediates the glucose uptake into cells. The present systematic review sought to elucidate the association between GLUT 1 and 3 expression with SUV values in various tumors. Methods MEDLINE library was screened for associations between FDG-PET parameters and GLUT correlation cancer up to October 2018. Results There were 53 studies comprising 2291 patients involving GLUT 1 expression and 11 studies comprising 405 patients of GLUT 3 expression. The pooled correlation coefficient for GLUT 1 was r = 0.46 (95% CI 0.40–0.52), for GLUT 3 was r = 0.35 (95%CI 0.24–0.46). Thereafter, subgroup analyses were performed. The highest correlation coefficient for GLUT 1 was found in pancreatic cancer r = 0.60 (95%CI 0.46–0.75), the lowest was identified in colorectal cancer with r = 0.21 (95% CI -0.57–0.09). Conclusion An overall only moderate association was found between GLUT 1 expression and SUV values derived from FDG-PET. The correlation coefficient with GLUT 3 was weaker. Presumably, the underlying mechanisms of glucose hypermetabolism in tumors are more complex and not solely depended on the GLUT expression.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
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Taira N, Atsumi E, Nakachi S, Takamatsu R, Yohena T, Kawasaki H, Kawabata T, Yoshimi N. Comparison of GLUT-1, SGLT-1, and SGLT-2 expression in false-negative and true-positive lymph nodes during the 18F-FDG PET/CT mediastinal nodal staging of non-small cell lung cancer. Lung Cancer 2018; 123:30-35. [PMID: 30089592 DOI: 10.1016/j.lungcan.2018.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/03/2018] [Accepted: 06/08/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Although positron emission tomography (PET) with 2-deoxy-2-[fluorine-18]fluoro-d-glucose integrated with computed tomography (CT), (18F-FDG PET/CT), has recently improved the mediastinal nodal staging of non-small cell lung cancer (NSCLC), this method can show false negativity. We immunohistochemically investigated the expression of glucose transporters (GLUT-1, SGLT-1, and SGLT-2) in false negative and true positive mediastinal nodes via 18F-FDG PET/CT. METHODS We investigated patients with clinically-diagnosed N0/pathological N2 diseases and patients with clinically-diagnosed N2/pathological N2 disease. The patients who were included in this study were evaluated using 18F-FDG PET/CT followed by surgical resection between January 2004 and December 2015. The expression of GLUT-1, SGLT-1, and SGLT-2 in the metastatic mediastinal lymph nodes, and clinicopathological variables such as primary tumor size, lymph node size, histological type, and SUVmax of the primary lesion, were compared between false negative nodes and true positive nodes. RESULTS The total number of PET false negative metastatic mediastinal lymph nodes was 22 in the 17 patients who were clinical N0/pathological N2, and the number of PET true positives was 15 in the 11 patients who were clinical N2/pathological N2. GLUT-1 expression was positive in five false negative nodes and 10 true positive nodes. SGLT-2 expression was positive in 12 false negative nodes and one true positive node, whereas both false negative and true positive nodes showed no SGLT-1 staining. Univariate analysis showed that the reduced expression of GLUT-1 (P = 0.015), and overexpression of SGLT-2 (P = 0.004) were the significant causative factors for false negative nodes. Multivariate analysis also showed that the reduced expression of GLUT-1 (P = 0.012) and overexpression of SGLT-2 (P = 0.006) were the significant causative factors for false negative nodes. CONCLUSION It suggests that the reduced expression of GLUT-1 and overexpression of SGLT-2 are associated with false-negative lymph node metastases in NSCLC.
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Affiliation(s)
- Naohiro Taira
- Department of Pathology and Oncology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan; Department of Surgery, National Hospital Organization, Okinawa National Hospital, Okinawa, Japan.
