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Xue M, Liu J, Li Z, Lu M, Zhang H, Liu W, Tian H. The role of adenocarcinoma subtypes and immunohistochemistry in predicting lymph node metastasis in early invasive lung adenocarcinoma. BMC Cancer 2024; 24:139. [PMID: 38287300 PMCID: PMC10823663 DOI: 10.1186/s12885-024-11843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Identifying lymph node metastasis areas during surgery for early invasive lung adenocarcinoma remains challenging. The aim of this study was to develop a nomogram mathematical model before the end of surgery for predicting lymph node metastasis in patients with early invasive lung adenocarcinoma. METHODS In this study, we included patients with invasive lung adenocarcinoma measuring ≤ 2 cm who underwent pulmonary resection with definite pathology at Qilu Hospital of Shandong University from January 2020 to January 2022. Preoperative biomarker results, clinical features, and computed tomography characteristics were collected. The enrolled patients were randomized into a training cohort and a validation cohort in a 7:3 ratio. The training cohort was used to construct the predictive model, while the validation cohort was used to test the model independently. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. The prediction model and nomogram were established based on the independent risk factors. Recipient operating characteristic (ROC) curves were used to assess the discrimination ability of the model. Calibration capability was assessed using the Hosmer-Lemeshow test and calibration curves. The clinical utility of the nomogram was assessed using decision curve analysis (DCA). RESULTS The overall incidence of lymph node metastasis was 13.23% (61/461). Six indicators were finally determined to be independently associated with lymph node metastasis. These six indicators were: age (P < 0.001), serum amyloid (SA) (P = 0.008); carcinoma antigen 125 (CA125) (P = 0. 042); mucus composition (P = 0.003); novel aspartic proteinase of the pepsin family A (Napsin A) (P = 0.007); and cytokeratin 5/6 (CK5/6) (P = 0.042). The area under the ROC curve (AUC) was 0.843 (95% CI: 0.779-0.908) in the training cohort and 0.838 (95% CI: 0.748-0.927) in the validation cohort. the P-value of the Hosmer-Lemeshow test was 0.0613 in the training cohort and 0.8628 in the validation cohort. the bias of the training cohort corrected C-index was 0.8444 and the bias-corrected C-index for the validation cohort was 0.8375. demonstrating that the prediction model has good discriminative power and good calibration. CONCLUSIONS The column line graphs created showed excellent discrimination and calibration to predict lymph node status in patients with ≤ 2 cm invasive lung adenocarcinoma. In addition, the predictive model has predictive potential before the end of surgery and can inform clinical decision making.
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Affiliation(s)
- Mengchao Xue
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Lixia District, Jinan City, Shandong Province, China
| | - Junjie Liu
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Lixia District, Jinan City, Shandong Province, China
| | - Zhenyi Li
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Lixia District, Jinan City, Shandong Province, China
| | - Ming Lu
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Lixia District, Jinan City, Shandong Province, China
| | - Huiying Zhang
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Lixia District, Jinan City, Shandong Province, China
| | - Wen Liu
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Lixia District, Jinan City, Shandong Province, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital, Shandong University, Lixia District, Jinan City, Shandong Province, China.
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Santos FDS, Verma N, Watte G, Marchiori E, Mohammed TLH, Medeiros TM, Hochhegger B. Diffusion-weighted magnetic resonance imaging for differentiating between benign and malignant thoracic lymph nodes: a meta-analysis. Radiol Bras 2021; 54:225-231. [PMID: 34393288 PMCID: PMC8354191 DOI: 10.1590/0100-3984.2020.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022] Open
Abstract
Objective To establish the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) in discriminating malignant from non-malignant thoracic lymph nodes. Materials and Methods This was a meta-analysis involving systematic searches of the MEDLINE, EMBASE, and Web of Science databases up through April 2020. Studies reporting thoracic DWI and lymph node evaluation were included. The pooled sensitivity, specificity, diagnostic odds ratio, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated. Results We evaluated six studies, involving a collective total of 356 mediastinal lymph nodes in 214 patients. Thoracic DWI had a pooled sensitivity and specificity of 92% (95% confidence interval [95% CI]: 71-98%) and 93% (95% CI: 79-98%), respectively. The positive and negative likelihood ratios were 13.2 (95% CI: 4.0-43.8) and 0.09 (95% CI: 0.02-0.36), respectively. The diagnostic odds ratio was 149 (95% CI: 18-1,243), and the AUC was 0.97 (95% CI: 0.95-0.98). Conclusion DWI is a reproducible technique and has demonstrated high accuracy for differentiating between malignant and benign states in thoracic lymph nodes.
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Affiliation(s)
- Francisco de Souza Santos
- Graduate Program in Internal Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Nupur Verma
- Department of Radiology, University of Florida (UF), Gainesville, FL, USA
| | - Guilherme Watte
- Graduate Program in Internal Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Tássia Machado Medeiros
- Graduate Program in Internal Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Bruno Hochhegger
- Graduate Program in Internal Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Santos FDS, Verma N, Marchiori E, Watte G, Medeiros TM, Mohammed TLH, Hochhegger B. MRI-based differentiation between lymphoma and sarcoidosis in mediastinal lymph nodes. J Bras Pneumol 2021; 47:e20200055. [PMID: 33825792 PMCID: PMC8332845 DOI: 10.36416/1806-3756/e20200055] [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: 02/11/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Evaluation of enlarged mediastinal lymph nodes is crucial for patient management. Malignant lymphoma and sarcoidosis are often difficult to differentiate. Our objective was to determine the diagnostic accuracy of MRI for differentiating between sarcoidosis and malignant lymphoma. METHODS This was a retrospective study involving 47 patients who underwent chest MRI and were diagnosed with one of the diseases between 2017 and 2019. T1, T2, and diffusion-weighted signal intensity were measured. Apparent diffusion coefficients (ADCs) and T2 ratios were calculated. The diagnostic performance of MRI was determined by ROC analysis. RESULTS Mean T2 ratio was significantly lower in the sarcoidosis group than in the lymphoma group (p = 0.009). The T2-ratio cutoff value that best differentiated between lymphoma-related and sarcoidosis-related enlarged lymph nodes was 7.1, with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 58.3%, 95.6%, 76.5%, 93.3%, and 68.7%, respectively. The mean ADC was significantly lower in the lymphoma group than in the sarcoidosis group (p = 0.002). The ADC cutoff value that best differentiated between lymphoma-related and sarcoidosis-related enlarged lymph nodes was 1.205, with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 87.5%, 82.6%, 85.1%, 84.0% and 86.3%, respectively. No significant differences were found between the two groups regarding T1 signal intensity, T2 signal intensity, and lymph node diameter. CONCLUSIONS MRI parameters such as ADC, diffusion, and T2 ratio can be useful in the differentiation between sarcoidosis and lymphoma in the evaluation of enlarged lymph nodes.
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Affiliation(s)
- Francisco de Souza Santos
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Nupur Verma
- . Department of Radiology, University of Florida, Gainesville (FL) USA
| | - Edson Marchiori
- . Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Guilherme Watte
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Tássia M Medeiros
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Bruno Hochhegger
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
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Tekchandani H, Verma S, Londhe N. Performance improvement of mediastinal lymph node severity detection using GAN and Inception network. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 194:105478. [PMID: 32447144 DOI: 10.1016/j.cmpb.2020.105478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE In lung cancer, the determination of mediastinal lymph node (MLN) status as benign or malignant influence treatment planning and survival rate. Invasive pathological tests for the classification of MLNs into benign and malignant have various shortcomings like painfulness, the risk associated with anesthesia, and depends to a large extent on skillset and preferences of the surgeon performing the test. Hence, computer-aided system for MLNs severity detection has been explored widely by the researchers. Very recently, in our earlier concluded work on non-invasive method for MLNs differential diagnosis in computed tomography (CT) images, combination of different data augmentation approaches and state-of-art fully convolutional network (FCN) were implemented to enhance the performance of malignancy detection. However, the performance of FCN network were highly depended on the selection of appropriate data augmentation approach and control of their hyperparameters. Moreover, a standard practice to get hierarchical features in convolutional neural network (CNN) models requires deeper stacking of layers. This leads to an increase in number of trainable parameters which prone to overfitting of the network. METHODS In view of the above mention limitations, in this paper, authors have proposed an approach that includes: 1) Generative Adversarial Network (GAN) for data augmentation, and 2) Inception network for malignancy detection. Unlike conventional data augmentation strategy, GAN based augmentation approach generates data that correlates to original data distribution. In the case of Inception based model, it uses multiple size kernels with factorized convolution for hierarchical feature extraction. This helps to a significant reduction in trainable parameters and the problem of overfitting. RESULTS In this paper, experiments with different GAN approaches, as well as with different Inception architectures, are conducted to evaluate and justify the selection of appropriate GAN and Inception architecture, respectively for MLNs severity detection. The proposed approach achieves superior results with an average accuracy, sensitivity, specificity, and area under curve of 94.95%, 93.65%, 96.67%, and 95%, respectively. CONCLUSION The obtained results validate the usefulness of GANs for data augmentation in the differential diagnosis of benign and malignant MLNs. The proposed Inception network based classifier for malignancy detection shows promising results compared to all investigated methods presented in various literature.
