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Sun X, Chang C, Xie C, Zhu J, Ni X, Xie W, Wang Y. Predictive value of SUVmax in visceral pleural invasive lung adenocarcinoma with different diameters. Nucl Med Commun 2023; 44:1020-1028. [PMID: 37661775 PMCID: PMC10566594 DOI: 10.1097/mnm.0000000000001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES This study aimed to investigate predictive visceral pleural invasion (VPI) occurrence value of the maximum standardized uptake value (SUVmax) in patients with lung adenocarcinoma (LA). PATIENTS AND METHODS A total of 388 LA patients were divided into D1ab, D1c, D1, D2, D2a, D2b, D3, and all patient groups based on their tumor diameter (D). Patients were also classified into negative VPI (VPI-n) and positive VPI (VPI-p) groups according to VPI presence. SUVmax of patients was measured with 18F-fluorodeoxyglucose (FDG) by PET/computed tomography (18F-PET/CT). Receiver operating characteristic (ROC) analysis and the area under curve (AUC) of SUVmax were applied to determine optimal cut-off value for predicting VPI occurrence. RESULTS There were significant differences in SUVmax between VPI-n and VPI-p groups ( P < 0.05) at the same tumor diameter. SUVmax cut-off value and sensitivity (Se,%) of VPI occurrence in each group were following: D1ab was 3.79 [AUC = 0.764, P < 0.001], Se86.11%; D1c was 5.47 (AUC = 0.706, P < 0.001), Se 93.75%; D1 was 5.49 (AUC = 0.731, P < 0.001), Se 79.76%; D2 was 7.36 (AUC = 0.726, P < 0.001), Se81.67%. All patient group was 7.26 (AUC = 0.735, P < 0.001), Se74.19%. CONCLUSION In LA patients with the same diameter, SUVmax of the VPI-p group was significantly higher than that of the VPI-n group. The cut-off value of SUVmax for predicting VPI of T1 stage, T1 substages, and T2 stage LA could be determined through ROC curve. SUVmax measurement by PET/CT scan in stratified tumor size is helpful for predicting VPI occurrences of the physician.
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Affiliation(s)
- Xiaoyan Sun
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou City
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Cheng Chang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Chun Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Jiahao Zhu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Xuping Ni
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou City
- The Nuclear Medicine and Molecular Imaging Clinical Translation Institute of Soochow University, Changzhou City, China
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Kawaguchi Y, Matsuura Y, Kondo Y, Ichinose J, Nakao M, Okumura S, Mun M. The predictive power of artificial intelligence on mediastinal lymphnode metastasis. Gen Thorac Cardiovasc Surg 2021; 69:1545-1552. [PMID: 34181182 DOI: 10.1007/s11748-021-01671-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to create the preoperative predictive model on mediastinal lymph-node metastasis based on artificial intelligence in surgically resected lung adenocarcinoma. METHODS We enrolled 301 surgical resections of patients with clinical stage N0-1 lung adenocarcinoma, who received positron emission tomography preoperatively between 2015 and 2019. We randomly assigned the patients into two groups: the training (n = 201) and validation groups (n = 100). The training group was used to obtain basic data for learning by artificial intelligence, whereas the validation group was used to verify the constructed algorithm. We used an automatic machine learning platform, to create artificial intelligence model. For comparison, multivariate analysis was performed in the training group, whereas for calculating and verifying the prediction accuracy rate, significant predicting factors were applied to the validation group. RESULTS Of the 301 patients, 41 patients were diagnosed as mediastinal lymph node metastasis. In multivariate analysis, the maximum standardized uptake value was an individual predictive factor. The accuracy rate of artificial intelligence model was 84%, and the specificity was 98% which were higher than those of the maximum standardized uptake value (61% and 57%). However, in terms of sensitivity, artificial intelligence model remarked low at 12%. CONCLUSIONS An artificial intelligence-based diagnostic algorithm showed remarkable specificity compared with the maximum standardized uptake value. Although this model is not ready to practical use and the result was preliminary because of poor sensitivity, artificial intelligence could be able to complement the shortcomings of existing diagnostic modalities.
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Affiliation(s)
- Yohei Kawaguchi
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Yasuto Kondo
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Chen Z, Jiang S, Li Z, Rao L, Zhang X. Clinical Value of 18F-FDG PET/CT in Prediction of Visceral Pleural Invasion of Subsolid Nodule Stage I Lung Adenocarcinoma. Acad Radiol 2020; 27:1691-1699. [PMID: 32063495 DOI: 10.1016/j.acra.2020.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES This study investigated the utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting visceral pleural invasion (VPI) of subsolid nodule (SSN) stage I lung adenocarcinoma. MATERIALS AND METHODS A retrospective analysis of 18F-FDG PET/CT data from 65 postsurgical cases with surgical pathology-confirmed SSN lung adenocarcinoma identified significant VPI predictors using multivariate logistic regression. RESULTS Nodule and solid component sizes, solid component-to-tumor ratios, pleural indentations, distances between nodules and pleura, and maximum standardized uptake values (SUVmax) differed significantly between VPI-positive (n = 30) and VPI-negative (n = 35) cases on univariate analysis. The distance between the nodule and pleura and SUVmax were significant independent VPI predictors on multivariate analysis. Areas under the curve of the distance between the nodule and pleura and SUVmax on receiver operating characteristic curves were 0.76 and 0.79, respectively; both factors were 0.90. The area under the curve of combined predictors was significantly superior to the distance between the nodule and pleura only but not SUVmax alone. The threshold of the distance between the nodule and pleura, to predict VPI was 4.50 mm, with 96.67% sensitivity, and 57.14% specificity. The threshold of SUVmax to predict VPI was 1.05, with 100% sensitivity and 60% specificity. The sensitivity and specificity of model 2 using the independent predictive factors were 96.67%, and 71.43%, respectively. CONCLUSION Distance between the nodule and pleura and SUVmax are independent predictors of VPI in SSN stage I lung adenocarcinoma. Further, combining these factors improves their predictive ability.