| | - Eriko Atsumi
- Department of Pathology and Oncology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan; Department of Pathology, National Hospital Organization, Okinawa National Hospital, Okinawa, Japan
| | - Saori Nakachi
- Department of Pathology and Oncology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Reika Takamatsu
- Department of Pathology and Oncology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Tomofumi Yohena
- Department of Surgery, National Hospital Organization, Okinawa National Hospital, Okinawa, Japan
| | - Hidenori Kawasaki
- Department of Surgery, National Hospital Organization, Okinawa National Hospital, Okinawa, Japan
| | - Tsutomu Kawabata
- Department of Surgery, National Hospital Organization, Okinawa National Hospital, Okinawa, Japan
| | - Naoki Yoshimi
- Department of Pathology and Oncology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
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Lee SJ, Lee WW, Yoon HJ, Lee HY, Lee KH, Kim YH, Park DJ, Kim HH, So Y, Kim SE. Regional PET/CT after water gastric inflation for evaluating loco-regional disease of gastric cancer. Eur J Radiol 2013; 82:935-42. [PMID: 23410909 DOI: 10.1016/j.ejrad.2013.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We aimed to improve diagnostic accuracy of (18)F-fluoro-2-deoxyglucose (FDG) PET/CT for gastric cancer with water gastric inflation. MATERIALS AND METHODS 44 gastric cancer patients (M:F=30:14, age ± std=62.1 ± 14.5 y) were enrolled before surgery. Fifty minutes after injection of FDG (0.14 mCi/kg body weight), whole body PET/CT was performed first and then regional PET/CT over gastric area was obtained 80 min post FDG injection after water gastric inflation. Diagnostic accuracies for loco-regional lesions were compared between whole body and regional PET/CT. RESULTS 48 primary tumors (23 EGC and 25 AGC) and 348 LN stations (61 metastatic and 287 benign) in 44 patients were investigated. Primary tumor sensitivity of whole body PET/CT (50%=24/48) was significantly improved by regional PET/CT (75%=36/48, p<0.005). Sensitivity of whole body PET/CT (24.6%=15/61) for LN metastasis was also significantly improved by regional PET/CT (36.1%=22/61, p<0.01), whereas specificity of whole body PET/CT (99.3%=285/287) was not compromised by regional PET/CT (98.3%=282/287, p>0.05). Higher primary tumor FDG uptake in regional PET/CT indicated shorter progress-free survival (p=0.0003). CONCLUSION Diagnostic accuracy of whole body PET/CT for loco-regional disease of gastric cancer could be significantly improved by regional PET/CT after water gastric inflation and prognosis could be effectively predicted by primary tumor FDG uptake in regional PET/CT.
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Affiliation(s)
- Soo Jin Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
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Sarcomatoid carcinoma (carcinosarcoma) of the lung mimics malignant pleural mesothelioma on 18F-FDG PET/CT: a report of 2 cases. Clin Nucl Med 2012; 37:416-9. [PMID: 22391723 DOI: 10.1097/rlu.0b013e31823ea47f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kwon SY, Min JJ, Song HC, Choi C, Na KJ, Bom HS. Impact of Lymphoid Follicles and Histiocytes on the False-Positive FDG Uptake of Lymph Nodes in Non-Small Cell Lung Cancer. Nucl Med Mol Imaging 2011; 45:185-91. [PMID: 24900002 DOI: 10.1007/s13139-011-0085-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Although (18)F-fluorodeoxyglucose (FDG) PET/CT has improved the accuracy of evaluating lymph node (LN) staging in non-small cell lung cancer (NSCLC), false-positive results remain a problem. The reason why benign LNs show high FDG uptake is still unclear. The aim of this study was to identify molecular and pathological characteristics of benign LNs showing high FDG uptake. MATERIALS AND METHODS We studied 108 mediastinal LNs of pathologically benign nature obtained from 43 patients with NSCLC who underwent FDG PET/CT and surgery. We measured the following parameters in each LN: maximum standardized uptake value (maxSUV), short diameter, maximum Hounsfield unit (maxHU) value, occupied proportions of lymphoid follicles, histiocytes in extrafollicular space and the degree of glucose transporter 1 (Glut1) expression. We compared the parameters between two LN groups according to maxSUV. RESULTS There were 74 LNs showing maxSUV≥3.0 (group 1) and 34 LNs with maxSUV<3.0 (group 2). The size of LN (p < 0.001) and maxHU (p = 0.003) in group 1 was higher than that in group 2. Histologically, the occupied proportions of lymphoid follicles (p = 0.031) or histiocytes (p = 0.004) were higher in group 1. The Glut1 expression of lymphoid follicles (p = 0.035) or histiocytes (p = 0.005) was also higher in group 1. CONCLUSION Lymphoid follicular hyperplasia and histiocyte infiltration associated with Glut1 overexpression are important molecular and pathological mechanisms for false-positive FDG uptake in benign mediastinal LNs in patients with NSCLC.