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Affiliation(s)
- Hitesh Tekchandani
- Electronics and Communication Engineering, National Institute of Technology Raipur, NIT Raipur, G E Road, Raipur, Chhattisgarh 492010, India
| | - Shrish Verma
- Electronics and Communication Engineering, National Institute of Technology Raipur, NIT Raipur, G E Road, Raipur, Chhattisgarh 492010, India
| | - Narendra Londhe
- Electrical Engineering, National Institute of Technology Raipur, NIT Raipur,G E Road, Raipur, Chhattisgarh 492010, India.
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Distinguishing Lymphomatous and Cancerous Lymph Nodes in 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography by Radiomics Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2020. [DOI: 10.1155/2020/3959236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background. The National Comprehensive Cancer Network guidelines recommend excisional biopsies for the diagnosis of lymphomas. However, resection biopsies in all patients who are suspected of having malignant lymph nodes may cause unnecessary injury and increase medical costs. We investigated the usefulness of 18F-fluorodeoxyglucose positron emission/computed tomography- (18F-FDG-PET/CT-) based radiomics analysis for differentiating between lymphomatous lymph nodes (LLNs) and cancerous lymph nodes (CLNs). Methods. Using texture analysis, radiomic parameters from the 18F-FDG-PET/CT images of 492 lymph nodes (373 lymphomatous lymph nodes and 119 cancerous lymph nodes) were extracted with the LIFEx package. Predictive models were generated from the six parameters with the largest area under the receiver operating characteristics curve (AUC) in PET or CT images in the training set (70% of the data), using binary logistic regression. These models were applied to the test set to calculate predictive variables, including the combination of PET and CT predictive variables (PREcombination). The AUC, sensitivity, specificity, and accuracy were used to compare the differentiating ability of the predictive variables. Results. Compared with the pathological diagnosis of the patient’s primary tumor, the AUC, sensitivity, specificity, and accuracy of PREcombination in differentiating between LLNs and CLNs were 0.95, 91.67%, 94.29%, and 92.96%, respectively. Moreover, PREcombination could effectively distinguish LLNs caused by various lymphoma subtypes (Hodgkin’s lymphoma and non-Hodgkin’s lymphoma) from CLNs, with the AUC, sensitivity, specificity, and accuracy being 0.85 and 0.90, 77.78% and 77.14%, 97.22% and 88.89%, and 90.74% and 83.10%, respectively. Conclusions. Radiomics analysis of 18F-FDG-PET/CT images may provide a noninvasive, effective method to distinguish LLN and CLN and inform the choice between fine-needle aspiration and excision biopsy for sampling suspected lymphomatous lymph nodes.
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Cai P, Su D, Yang W, He Z, Zhang C, Liu H, Liu Z, Zhang X, Gao L, Liu Y, Jiang H, Gao F, Gao X. Inherently PET/CT Dual Modality Imaging Lipid Nanocapsules for Early Detection of Orthotopic Lung Tumors. ACS APPLIED BIO MATERIALS 2020; 3:611-621. [DOI: 10.1021/acsabm.9b00993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Pengju Cai
- Department of Chemistry and Chemical Engineering, Beijing University of Technology, Beijing, 100124, P. R. China
| | - Dongdong Su
- Department of Chemistry and Chemical Engineering, Beijing University of Technology, Beijing, 100124, P. R. China
| | | | | | - Chunyu Zhang
- Department of Chemistry and Chemical Engineering, Beijing University of Technology, Beijing, 100124, P. R. China
| | - Hui Liu
- Beijing National Laboratory for Molecular Sciences, Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, P. R. China
| | - Zhibo Liu
- Beijing National Laboratory for Molecular Sciences, Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, P. R. China
| | | | - Liang Gao
- Department of Chemistry and Chemical Engineering, Beijing University of Technology, Beijing, 100124, P. R. China
| | | | - Huaidong Jiang
- School of Physical Science and Technology, Shanghai Tech University, Shanghai 201210, China
| | | | - Xueyun Gao
- Department of Chemistry and Chemical Engineering, Beijing University of Technology, Beijing, 100124, P. R. China
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Zhao F, Zhen FX, Zhou Y, Huang CJ, Yu Y, Li J, Li QF, Zhu CX, Yang XY, You SH, Wu QG, Qin XY, Liu Y, Chen L, Wang W. Clinicopathologic predictors of metastasis of different regional lymph nodes in patients intraoperatively diagnosed with stage-I non-small cell lung cancer. BMC Cancer 2019; 19:444. [PMID: 31088404 PMCID: PMC6518627 DOI: 10.1186/s12885-019-5632-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 04/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background Selection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC). Here, we sought to identify the clinicopathologic predictors of regional lymph node metastasis in patients intraoperatively diagnosed with stage-I NSCLC. Methods A retrospective review of 595 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection was performed. Univariate and multivariable logistic regression analysis was performed to determine the independent predictors of regional lymph node metastasis. Results Univariate logistic regression and multivariable analysis revealed three independent predictors of the presence of metastatic hilar lymph nodes, five independent predictors for lobe specific mediastinal lymph nodes, two independent predictors for lobe nonspecific mediastinal lymph nodes and two independent predictors for skipping mediastinal lymph nodes. Conclusions A complete mediastinal lymph node dissection may be considered for patients suspected of nerve invasion and albumin (> 43.1 g/L) or nerve and vascular invasions. Lobe-specific lymph node dissection should probably be performed for patients suspected of pulmonary membrane invasion, vascular invasion, CEA (> 2.21 ng/mL), and tumor (> 1.6 cm) in the right lower lobe or mixed lobes. Hilar lymph node dissection should probably be performed for patients suspected of having bronchial mucosa and cartilage invasion, vascular invasion, and CEA (> 2.21 ng/mL). Electronic supplementary material The online version of this article (10.1186/s12885-019-5632-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fei Zhao
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Fu-Xi Zhen
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Zhou
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Chen-Jun Huang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Yu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jun Li
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qi-Fan Li
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Cheng-Xiang Zhu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiao-Yu Yang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shu-Hui You
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qian-Ge Wu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xue-Yun Qin
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yi Liu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Liang Chen
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Wei Wang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Bae SU, Won KS, Song BI, Jeong WK, Baek SK, Kim HW. Accuracy of F-18 FDG PET/CT with optimal cut-offs of maximum standardized uptake value according to size for diagnosis of regional lymph node metastasis in patients with rectal cancer. Cancer Imaging 2018; 18:32. [PMID: 30217167 PMCID: PMC6137872 DOI: 10.1186/s40644-018-0165-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/30/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The low sensitivity of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the evaluation of metastatic lymph nodes (LNs) is mainly due to the partial volume effect in patients with rectal cancer. This retrospective study evaluated the diagnostic accuracy of F-18 FDG PET/CT with optimal cut-off values of the maximum standardized uptake value (SUVmax), according to LN size, for the evaluation of regional LN in rectal cancer patients. METHODS This study included 176 patients with rectal cancer who underwent F-18 FDG PET/CT for initial staging. Patients were classified based on the long-axis diameter of the regional LN on CT images as small (≤ 7 mm; n = 118) and large (> 7 mm; n = 58) LN groups. The optimal cut-off value of SUVmax was determined for each group, using receiver operating characteristic curve analysis. Areas under the curve (AUC) were compared by C-statistics using two methods: the cut-off value of SUVmax optimized according to LN size, and a fixed SUVmax cut-off value of 2.5. RESULTS The optimal cut-off values of SUVmax for the small and large LN groups were 1.1, and 2.1, respectively. The sensitivity, specificity, and accuracy of F-18 FDG PET/CT using the optimal cut-off values were 90.6, 70.9, and 76.3% in the small LN group, and 68.6, 78.3, and 72.4% in the large LN group. The sensitivity, specificity, and accuracy of F-18 FDG PET/CT using the fixed cut-off value were 18.8, 100, and 78.0% in the small LN group, and 51.4, 87.0, and 65.5% in the large LN group. The AUC was significantly higher using the optimal cut-off values than the fixed cut-off value (0.808 vs. 0.594, p = 0.005) in the small LN group, but not in the large LN group (0.734 vs. 0.692, p = 0.429). CONCLUSIONS Application of the lower cut-off value of SUVmax improves the diagnostic performance of F-18 FDG PET/CT for the evaluation of small regional LNs in patients with rectal cancer.
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Affiliation(s)
- Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Kyoung Sook Won
- Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu, 41931, Republic of Korea
| | - Bong-Il Song
- Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu, 41931, Republic of Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hae Won Kim
- Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu, 41931, Republic of Korea.