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Affiliation(s)
- Zhifeng Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan 2 Road, Guangzhou 510080, China
| | - Suxiang Jiang
- Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Zhoulei Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan 2 Road, Guangzhou 510080, China
| | - Liangjun Rao
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangsong Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-Sen University, 58#, Zhongshan 2 Road, Guangzhou 510080, China.
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Nakahashi K, Tsunooka N, Hirayama K, Matsuno M, Endo M, Akahira J, Taguri M. Preoperative predictors of lymph node metastasis in clinical T1 adenocarcinoma. J Thorac Dis 2020; 12:2352-2360. [PMID: 32642140 PMCID: PMC7330315 DOI: 10.21037/jtd.2020.03.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The subcategory “solid component of tumor” is a new criterion of tumor categories in the updated eighth edition of the TNM classification. Nevertheless, the predictors of lymph node metastasis among patients with clinical T1 adenocarcinoma, based on the TNM classification 8th edition, remain unclear. This study aimed to identify the preoperative predictors of lymph node metastasis in clinical T1 adenocarcinoma by comparing clinicopathological characteristics between the groups with and without lymph node metastasis. Methods We performed a retrospective observational single-center study at the Sendai Kousei Hospital. From January 2012 to September 2019, we included 515 patients who underwent curative lobectomy or segmentectomy and mediastinal lymph node dissection among those with clinical T1 adenocarcinoma according to the UICC-TNM staging 8th edition. They were divided into two groups: those with lymph node metastasis (positive group) and those without (negative group). The clinicopathological factors were retrospectively analyzed and compared between the groups. Results In univariate analysis, carcinoembryonic antigen (>5.0 ng/mL) (P=0.0007), maximum standardized uptake (>3.5) (P<0.0001), clinical T factor (T1c) (P<0.0001), and consolidation tumor ratio (>0.85) (P<0.0001) were significant predictors of lymph node metastasis. Multivariate analysis revealed that maximum standardized uptake SUVmax (>3.5) (odds ratio =10.4, P<0.0001) was independently associated with lymph node metastasis. In univariate analysis, carcinoembryonic antigen (>5.0) (P=0.048) was the only predictor of lymph node metastasis among patients of cT1b, while no parameters were identified as significant predictors among patients of cT1c. Conclusions SUVmax and CEA are useful preoperative predictors of lymph node metastases in patients with clinical T1 adenocarcinoma, stratified to T1b and T1c, based on the 8th TNM classification.
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Affiliation(s)
- Kenta Nakahashi
- Department of Thoracic Surgery, Sendai Kousei Hospital, Sendai, Japan
| | - Nobuo Tsunooka
- Department of Thoracic Surgery, Sendai Kousei Hospital, Sendai, Japan
| | - Kyo Hirayama
- Department of Thoracic Surgery, Sendai Kousei Hospital, Sendai, Japan
| | - Masahiro Matsuno
- Department of Thoracic Surgery, Sendai Kousei Hospital, Sendai, Japan
| | - Mareyuki Endo
- Department of Pathology, Sendai Kousei Hospital, Sendai, Japan
| | - Junichi Akahira
- Department of Pathology, Sendai Kousei Hospital, Sendai, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University, School of Data Science, Yokohama, Japan
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Varela G, Jiménez MF. Dissection of the left paratracheal area is frequently missed during left side non-small cell lung cancer surgery. J Thorac Dis 2019; 11:S1226-S1228. [PMID: 31245092 DOI: 10.21037/jtd.2019.03.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gonzalo Varela
- Salamanca Institute of Biomedical Research (IBSAL), Salamanca, Spain
| | - Marcelo F Jiménez
- Thoracic Surgery Service, Salamanca University Hospital, Salamanca, Spain
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Miao H, Shaolei L, Nan L, Yumei L, Shanyuan Z, Fangliang L, Yue Y. Occult mediastinal lymph node metastasis in FDG-PET/CT node-negative lung adenocarcinoma patients: Risk factors and histopathological study. Thorac Cancer 2019; 10:1453-1460. [PMID: 31127706 PMCID: PMC6558456 DOI: 10.1111/1759-7714.13093] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/27/2019] [Accepted: 05/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to investigate predictive factors of occult mediastinal lymph node metastasis (MLNM) in preoperative 18F‐fluorodeoxy‐glucose PET/CT node‐negative lung adenocarcinoma patients. Methods We reviewed the clinical data and PET/CT parameters of 360 consecutive pulmonary adenocarcinoma patients who were scheduled to undergo anatomical pulmonary resection and systemic mediastinal node dissection. The nodal metastasis was pathologically defined and all resected tumors were classified according to the 2011 IASLC/ATS/ERS classification. Univariate and multivariate analysis were conducted to evaluate the associations between clinicopathological variables and MLNM. Results Of all 360 patients, 54 (15.0%) had pathological N2 diseases. The serum CEA level, nodule type, hilar nodal SUVmax, tumor SUVmax, size, location and histologic subtype were associated with MLNM significantly on univariate analysis. On multivariate analysis, CEA ≥ 5.0 ng/mL (P < 0.001), solid nodule (P = 0.012), tumor SUVmax ≥ 3.7 (P < 0.027), hilar nodal SUVmax ≥ 2.0 (P < 0.001) and centrally located tumor (P = 0.035) were independent risk factors for MLNM. The area under the ROC curve (AUC) for tumor SUVmax and hilar nodal SUVmax in predicting MLNM was 0.764 and 0.730, respectively, and the combined use of five factors yielded a higher AUC of 0.885. Conclusion Increased primary tumor and hilar lymph node SUVmax, solid nodule, centrally located tumor and increased CEA level predicted the increased risk of mediastinal lymph node metastasis. Combined use of these factors improved the diagnostic capacity for predicting N2 disease preoperatively. Invasive mediastinal staging should be considered for patients with these risk factors, even those with a negative mediastinum on PET/CT.