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Affiliation(s)
- Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun, Chonnam, 519-809 Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun, Chonnam, 519-809 Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun, Chonnam, 519-809 Republic of Korea
| | - Chan Choi
- Department of Pathology, Chonnam National University Hwasun Hospital, Chonnam, Republic of Korea
| | - Kook-Joo Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam, Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun, Chonnam, 519-809 Republic of Korea
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Fluorodeoxyglucose uptake by lymph nodes of HIV patients is inversely related to CD4 cell count. Nucl Med Commun 2010; 31:137-40. [DOI: 10.1097/mnm.0b013e3283331114] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jadvar H, Alavi A, Gambhir SS. 18F-FDG uptake in lung, breast, and colon cancers: molecular biology correlates and disease characterization. J Nucl Med 2009; 50:1820-7. [PMID: 19837767 DOI: 10.2967/jnumed.108.054098] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
It is hoped that in the not too distant future, noninvasive imaging-based molecular interrogation and characterization of tumors can improve our fundamental understanding of the dynamic biologic behavior of cancer. For example, the new dimension of diagnostic information that is provided by (18)F-FDG PET has led to improved clinical decision making and management changes in a substantial number of patients with cancer. In this context, the aim of this review is to bring together and summarize the current data on the correlation between the underlying molecular biology and the clinical observations of tumor (18)F-FDG accumulation in 3 major human cancers: lung, breast, and colon.
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Affiliation(s)
- Hossein Jadvar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Ruibal A, Abdulkader I, Gude F, León L. [The maximum standardized uptake value (18)F-FDG PET is independent of the immunohistochemical expression of platelet derived endothelial growth factor in patients with non-small cell lung cancer]. Med Clin (Barc) 2009; 132:645-6. [PMID: 19268326 DOI: 10.1016/j.medcli.2008.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 04/15/2008] [Indexed: 10/20/2022]
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Shim HK, Lee WW, Park SY, Kim H, So Y, Kim SE. Expressions of glucose transporter Types 1 and 3 and hexokinase-II in diffuse large B-cell lymphoma and other B-cell non-Hodgkin's lymphomas. Nucl Med Biol 2009; 36:191-7. [DOI: 10.1016/j.nucmedbio.2008.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 11/14/2008] [Accepted: 11/21/2008] [Indexed: 11/28/2022]
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Nakagawa T, Yamada M, Suzuki Y. 18F-FDG uptake in reactive neck lymph nodes of oral cancer: relationship to lymphoid follicles. J Nucl Med 2008; 49:1053-9. [PMID: 18587087 DOI: 10.2967/jnumed.107.049718] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
UNLABELLED PET using (18)F-FDG is acceptable as a preoperative diagnostic tool for head and neck cancer. PET combined with CT provides precise localization of neck lymph nodes. Reactive lymphadenopathy is well known as a principal cause of false-positive findings on PET/CT for nodal staging. We investigated the reactive lymph nodes of oral cancer to elucidate the (18)F-FDG-avid area in these nodes. METHODS Surgically dissected neck lymph nodes of oral cancer were retrospectively reviewed. Of the patients without pathologic nodal metastasis who underwent preoperative PET/CT, 11 patients with 31 enlarged lymph nodes at 20 levels were enrolled. The maximum standardized uptake value (SUVmax) of each lymph node was recorded. The diameters of the long and short axes were measured by pathologic sectioning, and the sectional surface area was calculated in square millimeters. Besides being stained with hematoxylin and eosin, the sections were immunohistochemically stained by CD79a for B cells, CD3 for T cells, CD68 for macrophages, CD21 for follicular dendritic cells (FDCs), and ubiquitous glucose transporter type 1 (GLUT1). The expression of GLUT1 was compared with staining of lymphoid cells. The numbers of total lymphoid follicles and hyperplastic secondary follicles were counted on CD21 and hematoxylin and eosin sections, respectively. The follicular reactivity index was determined as the ratio of secondary follicles relative to total follicles on the corresponding section. These parameters of reactive lymph nodes were analyzed on a level basis. RESULTS GLUT1 was expressed exclusively in lymphoid follicles, whose staining pattern was identical to that of FDCs. The calculated sectional area correlated significantly with the number of total follicles (r = 0.560; P = 0.0101). SUVmax did not correlate with the number of total follicles (P = 0.8947) but correlated significantly with the number of secondary follicles (r = 0.535; P = 0.0152). In addition, a strong positive correlation between SUVmax and the follicular reactivity index was demonstrated (r = 0.829; P < 0.0001). CONCLUSION GLUT1 was expressed on cytoplasmic protrusions of FDCs in lymphoid follicles. The (18)F-FDG accumulation in reactive lymphadenopathy depended on secondary follicles. FDCs in germinal centers of secondary follicles are suggested to be avid for (18)F-FDG and the principal cause of false-positive findings for nodal staging.
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Affiliation(s)
- Tassei Nakagawa
- Department of Radiology, Asahi General Hospital, Chiba, Japan.