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Molecular Imaging Using PET/CT for Radiation Therapy Planning for Adult Cancers: Current Status and Expanding Applications. Int J Radiat Oncol Biol Phys 2018; 102:783-791. [PMID: 30353883 DOI: 10.1016/j.ijrobp.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/23/2018] [Accepted: 03/13/2018] [Indexed: 12/25/2022]
Abstract
Accurate tumor delineation is a priority in radiation therapy (RT). Metabolic imaging has a key and evolving role in target volume selection and delineation. This is especially so for non-small cell lung cancer, squamous cell cancer of the head and neck, and lymphoma, for which positron emission tomography/computed tomography (PET/CT) is complimentary to structural imaging modalities, not only in delineating primary tumors, but also often in revealing previously undiagnosed regional nodal disease. At some sites, PET/CT has been confirmed to enable target size reduction compared with structural imaging alone, with enhanced normal tissue sparing and potentially allowing for dose escalation. These contributions often dramatically affect RT strategies. However, some limitations exist to the use of fluorodeoxyglucose-PET in RT planning, including its relatively poor spatial resolution and partial voluming effects for small tumors. A role is developing for contributions from metabolic imaging to RT planning at other tumor sites and exciting new applications for the use of non-fluorodeoxyglucose metabolic markers for RT planning.
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Sigovan M, Akl P, Mesmann C, Tronc F, Si-Mohamed S, Douek P, Boussel L. Benign and malignant enlarged chest nodes staging by diffusion-weighted MRI: an alternative to mediastinoscopy? Br J Radiol 2017; 91:20160919. [PMID: 29125330 DOI: 10.1259/bjr.20160919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of diffusion-weighted MRI with background suppression (DWIBS) in differentiating between malignant and benign mediastinal lymph-nodes. METHODS Consecutive patients with enlarged mediastinal lymph-nodes underwent MRI DWIBS within 10 days prior to mediastinoscopy. Relative contrast ratios (RCRs) were computed on b800 and apparent diffusion coefficient (ADC) maps by dividing the node signal with the chest muscle signal, using manually drawn regions of interest (ROIs) by radiologists, blinded to pathology. Unpaired Student's t-tests were used to compare RCR-b800 and ADC between malignant and benign nodes. Receiver operating characteristic curves analyses were also performed. RESULTS Six patients were excluded for poor image quality. Analysis was performed for 54 patients. Mean ADC values were significantly higher for benign (1740 ± 401 × 10-6 mm2 s-1) compared with malignant nodes (1266 ± 403 × 10-6 mm2 s-1, p = 0.0001). Mean RCR-b800 values were significantly lower for benign (2.64 ± 1.07) compared with malignant nodes (6.44 ± 3.47, p < 0.0001). Receiver operating characteristic analysis for RCR-b800 (cut-off of 3.6), showed a sensitivity of 90.9%, a specificity 83% and an accuracy 85% for differentiating benign from malignant nodes. For ADC (cut-off of 1285), the sensitivity was 68.2%, the specificity 84.6% and the accuracy 80.4%. CONCLUSION DWIBS can accurately differentiate malignant from benign states in enlarged mediastinal lymph-nodes and represents an alternative method in aetiological work-up of mediastinal lymphadenopathies. Advances in knowledge: DWIBS may represent a useful adjunctive imaging modality, particularly for diagnosis of benign mediastinal lymph node, and thus may reduce the frequency of futile mediastinoscopy, which remains an invasive procedure.
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Affiliation(s)
- Monica Sigovan
- 1 CNRS, CREATIS UMR 5220, Université Claude Bernard Lyon 1, Inserm U1206, INSA , Lyon , France
| | - Pia Akl
- 2 Department of Radiology, University of Lyon, Hospices Civils de Lyon, Croix Rousse Hospital , University of Lyon, Hospices Civils de Lyon, Croix Rousse Hospital , Lyon , France
| | - Caroline Mesmann
- 2 Department of Radiology, University of Lyon, Hospices Civils de Lyon, Croix Rousse Hospital , University of Lyon, Hospices Civils de Lyon, Croix Rousse Hospital , Lyon , France
| | - Francois Tronc
- 3 Department of Thoracic Surgery, University of Lyon, Hospices Civils de Lyon, Hospital Louis Pradel , University of Lyon, Hospices Civils de Lyon, Hospital Louis Pradel , Lyon , France
| | - Salim Si-Mohamed
- 1 CNRS, CREATIS UMR 5220, Université Claude Bernard Lyon 1, Inserm U1206, INSA , Lyon , France.,4 Department of Radiology, University of Lyon, Hospices Civils de Lyon, Hospital Louis Pradel , University of Lyon, Hospices Civils de Lyon, Hospital Louis Pradel , Lyon , France
| | - Philippe Douek
- 1 CNRS, CREATIS UMR 5220, Université Claude Bernard Lyon 1, Inserm U1206, INSA , Lyon , France.,4 Department of Radiology, University of Lyon, Hospices Civils de Lyon, Hospital Louis Pradel , University of Lyon, Hospices Civils de Lyon, Hospital Louis Pradel , Lyon , France
| | - Loic Boussel
- 1 CNRS, CREATIS UMR 5220, Université Claude Bernard Lyon 1, Inserm U1206, INSA , Lyon , France.,2 Department of Radiology, University of Lyon, Hospices Civils de Lyon, Croix Rousse Hospital , University of Lyon, Hospices Civils de Lyon, Croix Rousse Hospital , Lyon , France
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Dynamic Contrast-Enhanced Perfusion Area-Detector CT: Preliminary Comparison of Diagnostic Performance for N Stage Assessment With FDG PET/CT in Non-Small Cell Lung Cancer. AJR Am J Roentgenol 2017; 209:W253-W262. [PMID: 28929810 DOI: 10.2214/ajr.17.17959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to directly compare the capability of dynamic first-pass contrast-enhanced (CE) perfusion area-detector CT (ADCT) and FDG PET/CT for differentiation of metastatic from nonmetastatic lymph nodes and assessment of N stage in patients with non-small cell lung carcinoma (NSCLC). SUBJECTS AND METHODS Seventy-seven consecutive patients, 45 men (mean age ± SD, 70.4 ± 5.9 years) and 32 women (71.2 ± 7.7 years), underwent dynamic first-pass CE-perfusion ADCT at two or three different positions for covering the entire thorax, FDG PET/CT, surgical treatment, and pathologic examination. From all ADCT data for each of the subjects, a whole-chest perfusion map was computationally generated using the dual- and single-input maximum slope and Patlak plot methods. For quantitative N stage assessment, perfusion parameters and the maximum standardized uptake value (SUVmax) for each lymph node were determined by measuring the relevant ROI. ROC curve analyses were performed for comparing the diagnostic capability of each of the methods on a per-node basis. N stages evaluated by each of the indexes were then statistically compared with the final pathologic diagnosis by means of chi-square and kappa statistics. RESULTS The area under the ROC curve (Az) values of systemic arterial perfusion (Az = 0.89), permeability surface (Az = 0.78), and SUVmax (Az = 0.85) were significantly larger than the Az values of total perfusion (Az = 0.70, p < 0.05) and distribution volume (Az = 0.55, p < 0.05). For each of the threshold values, agreement for systemic arterial perfusion calculated using the dual-input maximum slope model was substantial (κ = 0.70, p < 0.0001), and agreement for SUVmax was moderate (κ = 0.60, p < 0.0001). CONCLUSION Dynamic first-pass CE-perfusion ADCT is as useful as FDG PET/CT for the differentiation of metastatic from nonmetastatic lymph nodes and assessment of N stage in patients with NSCLC.