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Affiliation(s)
- Huang Miao
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Li Shaolei
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Li Nan
- Department of Nuclear Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lai Yumei
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhang Shanyuan
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lu Fangliang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yang Yue
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
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Duranti L, Leo F, Pastorino U. PET Scan Contribution in Chest Tumor Management: A Systematic Review for Thoracic Surgeons. TUMORI JOURNAL 2018; 98:175-84. [DOI: 10.1177/030089161209800201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Aims and background In the 90s, the introduction of positron emission tomography (PET) represented a milestone in the staging of thoracic tumors. In the last 10 years, PET scan has been widely adopted in thoracic oncology, showing high accuracy in diagnosis and staging and with promising issues in defining prognosis. The aim of this systematic review was to focus on the results and pitfalls of PET scan use in the modern management of chest tumors. Methods and study design. The literature search was performed on May 2010 in PubMed, Embase, and Cochrane according to PRISMA protocol. The search was restricted to publications in English, using in the same string the word “PET” with 9 different chest tumors; results were then filtered by eliminating technical articles, focusing only on papers in which surgery was considered as a potential diagnostic or therapeutic tool. From 6600 papers initially selected, 99 manuscripts were fully analyzed. Results Glucose uptake is a metabolic marker useful in the diagnosis and staging of chest tumors. In lung cancer screening, standard uptake value is helpful in defining the risk of malignancy of isolated pulmonary nodules. The addition of PET scan to conventional staging increases detection of nodal and distant metastases in lung cancer, esophageal cancer and malignant mesothelioma. In thymoma, a close relationship between standard uptake value, histology, and Masaoka stage has been advocated. This link between glucose uptake and prognosis suggests that PET translates biological tumor behavior into clinically detectable findings. Conclusions PET scan has a crucial role in thoracic oncology due to its impact on diagnosis, staging and prognosis. PET scan expresses the biological behavior of tumors, opening interesting perspectives in chest tumor management and improving detection and stage grouping in lung cancer. It anticipates the diagnosis in long-incubating diseases such as mesothelioma and increases biological knowledge of rare diseases, such as thymoma and other mediastinal tumors.
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Leo
- Thoracic Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Prognostic value of pre-operative glucose-corrected maximum standardized uptake value in patients with non-small cell lung cancer after complete surgical resection and 5-year follow-up. Ann Nucl Med 2016; 30:362-8. [DOI: 10.1007/s12149-016-1070-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/22/2016] [Indexed: 11/25/2022]
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9
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Tanaka T, Shinya T, Sato S, Mitsuhashi T, Ichimura K, Soh J, Toyooka S, Kaji M, Miyoshi S, Kanazawa S. Predicting pleural invasion using HRCT and 18F-FDG PET/CT in lung adenocarcinoma with pleural contact. Ann Nucl Med 2015; 29:757-65. [DOI: 10.1007/s12149-015-0999-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/29/2015] [Indexed: 11/30/2022]
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10
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de Groot PM, Carter BW, Betancourt Cuellar SL, Erasmus JJ. Staging of lung cancer. Clin Chest Med 2015; 36:179-96, vii-viii. [PMID: 26024599 DOI: 10.1016/j.ccm.2015.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primary lung cancer is the leading cause of cancer mortality in the world. Thorough clinical staging of patients with lung cancer is important, because therapeutic options and management are to a considerable degree dependent on stage at presentation. Radiologic imaging is an essential component of clinical staging, including chest radiography in some cases, computed tomography, MRI, and PET. Multiplanar imaging modalities allow assessment of features that are important for surgical, oncologic, and radiation therapy planning, including size of the primary tumor, location and relationship to normal anatomic structures in the thorax, and existence of nodal and/or metastatic disease.