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Nguyen XC, So Y, Chung JH, Lee WW, Park SY, Kim SE. High correlations between primary tumours and loco-regional metastatic lymph nodes in non-small-cell lung cancer with respect to glucose transporter type 1-mediated 2-deoxy-2-F18-fluoro-D-glucose uptake. Eur J Cancer 2008; 44:692-8. [PMID: 18314327 DOI: 10.1016/j.ejca.2008.02.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 01/30/2008] [Accepted: 02/05/2008] [Indexed: 11/17/2022]
Abstract
The purpose of the study was to investigate whether glucose transporter type 1 (Glut-1) mediated 2-deoxy-2-F18-fluoro-D-glucose (FDG) uptake of primary tumour is related to the likelihood of malignancy involvement in loco-regional lymph nodes (LNs) in 126 non-small-cell lung cancer (NSCLC) patients (M:F=103:23, age=65+/-9.7 years). Maximum standardised uptake values (maxSUV) and Glut-1 expression levels (determined by PET and immunostaining, respectively) of primary tumours and PET positive loco-regional LNs were compared. Significant correlations were found between malignant LNs and primary tumours with respect to maxSUV (r=0.6451, p<0.0001), %Glut-1 expression (r=0.8341, p<0.0001) and Glut-1 staining intensity (rho=0.827, p<0.0001). The area-under-curve value for LN differentiation using lymph node maxSUV was significantly higher in patients with a primary tumour maxSUV of >6 (AUC=0.775, p=0.0001). High correlations between the primary tumours and metastatic LNs in NSCLC with respect to the Glut-1 mediated FDG uptake may be useful for mediastinal LN discrimination by FDG-PET.
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Affiliation(s)
- Xuan Canh Nguyen
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Lee BE, Redwine J, Foster C, Abella E, Lown T, Lau D, Follette D. Mediastinoscopy might not be necessary in patients with non–small cell lung cancer with mediastinal lymph nodes having a maximum standardized uptake value of less than 5.3. J Thorac Cardiovasc Surg 2008; 135:615-9. [DOI: 10.1016/j.jtcvs.2007.09.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 08/27/2007] [Accepted: 09/14/2007] [Indexed: 11/29/2022]
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Song YS, Lee WW, Chung JH, Park SY, Kim YK, Kim SE. Correlation between FDG uptake and glucose transporter type 1 expression in neuroendocrine tumors of the lung. Lung Cancer 2008; 61:54-60. [PMID: 18191496 DOI: 10.1016/j.lungcan.2007.11.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 11/13/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
Abstract
Neuroendocrine (NE) lung tumors are subdivided into the following types; typical (TC) and atypical carcinoids (AC), large cell neuroendocrine carcinoma (LCNEC), and small cell lung carcinoma (SCLC). Moreover, the determinants of the FDG uptakes of NE lung tumors have not been elucidated. Thus, the aim of the present study was to investigate the relationships between FDG uptake and glucose transporter type 1 (Glut-1) expression in these NE tumors. Tissue-proven NE lung tumor patients (n=32; age, mean+/-S.D.=67.8+/-10 years; male:female=28:4) who had undergone F-18 FDG-PET before treatment were enrolled in this study. There were 1 TC, 3 AC, 5 LCNEC, and 23 SCLC patients. FDG uptakes were quantified using maximum standardized uptake values (maxSUV). Paraffin sections of tumor tissues were immunostained using anti-Glut-1 antibody (Neomarkers, 1:50). Levels of Glut-1 expression are presented as percentages of tumor cells positively immunostained (%Glut-1). Relations between FDG uptakes and Glut-1 expression were assessed using Pearson correlation analysis. The maxSUVs of all NE lung tumors ranged from 0.6 to 29.5 (mean+/-S.D.=7.7+/-5.4) and %Glut-1 expression ranged from 0 to 100% (18+/-24%). The maxSUVs of all NE lung tumors were found to be significantly correlated with %Glut-1 expression (r=0.6471, p=0.0001). By subgroup analysis, maxSUV was also found to be significantly correlated with %Glut-1 expression in SCLC (n=23, r=0.6189, p=0.0016). FDG uptake was found to be highly correlated with Glut-1 expression in NE lung tumors. This result suggests that Glut-1 plays a crucial role in determining FDG uptake in these tumors.
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Affiliation(s)
- Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University College of Medicine, Republic of Korea
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Al-Sarraf N, Gately K, Lucey J, Wilson L, McGovern E, Young V. Mediastinal Lymph Node Staging by Means of Positron Emission Tomography Is Less Sensitive in Elderly Patients with Non-Small-Cell Lung Cancer. Clin Lung Cancer 2008; 9:39-43. [DOI: 10.3816/clc.2008.n.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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