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Zhao F, Zhou Y, Ge PF, Huang CJ, Yu Y, Li J, Sun YG, Meng YC, Xu JX, Jiang T, Zhang ZX, Sun JP, Wang W. A prediction model for lymph node metastases using pathologic features in patients intraoperatively diagnosed as stage I non-small cell lung cancer. BMC Cancer 2017; 17:267. [PMID: 28407802 PMCID: PMC5390383 DOI: 10.1186/s12885-017-3273-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 04/07/2017] [Indexed: 11/27/2022] Open
Abstract
Background There is little information on which pattern should be chosen to perform lymph node dissection for stage I non-small-cell lung cancer. This study aimed to develop a model for predicting lymph node metastasis using pathologic features of patients intraoperatively diagnosed as stage I non-small-cell lung cancer. Methods We collected pathology data from 284 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection from 2013 through 2014, assessing various factors for an association with metastasis to lymph nodes (age, gender, pathology, tumour location, tumour differentiation, tumour size, pleural invasion, bronchus invasion, multicentric invasion and angiolymphatic invasion). After analysing these variables, we developed a multivariable logistic model to estimate risk of metastasis to lymph nodes. Results Univariate logistic regression identified tumour size >2.65 cm (p < 0.001), tumour differentiation (p < 0.001), pleural invasion (p = 0.034) and bronchus invasion (p < 0.001) to be risk factors significantly associated with the presence of metastatic lymph nodes. On multivariable analysis, only tumour size >2.65 cm (p < 0.001), tumour differentiation (p = 0.006) and bronchus invasion (p = 0.017) were independent predictors for lymph node metastasis. We developed a model based on these three pathologic factors that determined that the risk of metastasis ranged from 3% to 44% for patients intraoperatively diagnosed as stage I non-small-cell lung cancer. By applying the model, we found that the values ŷ > 0.80, 0.43 < ŷ ≤ 0.80, ŷ ≤ 0.43 plus tumour size >2 cm and ŷ ≤0.43 plus tumour size ≤2 cm yielded positive lymph node metastasis predictive values of 44%, 18%, 14% and 0%, respectively. Conclusions A non-invasive prediction model including tumour size, tumour differentiation and bronchus invasion may be useful to give thoracic surgeons recommendations on lymph node dissection for patients intraoperatively diagnosed as Stage I non-small cell lung cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3273-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fei Zhao
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Zhou
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Peng-Fei Ge
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Chen-Jun Huang
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Yu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jun Li
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yun-Gang Sun
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yang-Chun Meng
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jian-Xia Xu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Ting Jiang
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Zhi-Xuan Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin-Peng Sun
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Wei Wang
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Bustos García de Castro A, Ferreirós Domínguez J, Delgado Bolton R, Fernández Pérez C, Cabeza Martínez B, García García-Esquinas M, Carreras Delgado J. PET-CT in presurgical lymph node staging in non-small cell lung cancer: The importance of false-negative and false-positive findings. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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PET-CT in presurgical lymph node staging in non-small cell lung cancer: the importance of false-negative and false-positive findings. RADIOLOGIA 2017; 59:147-158. [PMID: 28238444 DOI: 10.1016/j.rx.2016.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/28/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the importance of false-negative and false-positive findings in computed tomography (CT) and 18F-FDG positron emission tomography (PET) in mediastinal lymph node staging in patients undergoing surgery for non-small cell lung cancer (NSCLC). MATERIAL AND METHODS This retrospective study included 113 consecutive patients and 120 resected NSCLCs; 22 patients received neoadjuvant treatment. We compared the findings on preoperative 18F-FDG PET-CT studies with the postoperative pathology findings. Lymph node size and primary tumor size were measured with CT, and lymph nodes and primary tumors were evaluated qualitatively and semiquantitatively (using standardized uptake values (SUVmax)) with PET. RESULTS Metastatic lymph nodes were found in 26 (21.7%) of the 120 tumors and in 41 (7.7%) of the 528 lymph node stations analyzed. 18F-FDG PET-CT yielded 53.8% sensitivity, 76.6% specificity, 38.9% positive predictive value, 85.7% negative predictive value, and 71.7% diagnostic accuracy. The false-negative rate was 14.2%. Multivariable analysis found that the factors associated with false-negative findings were a moderate degree of differentiation in the primary tumor (p = 0.005) and an SUVmax of the primary tumor >4 (p = 0.027). The false-positive rate was 61.1%, and the multivariable analysis found that lymph node size >1cm was associated with false-positive findings (p < 0.001). CONCLUSIONS In mediastinal lymph node staging in patients with NSCLC, 18F-FDG PET-CT improves the specificity and negative predictive value and helps clinicians to select the patients that will benefit from surgery. Given the high rate of false positives, histological confirmation of positive cases is recommendable.
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Numan RC, Berge MT, Burgers JA, Klomp HM, van Sandick JW, Baas P, Wouters MW. Pre- and postoperative care for stage I-III NSCLC: Which quality of care indicators are evidence-based? Lung Cancer 2016; 101:120-128. [PMID: 27794400 DOI: 10.1016/j.lungcan.2016.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 05/16/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
Identification of evidenced-based Quality of Care (QoC) indicators for lung cancer care is essential to quality improvement. The aim of this review was to identify evidence-based quality indicators for the pre- and postoperative care of stage I-III Non Small Cell Lung Cancer (NSCLC) provided by the lung physician. To obtain these indicators, a search in PubMed, Embase and the Cochrane library database was performed. English literature published between 1980 and 2012 was included and search terms regarding 'lung neoplasms', 'quality of care', 'pathology', 'diagnostic methods', 'preoperative and postoperative treatment' were used. The potential indicators were categorized as structure, process or outcome measures and the indicators supported by literature with high evidence level were selected. Five QoC indicators were identified. The use of the positron emission tomography-computed tomography (PET-CT) results in more accurate mediastinal staging compared to the CT scan. Endoscopic Ultrasound-Fine Needle Aspiration and Endobronchial Ultrasound-Fine Needle Aspiration are sensitive diagnostic tools for mediastinal staging and reduce futile thoracotomies. Pathological conformation of lung cancer can best be obtained by a combination of cytological and histological diagnostics used during bronchoscopy. For patients with clinical stage III NSCLC, preoperative multimodality treatment (i.e. preoperative chemoradiation) results in superior survival and increased mediastinal downstaging compared to single modality treatment (i.e. preoperative chemotherapy or radiotherapy). After surgery, the addition of chemotherapy results in a significant survival benefit for patients with pathological stage II and III NSCLC. These five QoC indicators can be used for benchmarking and ultimately quality improvement of lung cancer care.
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Affiliation(s)
- Rachel C Numan
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | - Martijn Ten Berge
- Department of Surgical Oncology, Leids Universitair Medisch Centrum, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jacobus A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Houke M Klomp
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Michel W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Cho J, Choe JG, Pahk K, Choi S, Kwon HR, Eo JS, Seo HJ, Kim C, Kim S. Ratio of Mediastinal Lymph Node SUV to Primary Tumor SUV in 18F-FDG PET/CT for Nodal Staging in Non-Small-Cell Lung Cancer. Nucl Med Mol Imaging 2016; 51:140-146. [PMID: 28559938 DOI: 10.1007/s13139-016-0447-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/29/2016] [Accepted: 08/12/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Following determination of the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes (SUV-LN) and of the primary tumor (SUV-T) on 18F-FDG PET/CT in patients with non-small-cell lung cancer (NSCLC), the aim of the study was to determine the value of the SUV-LN/SUV-T ratio in lymph node staging in comparison with that of SUV-LN. METHODS We retrospectively reviewed a total of 289 mediastinal lymph node stations from 98 patients with NSCLC who were examined preoperatively for staging and subsequently underwent pathologic studies of the mediastinal lymph nodes. We determined SUV-LN and SUV-R for each lymph node station on 18F-FDG PET/CT and then classified each station into one of three groups based on SUV-T (low, medium and high SUV-T groups). Diagnostic performance was assessed based on receiver operating characteristic (ROC) curve analysis, and the optimal cut-off values that would best discriminate metastatic from benign lymph nodes were determined for each method. RESULTS The average of SUV-R of malignant lymph nodes was significantly higher than that of benign lymph nodes (0.79 ± 0.45 vs. 0.36 ± 0.23, P < 0.0001). In the ROC curve analysis, the area under the curve (AUC) of SUV-R was significantly higher than that of SUV-LN in the low SUV-T group (0.885 vs. 0.810, P = 0.019). There were no significant differences between the AUCs of SUV-LN and of SUV-R in the medium and high SUV-T groups. The optimal cut-off value for SUV-R in the low SUV-T group was 0.71 (sensitivity 87.5 %, specificity 85.9 %). CONCLUSIONS The SUV-R performed well in distinguishing between metastatic and benign lymph nodes. In particular, SUV-R was found to have a better diagnostic performance than SUV-LN in the low SUV-T group.
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Affiliation(s)
- Jaehyuk Cho
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jae Gol Choe
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kisoo Pahk
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sunju Choi
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hye Ryeong Kwon
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyo Jung Seo
- Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Chulhan Kim
- Department of Nuclear Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do Republic of Korea
| | - Sungeun Kim
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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Beslic N, Sadija A, Milardovic R, Ceric T, Ceric S, Beganovic A, Kristic S, Cavaljuga S. Advantages of Combined PET-CT in Mediastinal Staging in Patients with Non-small Cell Lung Carcinoma. Acta Inform Med 2016; 24:99-102. [PMID: 27147799 PMCID: PMC4851521 DOI: 10.5455/aim.2016.24.99-102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/05/2016] [Indexed: 12/28/2022] Open
Abstract
Introduction: Precise mediastinal lymph node staging in patients with non-small cell lung carcinoma (NSCLC) provides important prognostic information and it is obligatory in treatment strategy planning. 18Fluoro-deoxy-glucose (18F-FDG) positron emission tomography - computerized tomography (PET-CT) based on detection of metabolic activity showed superiority in preoperative staging of lung carcinoma. Materials and Methods: Total number of 26 patients diagnosed with NSCLC were included in this retrospective, cross-sectional study. Status of mediastinal lymph nodes was assessed in all patients comparing contrast enhanced CT and 18F-FDG PET-CT findings. Discussion: We found in our study that 50% of patients had different N stage on contrast enhanced CT comparing to 18F-FDG PET-CT findings. Among the total number of patients which had different nodal status on PET-CT comparing to CT alone, we found in our study that 54% of patients had change in further therapy protocol after PET-CT change of nodal stage. Conclusion: Combined PET-CT which offers advantages of both modalities is excellent method for nodal (N) staging, so it is recommended in initial staging in patients with NSCLC. PET-CT used preopratively for mediastinal nodal staging has significant impact on further therapy planning and also has an consequential impact on health system savings.