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Affiliation(s)
- Patricia M de Groot
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA.
| | - Brett W Carter
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Sonia L Betancourt Cuellar
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Jeremy J Erasmus
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
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Duan XY, Wang W, Li M, Li Y, Guo YM. Predictive significance of standardized uptake value parameters of FDG-PET in patients with non-small cell lung carcinoma. ACTA ACUST UNITED AC 2015; 48:267-72. [PMID: 25651460 PMCID: PMC4381948 DOI: 10.1590/1414-431x20144137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/22/2014] [Indexed: 12/30/2022]
Abstract
18F-fluoro-2-deoxyglucose (FDG) positron emission tomography
(PET)/computed tomography (CT) is widely used to diagnose and stage non-small cell
lung cancer (NSCLC). The aim of this retrospective study was to evaluate the
predictive ability of different FDG standardized uptake values (SUVs) in 74 patients
with newly diagnosed NSCLC. 18F-FDG PET/CT scans were performed and
different SUV parameters (SUVmax, SUVavg, SUVT/L,
and SUVT/A) obtained, and their relationship with clinical characteristics
were investigated. Meanwhile, correlation and multiple stepwise regression analyses
were performed to determine the primary predictor of SUVs for NSCLC. Age, gender, and
tumor size significantly affected SUV parameters. The mean SUVs of squamous cell
carcinoma were higher than those of adenocarcinoma. Poorly differentiated tumors
exhibited higher SUVs than well-differentiated ones. Further analyses based on the
pathologic type revealed that the SUVmax, SUVavg, and
SUVT/L of poorly differentiated adenocarcinoma tumors were higher than
those of moderately or well-differentiated tumors. Among these four SUV parameters,
SUVT/L was the primary predictor for tumor differentiation. However, in
adenocarcinoma, SUVmax was the determining factor for tumor
differentiation. Our results showed that these four SUV parameters had predictive
significance related to NSCLC tumor differentiation; SUVT/L appeared to be
most useful overall, but SUVmax was the best index for adenocarcinoma
tumor differentiation.
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Affiliation(s)
- X-Y Duan
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
| | - W Wang
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
| | - M Li
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
| | - Y Li
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
| | - Y-M Guo
- PET-CT Center, The First Affiliated Hospital of Xi'an, Jiaotong University, Xi'an, Shaanxi, China
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The method and efficacy of support vector machine classifiers based on texture features and multi-resolution histogram from (18)F-FDG PET-CT images for the evaluation of mediastinal lymph nodes in patients with lung cancer. Eur J Radiol 2014; 84:312-7. [PMID: 25487819 DOI: 10.1016/j.ejrad.2014.11.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/27/2014] [Accepted: 11/01/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In clinical practice, image analysis is dependent on simply visual perception and the diagnostic efficacy of this analysis pattern is limited for mediastinal lymph nodes in patients with lung cancer. In order to improve diagnostic efficacy, we developed a new computer-based algorithm and tested its diagnostic efficacy. METHODS 132 consecutive patients with lung cancer underwent (18)F-FDG PET/CT examination before treatment. After all data were imported into the database of an on-line medical image analysis platform, the diagnostic efficacy of visual analysis was first evaluated without knowing pathological results, and the maximum short diameter and maximum standardized uptake value (SUVmax) were measured. Then lymph nodes were segmented manually. Three classifiers based on support vector machine (SVM) were constructed from CT, PET, and combined PET-CT images, respectively. The diagnostic efficacy of SVM classifiers was obtained and evaluated. RESULTS According to ROC curves, the areas under curves for maximum short diameter and SUVmax were 0.684 and 0.652, respectively. The areas under the ROC curve for SVM1, SVM2, and SVM3 were 0.689, 0.579, and 0.685, respectively. CONCLUSION The algorithm based on SVM was potential in the diagnosis of mediastinal lymph nodes.
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Schmidt‐Hansen M, Baldwin DR, Hasler E, Zamora J, Abraira V, Roqué i Figuls M. PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Database Syst Rev 2014; 2014:CD009519. [PMID: 25393718 PMCID: PMC6472607 DOI: 10.1002/14651858.cd009519.pub2] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND A major determinant of treatment offered to patients with non-small cell lung cancer (NSCLC) is their intrathoracic (mediastinal) nodal status. If the disease has not spread to the ipsilateral mediastinal nodes, subcarinal (N2) nodes, or both, and the patient is otherwise considered fit for surgery, resection is often the treatment of choice. Planning the optimal treatment is therefore critically dependent on accurate staging of the disease. PET-CT (positron emission tomography-computed tomography) is a non-invasive staging method of the mediastinum, which is increasingly available and used by lung cancer multidisciplinary teams. Although the non-invasive nature of PET-CT constitutes one of its major advantages, PET-CT may be suboptimal in detecting malignancy in normal-sized lymph nodes and in ruling out malignancy in patients with coexisting inflammatory or infectious diseases. OBJECTIVES To determine the diagnostic accuracy of integrated PET-CT for mediastinal staging of patients with suspected or confirmed NSCLC that is potentially suitable for treatment with curative intent. SEARCH METHODS We searched the following databases up to 30 April 2013: The Cochrane Library, MEDLINE via OvidSP (from 1946), Embase via OvidSP (from 1974), PreMEDLINE via OvidSP, OpenGrey, ProQuest Dissertations & Theses, and the trials register www.clinicaltrials.gov. There were no language or publication status restrictions on the search. We also contacted researchers in the field, checked reference lists, and conducted citation searches (with an end-date of 9 July 2013) of relevant studies. SELECTION CRITERIA Prospective or retrospective cross-sectional studies that assessed the diagnostic accuracy of integrated PET-CT for diagnosing N2 disease in patients with suspected resectable NSCLC. The studies must have used pathology as the reference standard and reported participants as the unit of analysis. DATA COLLECTION AND ANALYSIS Two authors independently extracted data pertaining to the study characteristics and the number of true and false positives and true and false negatives for the index test, and they independently assessed the quality of the included studies using QUADAS-2. We calculated sensitivity and specificity with 95% confidence intervals (CI) for each study and performed two main analyses based on the criteria for test positivity employed: Activity > background or SUVmax ≥ 2.5 (SUVmax = maximum standardised uptake value), where we fitted a summary receiver operating characteristic (ROC) curve using a hierarchical summary ROC (HSROC) model for each subset of studies. We identified the average operating point on the SROC curve and computed the average sensitivities and specificities. We checked for heterogeneity and examined the robustness of the meta-analyses through sensitivity analyses. MAIN RESULTS We included 45 studies, and based on the criteria for PET-CT positivity, we categorised the included studies into three groups: Activity > background (18 studies, N = 2823, prevalence of N2 and N3 nodes = 679/2328), SUVmax ≥ 2.5 (12 studies, N = 1656, prevalence of N2 and N3 nodes = 465/1656), and Other/mixed (15 studies, N = 1616, prevalence of N2 to N3 nodes = 400/1616). None of the studies reported (any) adverse events. Under-reporting generally hampered the quality assessment of the studies, and in 30/45 studies, the applicability of the study populations was of high or unclear concern.The summary sensitivity and specificity estimates for the 'Activity > background PET-CT positivity criterion were 77.4% (95% CI 65.3 to 86.1) and 90.1% (95% CI 85.3 to 93.5), respectively, but the accuracy estimates of these studies in ROC space showed a wide prediction region. This indicated high between-study heterogeneity and a relatively large 95% confidence region around the summary value of sensitivity and specificity, denoting a lack of precision. Sensitivity analyses suggested that the overall estimate of sensitivity was especially susceptible to selection bias; reference standard bias; clear definition of test positivity; and to a lesser extent, index test bias and commercial funding bias, with lower combined estimates of sensitivity observed for all the low 'Risk of bias' studies compared with the full analysis.The summary sensitivity and specificity estimates for the SUVmax ≥ 2.5 PET-CT positivity criterion were 81.3% (95% CI 70.2 to 88.9) and 79.4% (95% CI 70 to 86.5), respectively.In this group, the accuracy estimates of these studies in ROC space also showed a very wide prediction region. This indicated very high between-study heterogeneity, and there was a relatively large 95% confidence region around the summary value of sensitivity and specificity, denoting a clear lack of precision. Sensitivity analyses suggested that both overall accuracy estimates were marginally sensitive to flow and timing bias and commercial funding bias, which both lead to slightly lower estimates of sensitivity and specificity.Heterogeneity analyses showed that the accuracy estimates were significantly influenced by country of study origin, percentage of participants with adenocarcinoma, (¹⁸F)-2-fluoro-deoxy-D-glucose (FDG) dose, type of PET-CT scanner, and study size, but not by study design, consecutive recruitment, attenuation correction, year of publication, or tuberculosis incidence rate per 100,000 population. AUTHORS' CONCLUSIONS This review has shown that accuracy of PET-CT is insufficient to allow management based on PET-CT alone. The findings therefore support National Institute for Health and Care (formally 'clinical') Excellence (NICE) guidance on this topic, where PET-CT is used to guide clinicians in the next step: either a biopsy or where negative and nodes are small, directly to surgery. The apparent difference between the two main makes of PET-CT scanner is important and may influence the treatment decision in some circumstances. The differences in PET-CT accuracy estimates between scanner makes, NSCLC subtypes, FDG dose, and country of study origin, along with the general variability of results, suggest that all large centres should actively monitor their accuracy. This is so that they can make reliable decisions based on their own results and identify the populations in which PET-CT is of most use or potentially little value.