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Affiliation(s)
- Nermina Beslic
- Clinic for Nuclear Medicine, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Amera Sadija
- Clinic for Nuclear Medicine, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Renata Milardovic
- Clinic for Nuclear Medicine, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Timur Ceric
- Clinic for Oncology, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Sejla Ceric
- Clinic for Nuclear Medicine, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Adnan Beganovic
- Department of Medical Physics and Radiation Safety, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Spomenka Kristic
- Clinic for Radiology, University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Semra Cavaljuga
- Medical Faculty, University in Sarajevo, Bosnia and Herzegovina
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Xia Y, Zhang B, Zhang H, Li W, Wang KP, Shen H. Evaluation of lymph node metastasis in lung cancer: who is the chief justice? J Thorac Dis 2016; 7:S231-7. [PMID: 26807270 DOI: 10.3978/j.issn.2072-1439.2015.11.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Accurate determination of the diagnosis and the stage of lung cancer play a critical role to ensure that patients are provided the optimal treatment. However, the process is usually beyond complex. Early studies have suggested lymph nodes (LNs) >1.0 cm in size on computed tomography (CT) are considered as metastatic nodes, while the sensitivity of this criterion is not satisfied. Subsequently, positron emission tomography-computed tomography (PET-CT) was shown to be superior to CT alone on assessment of nodal involvement and was widely used to estimate suitability for resection with curative intent, but the dependability also remains controversial. Furthermore, transbronchial needle aspiration (TBNA) with and without endobronchial ultrasound (EBUS), as a well-accepted minimally invasive approach for LN biopsy, has been documented as an efficient tool in evaluation of CT and PET-CT negative LNs. Additionally, radiographic features including ground-glass/solid nodules ratio, referring as imaging biomarker, were indicated to be correlated with metastasis. Hence, we highlight the importance of comprehensive estimation of mediastinal and hilar LNs, and we suggested the judgment of LNs by radiographic tools alone might not be reliable and TBNA is indispensable in certain circumstances.
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Affiliation(s)
- Yang Xia
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Bin Zhang
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Hao Zhang
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Wen Li
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Ko-Pen Wang
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
| | - Huahao Shen
- 1 Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China ; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD 21025, USA
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Predicted extracapsular invasion of hilar lymph node metastasis by fusion positron emission tomography/computed tomography in patients with lung cancer. Mol Clin Oncol 2015; 3:1035-1040. [PMID: 26623046 DOI: 10.3892/mco.2015.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/11/2015] [Indexed: 12/25/2022] Open
Abstract
Intraoperative detection of hilar lymph node metastasis, particularly with extracapsular invasion, may affect the surgical procedure in patients with lung cancer, as the preoperative estimation of hilar lymph node metastasis is unsatisfactory. The aim of this study was to investigate whether fusion positron emission tomography/computed tomography (PET/CT) is able to predict extracapsular invasion of hilar lymph node metastasis. Between April, 2007 and April, 2013, 509 patients with primary lung cancer underwent surgical resection at our institution, among whom 28 patients exhibiting hilar lymph node metastasis (at stations 10 and 11) were enrolled in this study. A maximum lymph node standardized uptake value of >2.5 in PET scans was interpreted as positive. A total of 17 patients had positive preoperative PET/CT findings in their hilar lymph nodes, while the remaining 11 had negative findings. With regard to extracapsular nodal invasion, the PET/CT findings (P=0.0005) and the histological findings (squamous cell carcinoma, P=0.05) were found to be significant predictors in the univariate analysis. In the multivariate analysis, the PET/CT findings were the only independent predictor (P=0.0004). The requirement for extensive pulmonary resection (sleeve lobectomy, bilobectomy or pneumonectomy) was significantly more frequent in the patient group with positive compared with the group with negative PET/CT findings (76 vs. 9%, respectively, P=0.01). Therefore, the PET/CT findings in the hilar lymph nodes were useful for the prediction of extracapsular invasion and, consequently, for the estimation of possible extensive pulmonary resection.
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Shen G, Hu S, Deng H, Jia Z. Diagnostic value of dual time-point 18 F-FDG PET/CT versus single time-point imaging for detection of mediastinal nodal metastasis in non-small cell lung cancer patients: a meta-analysis. Acta Radiol 2015; 56:681-7. [PMID: 24917609 DOI: 10.1177/0284185114535210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/19/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lymph node staging in non-small cell lung cancer (NSCLC) is challenging and important for determining treatment policy. Conflicting results have been presented to date. PURPOSE To evaluate the diagnostic performance of dual time-point (DTP) 18 F-FDG PET/CT compared with single time-point (STP) imaging for detecting mediastinal nodal metastases in patients with NSCLC. MATERIAL AND METHODS The PubMed, EMBASE, EBSCO, and Web of Knowledge databases were searched for relevant articles. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated using Meta-Disc software. Summary receiver-operating characteristic (SROC) curves were also constructed. The potential for between-study heterogeneity was explored using subgroup analyses. RESULTS A total of eight studies involving 654 patients fulfilled the inclusion criteria. On a per-patient analysis, the pooled sensitivity and specificity with a 95% confidence interval (CI) for DTP PET/CT were 0.85 (0.78-0.91), 0.75 (0.68-0.82), and for STP imaging, they were 0.79 (0.70-0.85), 0.73 (0.65-0.79), respectively. On a per-lesion basis, the corresponding values for DTP imaging were 0.84 (0.81-0.86), 0.89 (0.87-0.91), and for STP imaging, they were 0.84 (0.80-0.86), 0.83 (0.81-0.85), respectively. CONCLUSION DTP PET/CT performed better than STP imaging in evaluating the lymph node status of NSCLC patients and had the potential to be broadly applied in clinical practice. However, due to the small sample size and large heterogeneity, current evidence does not justify the implementation of DTP imaging in routine PET protocols for mediastinal lymph node staging of NSCLC.
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Affiliation(s)
- Guohua Shen
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, PR China
| | - Shuang Hu
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, PR China
| | - Houfu Deng
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, PR China
| | - Zhiyun Jia
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, PR China
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Rubin GD. Computed tomography: revolutionizing the practice of medicine for 40 years. Radiology 2015; 273:S45-74. [PMID: 25340438 DOI: 10.1148/radiol.14141356] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computed tomography (CT) has had a profound effect on the practice of medicine. Both the spectrum of clinical applications and the role that CT has played in enhancing the depth of our understanding of disease have been profound. Although almost 90 000 articles on CT have been published in peer-reviewed journals over the past 40 years, fewer than 5% of these have been published in Radiology. Nevertheless, these almost 4000 articles have provided a basis for many important medical advances. By enabling a deepened understanding of anatomy, physiology, and pathology, CT has facilitated key advances in the detection and management of disease. This article celebrates this breadth of scientific discovery and development by examining the impact that CT has had on the diagnosis, characterization, and management of a sampling of major health challenges, including stroke, vascular diseases, cancer, trauma, acute abdominal pain, and diffuse lung diseases, as related to key technical advances in CT and manifested in Radiology.
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Affiliation(s)
- Geoffrey D Rubin
- From the Duke Clinical Research Institute and Department of Radiology, Duke University School of Medicine, PO Box 17969, 2400 Pratt St, Durham, NC 27715
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Rosenzweig KE, Sura S. Image-Guided Radiation Therapy. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kumar R, Nadig MR, Chauhan A. Positron emission tomography: clinical applications in oncology. Part 1. Expert Rev Anticancer Ther 2014; 5:1079-94. [PMID: 16336099 DOI: 10.1586/14737140.5.6.1079] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Positron emission tomography is a functional diagnostic imaging technique, which can accurately measure in vivo distribution of a radiopharmaceutical with high resolution. The ability of positron emission tomography to study various biologic processes opens up new possibilities for both research and day-to-day clinical use. Positron emission tomography has progressed rapidly from being a research technique in laboratories to a routine clinical imaging modality becoming part of armamentarium for the medical profession. The most widely used radiotracer in positron emission tomography is 18F-fluoro-2-deoxy-D-glucose (FDG), which is an analog of glucose. FDG uptake in cells is directly proportional to glucose metabolism of cells. Since glucose metabolism is increased many fold in malignant tumors, positron emission tomography has a high sensitivity and high negative predictive value. Positron emission tomography with FDG is now the standard of care in initial staging, monitoring the response to therapy and management of lung cancer, colorectal cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer and breast cancer. The aim of this article is to review the clinical applications of positron emission tomography in oncology.