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Affiliation(s)
- Mia Schmidt‐Hansen
- Royal College of Obstetricians and GynaecologistsNational Guideline Alliance27 Sussex PlRegent's ParkLondonUKNW1 4RG
| | - David R Baldwin
- Nottingham University Hospitals, NHS Trust, Nottingham City HospitalDepartment of Respiratory MedicineHucknall RoadNottinghamUKNG5 1PB
| | - Elise Hasler
- Royal College of Obstetricians and GynaecologistsNational Guideline Alliance27 Sussex PlRegent's ParkLondonUKNW1 4RG
| | - Javier Zamora
- Ramon y Cajal Institute for Health Research (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP), Madrid (Spain) and Queen Mary University of LondonClinical Biostatistics UnitCtra. Colmenar km 9,100MadridMadridSpain28034
| | - Víctor Abraira
- Ramon y Cajal Institute for Health Research (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP) and Cochrane Collaborating CentreClinical Biostatistics UnitCrta Colmenar Km 9.1MadridMadridSpain28034
| | - Marta Roqué i Figuls
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 171Edifici Casa de ConvalescènciaBarcelonaCatalunyaSpain08041
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14
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Fernandez FG, Kozower BD, Crabtree TD, Force SD, Lau C, Pickens A, Krupnick AS, Veeramachaneni N, Patterson GA, Jones DR, Meyers BF. Utility of mediastinoscopy in clinical stage I lung cancers at risk for occult mediastinal nodal metastases. J Thorac Cardiovasc Surg 2014; 149:35-41, 42.e1. [PMID: 25439769 DOI: 10.1016/j.jtcvs.2014.08.075] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/15/2014] [Accepted: 08/20/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The prevalence of mediastinal lymph node metastases is unknown for patients with clinical N0 lung cancer who are thought to be at high risk for occult nodal metastases. Further, the utility of mediastinoscopy in these patients is unknown. We performed a prospective trial to evaluate the utility of routine cervical mediastinoscopy for patients who may be at high risk of occult nodal metastases. METHODS From January 1, 2008, July 31, 2013, 90 patients with lung cancer with clinical stage T2N0 or T1N0 with standardized uptake value greater than 10 by positron emission tomography/computed tomography underwent routine cervical mediastinoscopy before lung resection. Biopsy of a minimum of 3 nodal stations at mediastinoscopy and a minimum of 4 nodal stations with lung resection was advised. The prevalence of nodal metastases at mediastinoscopy and lung resection was recorded. RESULTS Some 64% of patients with lung cancer were male with a mean age of 67.3 years. A total of 81 patients had clinical T2N0 and 9 patients had T1N0 with standardized uptake value greater than 10. Mean tumor size was 4.3 ± 1.7 cm, and mean standardized uptake value was 13.5 ± 6.8. One patient (1.1%) had occult metastases detected at mediastinoscopy. A total of 86 patients underwent surgical resection; 4 patients (4.6%) were upstaged to pN2, and 18 patients (21%) were upstaged to pN1. Of 90 patients with clinically staged N0 lung cancer by positron emission tomography/computed tomography, 5.6% (5) were upstaged to pN2 and 20% (18) were upstaged to pN1 (total nodal upstaging = 25.6%). CONCLUSIONS Mediastinoscopy seems to have limited utility in these patients with T1 and T2 clinically staged N0 by positron emission tomography/computed tomography. Selective use of mediastinoscopy is recommended, along with thorough mediastinal lymph node evaluation in all patients at the time of lung cancer resection.
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Affiliation(s)
- Felix G Fernandez
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga; Atlanta Veterans Affairs Medical Center, Decatur, Ga.
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Traves D Crabtree
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | - Seth D Force
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Christine Lau
- Division of Cardiothoracic Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Allan Pickens
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Alexander S Krupnick
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | | | - G Alexander Patterson
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | - David R Jones
- Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bryan F Meyers
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
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15
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Lee H, Hwang KH, Kim SG, Koh G, Kim JH. Can Initial (18)F-FDG PET-CT Imaging Give Information on Metastasis in Patients with Primary Renal Cell Carcinoma? Nucl Med Mol Imaging 2013; 48:144-52. [PMID: 24900155 PMCID: PMC4028476 DOI: 10.1007/s13139-013-0245-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 10/10/2013] [Accepted: 10/15/2013] [Indexed: 12/22/2022] Open
Abstract
Purpose The aim of this study was to investigate the relationship between the maximum standardized uptake values (SUVmax) of primary renal cancers with and without metastatic lesions, if any. We also studied the relationship between the size of primary renal cancers and their SUVmax, and tried to find a clinical value of 18F-FDG PET-CT for the initial evaluation of renal cell carcinoma (RCC). Methods The cases of 23 patients, 16 men and 7 women, who underwent PET-CT examination before operation were retrospectively reviewed. We measured the SUVmax of the primary renal cancers and those of any existing metastatic lesions, and the size of the primary renal cancers. We compared the SUVmax of primary RCCs with metastases and those without metastases, SUVmax of primary RCC and those of metastases, and studied the correlation between the size and SUVmax of primary RCCs. Results The SUVmax of primary RCC of the 16 patients without metastasis ranged from 1.1 to 5.6 with a median value of 2.6. Those of the patients with metastasis ranged from 2.9 to 7.6 with a median of 5.0. The size of the all 23 primary renal cancers ranged from 1.7 cm to 13.5 cm, with a median of 4.5 cm, and their SUVmax ranged from 1.1 to 7.6, with a median of 2.9. There was a statistically significant difference between the SUVmax of the primary RCC with metastasis (5.3 ± 1.7) and those without metastasis (2.9 ± 1.0). There was a moderate positive correlation between the sizes and SUVmax of all 23 primary RCCs. However, there was no statistically significant correlation between the sizes and SUVmax of primary RCCs with metastatic lesions and the same for RCCs without metastasis. The cutoff value of SUVmax for predicting extra-renal lesion was 4.4 and that for size was 5.8 cm according to the receiver operating characteristic curves. Conclusions Those who have primary RCC with high SUVmax are suggested to have a likelihood of metastasis. Also, there was a moderate trend of increasing value of SUVmax of primary RCC as their size increases. Physicians should beware of missing extra-renal lesions elsewhere.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Kyung Hoon Hwang
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Seog Gyun Kim
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Geon Koh
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Ji Hyun Kim
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
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Li X, Zhang H, Xing L, Xu X, Xie P, Ma H, Zhang L, Chen M, Sun X, Xu W, Chen L, Yu J. Predictive value of primary fluorine-18 fluorodeoxyglucose standard uptake value for a better choice of systematic nodal dissection or sampling in clinical stage ia non--small-cell lung cancer. Clin Lung Cancer 2013; 14:568-73. [PMID: 23835164 DOI: 10.1016/j.cllc.2013.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/23/2012] [Accepted: 02/12/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine whether the standard uptake value (SUV) of the primary lesion can predict mediastinal lymph node metastasis in clinical stage IA non--small-cell lung cancer (NSCLC). MATERIALS AND METHODS At 5 centers, patients with clinical stage IA NSCLC from February 2004 to August 2010 were analyzed retrospectively. Data from Shandong Cancer Hospital and from the Cancer Hospital Affiliated to Harbin Medical University were used as a testing set, and data from the other 3 institutions were used as the validation set. Final diagnosis was established based on the histopathologic examination. RESULTS Data from 144 patients were collected for the study. The primary results in our study showed that maximal SUV (SUVmax) of primary tumor might be a predictor of lymph node metastasis (χ(2) = 10.424; P = .001) and the best cutoff value was 7.25 (P = .029). For the testing set, lymph node metastasis rates in low-grade group (SUVmax < 7.25) and high-grade group (SUVmax > 7.25) were 5% (2/43) and 36% (9/25) (P = .001) For the total data set, lymph node metastasis rate was 7% (6/93) in low-grade group (SUVmax < 7.25) and 26% (13/51) in high-grade group (SUVmax > 7.25) (χ(2)= 10.424; P = .001). A multivariate analysis revealed that no factors were applied to predict the probability of metastasis. But the analysis showed a weak correlation between SUVmax and nodal status (r = 0.21; P = .011) with bivariate correlation. CONCLUSION Analysis of our data suggested that fluorine-18 fluorodeoxyglucose SUVmax of the primary tumor might be a predictor of lymph node involvement in stage IA NSCLC. The rate of mediastinal lymph node metastasis of patients with a lower fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography SUVmax might be relatively low, which provides more evidence for clinical procedures of clinical stage IA NSCLC.
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Affiliation(s)
- Xiaolin Li
- Department of Radiation Oncology and Key Laboratory of Radiation Oncology of Shandong Province, Department of Radiation Oncology of Shandong Cancer Hospital and Institute, Jinan, Shandong, China
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Clinicopathological determinants of positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value in head and neck carcinoma. The Journal of Laryngology & Otology 2013; 127:676-80. [PMID: 23790108 DOI: 10.1017/s002221511300128x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although positron emission tomography computed tomography has proven diagnostic and staging value in head and neck carcinoma, it does not have optimal sensitivity or specificity. The positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value has been shown to be associated with carcinoma stage. This study evaluated the impact of major clinicopathological factors on the standardised uptake value at the primary site and at neck lymph node metastases. SUBJECTS AND METHODS Two hundred and forty-three oral cavity and laryngopharyngeal carcinoma patients who underwent positron emission tomography computed tomography were included. Correlation between the positron emission tomography computed tomography standardised uptake value and various clinicopathological factors was analysed. RESULTS A positive correlation was found between the standardised uptake value and the size and depth of tumour infiltration, and lymph node positivity. Higher standardised uptake values were seen for more advanced tumour stages. The presence of perineural invasion, lymphatic invasion and extracapsular spread were all associated with increased standardised uptake values. CONCLUSION Most of the clinicopathological features of head and neck carcinoma which are well known to be poor prognostic factors have a significant impact on positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value.
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18
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Li M, Wu N, Zheng R, Liang Y, Liu Y, Zhang W, Li N, Zhao P. Primary tumor PET/CT [¹⁸F]FDG uptake is an independent predictive factor for regional lymph node metastasis in patients with non-small cell lung cancer. Cancer Imaging 2013; 12:566-72. [PMID: 23399986 PMCID: PMC3569669 DOI: 10.1102/1470-7330.2012.0040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: To investigate the correlation between [18F]fluorodeoxyglucose (FDG) uptake in a primary tumor and pathologic N stages, and to further analyze the possible risk factors contributing to the regional lymph node metastasis. Patients and methods: Eighty patients with non-small cell lung cancer (NSCLC) who underwent positron emission tomography/computed tomography were enrolled in the study. The FDG uptake in the primary tumor was compared for the different N staging groups and further correlation was performed. The degree of FDG uptake in the primary tumor and other possible variables related to the incidence of lymph node metastasis were examined by univariate and logistic multivariate analysis. FDG uptake was quantitated using the maximum standardized uptake value (SUVmax). Results: Statistically significant differences were found in the SUVmax of the primary tumors among different N staging groups (F = 4.124, P = 0.023), and the correlation between them was also statistically significant (r = 0.438, P = 0.000). Univariate analysis showed that blood tumor markers, primary tumor size, histologic grade, and SUVmax of the primary tumor were significantly associated with lymph node involvement. Logistic multivariate analysis showed that blood tumor makers and SUVmax of primary tumor might be considered as significant predictive factors for lymph node metastasis in patients with NSCLC. Conclusion: Our results show that there is a significant relationship between the SUVmax of the primary tumor and the pathologic N stage of NSCLC. FDG uptake by the primary tumor may be an independent predictor of regional lymph node metastasis in patients with NSCLC.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, Peoples Republic of China