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Affiliation(s)
- Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, E-62, Ansari Nagar (East), New Delhi, 110029, India.
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Rakheja R, Ko JP, Friedman K. Lung cancer: positron emission tomography/computed tomography and the new staging system. Semin Roentgenol 2013; 48:308-22. [PMID: 24034263 DOI: 10.1053/j.ro.2013.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Rajan Rakheja
- Division of Nuclear Medicine, New York University Langone Medical Center, New York, NY
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Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, Harris LJ, Detterbeck FC. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e211S-e250S. [PMID: 23649440 DOI: 10.1378/chest.12-2355] [Citation(s) in RCA: 916] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage. Several noninvasive imaging studies and invasive tests are available. Understanding the accuracy, advantages, and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making. METHODS Test accuracies for the available staging studies were updated from the second iteration of the American College of Chest Physicians Lung Cancer Guidelines. Systematic searches of the MEDLINE database were performed up to June 2012 with the inclusion of selected meta-analyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables. RESULTS The sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were approximately 55% and 81%, respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, estimates of sensitivity and specificity for identifying mediastinal metastasis were approximately 77% and 86%, respectively. These findings demonstrate that PET scanning is more accurate than CT scanning, but tissue biopsy is still required to confirm PET scan findings. The needle techniques endobronchial ultrasound-needle aspiration, endoscopic ultrasound-needle aspiration, and combined endobronchial ultrasound/endoscopic ultrasound-needle aspiration have sensitivities of approximately 89%, 89%, and 91%, respectively. In direct comparison with surgical staging, needle techniques have emerged as the best first diagnostic tools to obtain tissue. Based on randomized controlled trials, PET or PET-CT scanning is recommended for staging and to detect unsuspected metastatic disease and avoid noncurative resections. CONCLUSIONS Since the last iteration of the staging guidelines, PET scanning has assumed a more prominent role both in its use prior to surgery and when evaluating for metastatic disease. Minimally invasive needle techniques to stage the mediastinum have become increasingly accepted and are the tests of first choice to confirm mediastinal disease in accessible lymph node stations. If negative, these needle techniques should be followed by surgical biopsy. All abnormal scans should be confirmed by tissue biopsy (by whatever method is available) to ensure accurate staging. Evidence suggests that more complete staging improves patient outcomes.
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Affiliation(s)
| | - Anne V Gonzalez
- Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Michael A Jantz
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL
| | | | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lynn T Tanoue
- Section of Pulmonary and Critical Care Medicine, New Haven, CT
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Abstract
Published in 2009, the 7th edition of the American Joint Committee on Cancer TNM staging system is the culmination of an extensive worldwide initiative to standardize and validate lung cancer staging. Unlike prior editions, the new staging system is now inclusive of small cell carcinoma and carcinoid tumors. In addition, significant changes were made to the T and M descriptors, resulting in improved prognostic stratification of disease. This review article highlights these changes, the rationale for their inclusion in the new staging manual, and the role of the radiologist in determining stage.
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Affiliation(s)
- Sophie Chheang
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York - Presbyterian Hospital, New York, New York
| | - Kathleen Brown
- Thoracic Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
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Wang YJ, Wu SJ, Guo KY, Chen C, Xie Q, Gu WW, Cai L, Zou F. ¹⁸F-FDG uptake by spleen helps rapidly predict the dose level after total body irradiation in a Tibetan minipig model. Eur Radiol 2012; 22:1844-51. [PMID: 22549103 DOI: 10.1007/s00330-012-2451-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/14/2012] [Accepted: 03/19/2012] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To investigate whether (18)F- FDG uptake can be applied in dosimetry to facilitate the rapid and accurate evaluation of individual radiation doses after a nuclear accident. METHODS Forty-eight Tibetan minipigs were randomised into a control group (n = 3) and treatment groups (n = 45). (18)F-FDG combined positron-emission tomography and computed tomography (PET/CT) were carried out before total body irradiation (TBI) and at 6, 24 and 72 h after receiving TBI doses ranging from 1 to 11 Gy. Spleen tissues and blood samples were also collected for histological examination, apoptosis and blood analysis. RESULTS Mean standardised uptake values (SUVs) of the spleen showed significant differences between the experimental and the control groups. Spleen SUV at 6 h post-irradiation showed significant correlation with radiation dose; Spearman's correlation coefficient was 0.97 (P < 0.01). Histological observations showed that damage to the splenic lymphocyte became more severe with an increase in the radiation dose. Moreover, apoptosis was one of the major routes of splenic lymphocyte death, which was also confirmed by flow cytometry analysis. CONCLUSIONS In the Tibetan minipig model, radiation doses have a close relationship with the (18)F-FDG uptake of the spleen. This finding suggests that (18)F-FDG PET/CT may be useful for the rapid detection of individual radiation doses.
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Affiliation(s)
- Yu Jue Wang
- Department of Laboratory Animal Center, Southern Medical University, 1838 Guangzhou North Road, 510515, Guangzhou, Guangdong, China
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Additional value of FDG-PET to contrast enhanced-computed tomography (CT) for the diagnosis of mediastinal lymph node metastasis in non-small cell lung cancer: a Japanese multicenter clinical study. Ann Nucl Med 2011; 25:777-86. [PMID: 21901365 DOI: 10.1007/s12149-011-0529-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study was a controlled multicenter clinical study to verify the diagnostic effects of additional FDG-PET to contrast-enhanced CT for mediastinal lymph node metastasis in patients with operable non-small cell lung cancer (NSCLC). METHODS NSCLC patients with enlarged mediastinal lymph nodes (short diameter, 7-20 mm), confirmed using contrast-enhanced CT, were examined using FDG-PET to detect metastases prior to surgery. The primary endpoint was the accuracy for concomitantly used CT and FDG-PET showing the additional effects of FDG, compared with CT alone. The secondary endpoints were the clinical impact of FDG-PET on therapeutic decisions and adverse reaction from FDG administration. The images were interpreted by investigators at each institution. Moreover, blinded readings were performed by an image interpretation committee independent of the institutions. The gold standard was the pathological diagnosis determined by surgery or biopsy after PET, and patients in whom a pathological diagnosis was not obtained were excluded from the analysis. RESULTS Among 99 subjects, the results for 81 subjects eligible for analysis showed that the accuracy improved from 69.1% (56/81) for CT alone to 75.3% (61/81) for CT + PET (p = 0.404). These findings contributed to treatment decisions in 63.0% (51/81) of the cases, mainly with regard to the selection of the operative procedure. The results of the image interpretation committee showed that the accuracy improved from 64.2% (52/81) (95% CI 52.8-74.6) for CT to 75.3% (61/81) (95% CI 64.5-84.2) for CT + PET. The accuracy for 106 mediastinal lymph nodes improved significantly from 62.3% (66/106) (95% CI 52.3-71.5) for CT to 79.2% (84/106) (95% CI 70.3-86.5) for CT + PET (p < 0.05). We found that no serious adverse drug reactions appeared in any of the 99 patients who received FDG, except for transient mild outliers in the laboratory data for two patients. CONCLUSIONS The addition of FDG-PET to contrast-enhanced CT imaging for the staging of NSCLC improved the diagnostic accuracy for mediastinal lymph node metastasis. FDG-PET improved the precision of the staging of NSCLC and contributed to the surgical decisions.
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Role of EUS for the evaluation of mediastinal adenopathy. Gastrointest Endosc 2011; 74:239-45. [PMID: 21802583 DOI: 10.1016/j.gie.2011.03.1255] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 12/11/2022]
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Delappe E, Dunphy M. 18F-2-Deoxy-d-Glucose positron emission tomography-computed tomography in lung cancer. Semin Roentgenol 2011; 46:208-23. [PMID: 21726705 DOI: 10.1053/j.ro.2011.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Eithne Delappe
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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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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Abstract
Accurate diagnosis and staging are essential for the optimal management of cancer patients. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) has emerged as a powerful imaging tool for the detection of various cancers. The combined acquisition of PET and CT has synergistic advantages over PET or CT alone and minimizes their individual limitations. It is a valuable tool for staging and restaging of some tumors and has an important role in the detection of recurrence in asymptomatic patients with rising tumor marker levels and patients with negative or equivocal findings on conventional imaging techniques. It also allows for monitoring response to therapy and permitting timely modification of therapeutic regimens. In about 27% of the patients, the course of management is changed. This review provides guidance for oncologists/radiotherapists and clinical and surgical specialists on the use of 18F-FDG PET/CT in oncology.
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Affiliation(s)
- Ahmad Almuhaideb
- Institute of Nuclear Medicine, University College London Hospitals National Health Service Trust, London, United Kingdom
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Abstract
Accurate staging is essential to offer the patient the most effective available treatment and the best estimate of prognosis. In non-small cell lung cancer (NSCLC), surgical resection offers the best chance of cure in the early stages, either alone or in combination with chemo- or radiotherapy at the more advanced stages. However, many patients present with metastatic disease at the time of diagnosis. Both computed tomography (CT) and positron emission tomography (PET) using fluorodeoxyglucose (FDG) play an important role in the diagnosis and staging of lung cancer. CT provides excellent morphologic information but has significant limitations in differentiating between benign and malignant lesions either in an organ or in lymph nodes. FDG-PET is highly accurate in the detection of mediastinal lymph node metastases as well as extratharacic metastases. However, due to the poor anatomic information provided by PET, additional morphologic information is needed to properly locate a lesion. Imaging with PET integrated with computed tomography (PET/CT) offers essential advantages in comparison to PET alone, CT alone, or visual correlation of separate PET and CT. A combined PET/CT system provides PET and CT images perfectly coregistered so that lesions can be exactly localized.
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Affiliation(s)
- Hans C Steinert
- Division of Nuclear Medicine, University Hospital of Zürich, Zürich, Switzerland.
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Kim JH, Chung WS, Kim YH, Kim H, Jeon SC. Accuracy of Nodal Staging with Integrated PET/CT Scanning in Non-small Cell Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ji-Hoon Kim
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, College of Medicine, Hanyang University
| | - Won Sang Chung
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, College of Medicine, Hanyang University
| | - Young-Hak Kim
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, College of Medicine, Hanyang University
| | - Hyuck Kim
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, College of Medicine, Hanyang University
| | - Seok-Chol Jeon
- Department of Diagnostic Radiology, College of Medicine, Hanyang University
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Lin A, Wood C, Hill-Kayser C, Mick R, Kaiser L, Metz J. Clinical application of positron emission tomography in designing radiation fields in non-small cell lung cancer patients. Exp Ther Med 2010; 1:1027-1033. [PMID: 22993636 DOI: 10.3892/etm.2010.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 09/17/2010] [Indexed: 01/30/2023] Open
Abstract
There is significant interest in incorporating positron emission tomography (PET) into radiation therapy planning, although limited data exist that separately consider its diagnostic accuracy with respect to the primary tumor, hilum and mediastinum. This study evaluates the accuracy of PET planning by region of interest. Between January 2003 and July 2005, 351 patients with a pre-operative PET study underwent surgical resection. Of this population, 257 (73%) patients with a diagnosis of non-small cell lung cancer were evaluated. PET study findings regarding the suspected primary tumor site, ipsilateral hilum and mediastinum were correlated with surgical pathology for determination of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The accuracy of the primary site (95%), ipsilateral hilum (80%) and mediastinum (84%) was relatively high. The NPV of the ipsilateral hilum and mediastinum was also high (92 and 86%, respectively). However, the PPV of the ipsilateral hilum (31%) and mediastinum (75%) was lower. PET accuracy evaluating bronchoalveolar primary tumors was lower vs. other histologies (86 vs. 96%, p=0.02), although there was no difference with regard to the hilum or mediastinum. PET scanning may be an important tool in designing radiation treatment fields for lung cancer when combined with other imaging modalities. However, caution must be exercised when evaluating lymph node regions, as the PPV is not as high for the ipsilateral hilum and mediastinum as for the primary tumor. The NPV is high for nodal regions and may help with the exclusion of large treatment volumes in selected cases.
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Affiliation(s)
- Alexander Lin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania
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PARK HK, JEON K, KOH WJ, SUH GY, KIM H, KWON OJ, CHUNG MP, LEE KS, SHIM YM, HAN J, UM SW. Occult nodal metastasis in patients with non-small cell lung cancer at clinical stage IA by PET/CT. Respirology 2010; 15:1179-84. [DOI: 10.1111/j.1440-1843.2010.01793.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Detection of nodal metastatic disease in patients with non-small cell lung cancer: comparison of positron emission tomography (PET), contrast-enhanced computed tomography (CT), and combined PET-CT. Clin Imaging 2010; 34:20-8. [DOI: 10.1016/j.clinimag.2009.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 03/10/2009] [Indexed: 11/22/2022]
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Şanlı M, Isik AF, Zincirkeser S, Elbek O, Mete A, Tuncozgur B, Elbeyli L. Reliability of positron emission tomography–computed tomography in identification of mediastinal lymph node status in patients with non–small cell lung cancer. J Thorac Cardiovasc Surg 2009; 138:1200-5. [DOI: 10.1016/j.jtcvs.2009.03.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 02/24/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
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Harewood GC, Pascual J, Raimondo M, Woodward T, Johnson M, McComb B, Odell J, Jamil LH, Gill KRS, Wallace MB. Economic analysis of combined endoscopic and endobronchial ultrasound in the evaluation of patients with suspected non-small cell lung cancer. Lung Cancer 2009; 67:366-71. [PMID: 19473723 DOI: 10.1016/j.lungcan.2009.04.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/23/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
Abstract
Lung cancer remains the most common cause of cancer-related death in the United States. This study evaluated the costs of alternative diagnostic evaluations for patients with suspected non-small cell lung cancer (NSCLC). Researchers used a cost-minimization model to compare various diagnostic approaches in the evaluation of patients with NSCLC. It was less expensive to use an initial endoscopic ultrasound (EUS) with fine needle aspiration (FNA) to detect a mediastinal lymph node metastasis ($18,603 per patient), compared with combined EUS FNA and endobronchial ultrasound (EBUS) with FNA ($18,753). The results were sensitive to the prevalence of malignant mediastinal lymph nodes; EUS FNA remained least costly, if the probability of nodal metastases was <32.9%, as would occur in a patient without abnormal lymph nodes on computed tomography (CT). While EUS FNA combined with EBUS FNA was the most economical approach, if the rate of nodal metastases was higher, as would be the case in patients with abnormal lymph nodes on CT. Both of these strategies were less costly than bronchoscopy or mediastinoscopy. The pre-test probability of nodal metastases can determine the most cost-effective testing strategy for evaluation of a patient with NSCLC. Pre-procedure CT may be helpful in assessing probability of mediastinal nodal metastases.
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Suga K, Kawakami Y, Hiyama A, Sugi K, Okabe K, Matsumoto T, Ueda K, Tanaka N, Matsunaga N. Differential diagnosis between (18)F-FDG-avid metastatic lymph nodes in non-small cell lung cancer and benign nodes on dual-time point PET/CT scan. Ann Nucl Med 2009; 23:523-31. [PMID: 19444550 DOI: 10.1007/s12149-009-0268-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 04/15/2009] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To clarify the difference of (18)F-FDG uptake kinetics between FDG-avid metastatic lymph nodes (LNs) in patients with non-small-cell lung cancer (NSCLC) and FDG-avid benign LNs associated with various etiologies on dual-time point PET/CT scan, and to determine the optimal parameter for differentiation. METHODS The subjects were 134 FDG-avid metastatic LNs in 67 patients with NSCLC and 62 FDG-avid benign LNs in 61 patients with various lung disorders including NSCLC. PET/CT scan was performed at 2 time points (at 60 min and at 120 min) after intravenous injection of 4.4 MBq/kg (18)F-FDG. The maximum standardized uptake value (SUVmax) on early and delayed scans and the percent change of SUVmax (%DeltaSUVmax) were measured at each FDG-avid LN. The optimal parameter for differentiation was determined by the receiver-operating characteristic analysis. RESULTS Delayed SUVmax was increased compared with early SUVmax in 114 (85.0%) FDG-avid metastatic LNs and 42 (67.7%) FDG-avid benign LNs, with significant higher delayed SUVmax than early values (7.0 +/- 5.0 vs. 5.9 +/- 3.4; P < 0.0001, and 3.0 +/- 1.3 vs. 2.8 +/- 1.0; P < 0.05, respectively). Early and delayed SUVmax and %DeltaSUVmax in metastatic LNs were significantly higher than those in benign LNs (P < 0.0001). The optimal parameter for the differentiation was the combined use of early SUVmax > 3.0 or delayed SUVmax > 4.0, yielding sensitivity of 88.8%, specificity of 80.6%, accuracy of 86.2%, negative predictive value of 76.9%, and positive predictive value of 90.6%. It provided better results than the use of early SUVmax > 3.0 alone (P = 0.019) or the optimal parameter for %DeltaSUVmax (>5%) (P = 0.012). However, 12 (19.3%) benign LNs were indistinguishable from metastatic LNs. CONCLUSIONS Although dual-time point PET/CT scan enhances the difference of FDG uptake between FDG-avid metastatic and benign LNs and improves the differentiation when compared with a single scan, biopsy procedure may be still required for accurate assessment of LN status in patients with NSCLC and possible etiologies showing intensive FDG uptake in benign LNs.
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Affiliation(s)
- Kazuyoshi Suga
- Department of Radiology, St. Hill Hospital, 1462-3 Nishikiwa, Ube, Yamaguchi 755-0151, Japan.