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Billè A, Okiror L, Skanjeti A, Errico L, Arena V, Penna D, Ardissone F, Pelosi E. The prognostic significance of maximum standardized uptake value of primary tumor in surgically treated non-small-cell lung cancer patients: analysis of 413 cases. Clin Lung Cancer 2012; 14:149-56. [PMID: 22682667 DOI: 10.1016/j.cllc.2012.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/21/2012] [Accepted: 04/23/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Integrated PET/CT is widely used in the preoperative staging and prognostic assessment of non-small-cell lung cancer (NSCLC) patients. The aims of this study were to evaluate the prognostic significance of SUVmax of primary tumor in patients undergoing surgical treatment and, in order to minimize technical interferences, to verify whether SUVmax standardized by SUVmax liver or SUVmax blood pool provided additional prognostic information. PATIENTS AND METHODS A retrospective study of 413 consecutive NSCLC patients undergoing potentially curative surgical resection after PET/CT obtained in the same PET center over a 6-year period. The SUVmax was calculated drawing region of interest around the primitive tumor, the liver, and the aortic arch in PET images. The same procedure was performed for 2 adjacent planes and the average of these measures was considered. RESULTS Nine patients were considered 30-day postoperative deaths and were excluded from the analysis. At the end of the study, 312 (77.2%) of the 404 patients were alive (median follow-up, 26 months) and 92 had died (median survival, 17 months). At multivariate analysis tumor-node-metastasis stage, primary tumor grading and primary tumor SUVmax (T-SUVmax) were found to be independent prognostic factors, while T-SUVmax/SUVmax blood pool ratio, and T-SUVmax/SUVmax liver ratio were not. CONCLUSIONS T-SUVmax is an independent predictor for survival in NSCLC patients undergoing surgery and might be helpful in guiding adjuvant treatment strategies. SUVmax of primary tumor normalized by SUV blood pool or SUV liver does not provide additional prognostic information.
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Affiliation(s)
- Andrea Billè
- Department of Thoracic Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust and Division of Cancer Studies, King's College London, London, UK.
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Wang J, Welch K, Wang L, Kong FMS. Negative predictive value of positron emission tomography and computed tomography for stage T1-2N0 non-small-cell lung cancer: a meta-analysis. Clin Lung Cancer 2011; 13:81-9. [PMID: 22056226 DOI: 10.1016/j.cllc.2011.08.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 08/03/2011] [Accepted: 08/09/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nodal staging of non-small-cell lung cancer (NSCLC) is crucial in evaluation of prognosis and determination of therapeutic strategy. This study aimed to determine the negative predictive value (NPV) of combined positron emission tomography and computed tomography (PET-CT) in patients with stage I (T1-2N0) NSCLC and to investigate the possible risk factors for occult nodal disease. METHODS Studies investigating the performance of PET in conjunction with CT in the nodal staging of stage I NSCLC were identified in the MEDLINE database. The initiative of standards for reporting of diagnostic accuracy (STARD) was used to ensure study quality. Pathologic assessments through mediastinoscopy or thoracotomy were required as the reference standard for evaluation of PET-CT accuracy. Stata-based meta-analysis was applied to calculate the individual and pooled NPVs. RESULTS Ten studies with a total of 1122 patients with stage I (T1-2N0) NSCLC were eligible for analysis. The NPVs of combined PET and CT for mediastinal metastases were 0.94 in T1 disease and 0.89 in T2 disease. Including both T1 disease and T2 disease, the NPVs were 0.93 for mediastinal metastases and 0.87 for overall nodal metastases. Adenocarcinoma histology type (risk ratio [RR], 2.72) and high fluorine-18 (18F) fluorodeoxyglucose (FDG) uptake in the primary lesion were associated with greater risk of occult nodal metastases. CONCLUSIONS Although overall occult nodal metastases in clinical stage T1-2N0 NSCLC is not infrequent, combined PET and CT provide a favorable NPV for mediastinal metastases in T1N0 NSCLC, suggesting a low yield from routine invasive staging procedures for this subgroup of patients.
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Affiliation(s)
- Jingbo Wang
- Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, PR China
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Ishibashi T, Kaji M, Kato T, Ishikawa K, Kadoya M, Tamaki N. 18F-FDG uptake in primary lung cancer as a predictor of intratumoral vessel invasion. Ann Nucl Med 2011; 25:547-53. [PMID: 21643806 DOI: 10.1007/s12149-011-0502-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/02/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated how fluorodeoxyglucose (FDG) uptake on PET in the primary tumor may predict intratumoral vessel invasion (IVI) in it. METHODS A total of 512 patients with lung neoplasms determined by a surgical procedure and histopathological diagnosis had undergone FDG-PET scanning. RESULTS Among the 440 cases confirmed to be malignant, the maximum standardized uptake value (SUV(max)) was significantly lower in IVI-negative cases than IVI-positive cases (P < 0.001). In the substudy on adenocarcinoma (AC), SUV(max) was significantly lower in IVI-negative cases too (P < 0.001), but SUV(max) in squamous cell carcinoma was without significant difference. In addition, IVI was associated with a significantly higher probability of lymph node metastasis (P < 0.001). CONCLUSIONS This study indicates that a malignant lung tumor with higher SUV(max) has a significantly higher probability of IVI and lymph node metastasis, particularly if the malignancy is an AC.
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Affiliation(s)
- Tetsuya Ishibashi
- Department of Radiology, Sapporo Minamisanjo Hospital, 4-2 Minami3 Nishi6, Sapporo, Hokkaido, 060-0063, Japan.
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