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Nambu A, Kato S, Sato Y, Okuwaki H, Nishikawa K, Saito A, Matsumoto K, Ichikawa T, Araki T. Relationship between maximum standardized uptake value (SUVmax) of lung cancer and lymph node metastasis on FDG-PET. Ann Nucl Med 2009; 23:269-75. [PMID: 19340527 DOI: 10.1007/s12149-009-0237-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 12/07/2008] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the relationship between SUVmax of primary lung cancers on FDG-PET and lymph node metastasis. METHOD AND MATERIALS The subjects were a total of consecutive 66 patients with lung cancer who were examined by FDG-PET and subsequently underwent surgery between October 2004 and January 2008. There were 41 males and 25 females, ranging in age from 45 to 83 years with an average of 68 years. The pathological subtypes of the lung cancers consisted of 49 adenocarcinomas, 11 squamous cell carcinomas, 2 adenosquamous carcinoma, 1 large cell carcinoma, 1 small cell carcinoma, 1 pleomorphic carcinoma and 1 mucoepidermoid carcinoma. We statistically compared (1) the mean SUVmax of lung cancer between the groups with and without lymph node metastasis (2) the frequency of lymph node metastasis between higher and lower SUVmax of lung cancer groups that were classified by using the median SUVmax of lung cancer, and (3) evaluated the relationship between the SUVmax of lung cancer and frequency of lymph node metastases, and (4) correlations between the SUVmax of lung cancer and number of the metastatic lymph nodes and pathological n stages. RESULTS The difference in the average of the SUVmax of lung cancer between the cases with and without lymph node metastases was statistically significant (p = 0.00513). Lymph node metastasis was more frequently seen in the higher SUVmax of lung cancer group (17/33, 52%) than in the lower SUVmax of lung cancer group (7/33, 21%) with a statistically significant difference. There was no lymph node metastasis in lung cancers with an SUVmax of lung cancer less than 2.5, and lung cancers with an SUVmax of lung cancer more than 12 had a 70% frequency of lymph node metastasis. There were moderate correlations between SUVmax of lung cancer, and the number of the metastatic lymph nodes (gamma = 0.404, p = 0.001) and pathological n stage (gamma = 0.411, p = 0.001). CONCLUSIONS The likelihood of lymph node metastasis increases with an increase of the SUV of a primary lung cancer.
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Affiliation(s)
- Atsushi Nambu
- Department of Radiology, University of Yamanashi, 1110 Shimokawato, Chuo, Yamanashi 409-3898, Japan.
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Nambu A, Kato S, Motosugi U, Araki T, Okuwaki H, Nishikawa K, Saito A, Matsumoto K, Ichikawa T. Thin-section CT of the mediastinum in preoperative N-staging of non-small cell lung cancer: comparison with FDG PET. Eur J Radiol 2009; 73:510-7. [PMID: 19246170 DOI: 10.1016/j.ejrad.2009.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 01/12/2009] [Accepted: 01/15/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare diagnostic capability of preoperative N-staging of lung cancer between thin-section CT of the mediastinum and FDG PET, and 5mm slice thickness CT. MATERIALS AND METHODS The subjects were 34 patients with lung carcinoma who were examined by both CT and PET, and subsequently underwent surgery between May 2005 and January 2007. CT was carried out with a 16 detector row helical CT scanner. The raw data were reconstructed into 5 mm slice thickness and 1mm slice thickness (thin-section CT). A total of 251 lymph node stations were retrospectively assessed for the presence of lymph node metastasis with thin-section CT, 5 mm CT and PET. In the interpretations of thin-section CT and 5 mm CT, we employed multi-criteria as follows: nodular calcification and intranodal fat as benign criteria, and short-axis diameter more than 10 mm (size criterion), focal low density other than fat, surrounding fat infiltration and convex margin in hilar lymph nodes, as malignant criteria. On PET, maximum standardized uptake value (SUVmax) of 2.5 or more was used as the criterion of malignancy. Sensitivity and specificity were compared between these examinations using McNemar test. RESULTS Sensitivities and specificities of thin-section CT, 5 mm CT and PET were 25%, 25%, 25%, and 97%, 94%, 98%, respectively. The statistical analysis revealed that the specificity of 5 mm CT was significantly lower than those of thin-section CT (p=0.039) and PET (p=0.006), while no difference was present between thin-section CT and PET. CONCLUSION Thin-section CT of the mediastinum using multiple criteria was comparable to PET in preoperative N-staging of lung cancer.
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Affiliation(s)
- Atsushi Nambu
- Department of Radiology, University of Yamanashi, Shimokawato, Chuo-shi, Yamanashi Prefecture, Japan.
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Mediastinal lymph nodes in patients with non-small cell lung cancer: preliminary experience with diffusion-weighted MR imaging. J Thorac Imaging 2009; 23:157-61. [PMID: 18728541 DOI: 10.1097/rti.0b013e318166d2f5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of our study was to describe our preliminary experience of evaluating mediastinal lymph node metastases with diffusion-weighted magnetic resonance (MR) imaging in patients with non-small cell lung cancer. MATERIALS AND METHODS Forty-two consecutive patients with non-small cell lung cancer underwent preoperative diffusion-weighted MR imaging using a non-breath-hold short inversion time inversion recovery-echo planar imaging sequence with a high b value of 1000 s/mm2. An experienced thoracic radiologist prospectively evaluated each study for mediastinal lymph node metastases on a per-patient basis. On diffusion-weighted MR imaging, mediastinal lymph node metastasis was defined as a focus of low signal intensity at the site of a visible lymph node on corresponding T2-weighted image. The MR results were correlated with histopathologic findings. RESULTS Diffusion-weighted MR imaging demonstrated mediastinal lymph node metastasis in 4 (80%) of 5 patients with pathologically proven metastasis and accurately identified 36 (97%) of 37 patients without mediastinal lymph node metastasis. Thus, 40 (95%) of 42 patients were accurately diagnosed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of diffusion-weighted MR imaging for mediastinal lymph node metastasis were 80%, 97%, 80%, 97%, and 95%, respectively. CONCLUSIONS Our preliminary results show that diffusion-weighted MR imaging has a high negative predictive value for excluding mediastinal lymph node metastases from non-small cell lung cancer and has the potential to be a reliable alternative non-invasive imaging method for the preoperative staging of mediastinal lymph node in patients with non-small cell lung cancer.
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Radiographic Staging of Mediastinal Lymph Nodes in Non–Small Cell Lung Cancer Patients. Thorac Surg Clin 2008; 18:349-61. [DOI: 10.1016/j.thorsurg.2008.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Dual-time-point FDG-PET for evaluation of lymph node metastasis in patients with non-small-cell lung cancer. Ann Nucl Med 2008; 22:245-50. [DOI: 10.1007/s12149-007-0103-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
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Bruzzi JF, Komaki R, Walsh GL, Truong MT, Gladish GW, Munden RF, Erasmus JJ. Imaging of non-small cell lung cancer of the superior sulcus: part 2: initial staging and assessment of resectability and therapeutic response. Radiographics 2008; 28:561-72. [PMID: 18349458 DOI: 10.1148/rg.282075710] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging plays a crucial role in the diagnosis and staging of superior sulcus tumors, assessment of their resectability, determination of the optimal approach to disease management, and evaluation of the response to therapy. Computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET)/CT contribute important and complementary information. Whereas CT is optimal for depicting bone erosion and for staging of intrathoracic disease, MR imaging is superior for evaluating tumor extension to the intervertebral neural foramina, the spinal cord, and the brachial plexus, primarily because of the higher contrast resolution and multiplanar capability available with MR imaging technology. Use of PET/CT enables the detection of unsuspected nodal and distant metastases. However, imaging has only limited usefulness for evaluating the response of a tumor to induction therapy and detecting local recurrence, and surgical biopsy often is necessary to verify the results of therapy.
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Affiliation(s)
- John F Bruzzi
- Division of Diagnostic Imaging, Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, Tex., USA.
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Hemandas AK, Robson NK, Hickish T, Talbot RW. Colorectal tubulovillous adenomas identified on fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scans. Colorectal Dis 2008; 10:386-9. [PMID: 17608754 DOI: 10.1111/j.1463-1318.2007.01261.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this retrospective study was to assess the significance of incidental focal colonic lesions on fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG PET/CT) scans in patients undergoing staging for noncolorectal cancer. METHOD Of the 110 patients in our PET/CT database, 10 were found to have abnormally high uptake of tracer in their large bowel. RESULTS Seven patients who underwent further endoscopic evaluation of these abnormalities had intermediate to high-risk adenomatous polyps. CONCLUSION Benign colonic polyps produce high-intensity focal FDG uptake in large bowel. Endoscopic evaluation is recommended before curative resectional surgery of the presenting cancer where appropriate.
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Affiliation(s)
- A K Hemandas
- Poole General Hospital, Poole, Dorset BH15 2JB, UK.
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The Relevance of PET in Diagnostic Oncology. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gastrointestinal Stromal Tumors. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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