New PET/CT criterion for predicting lymph node metastasis in resectable advanced (stage IB‐III) lung cancer: The standard uptake values ratio of ipsilateral/contralateral hilar nodes. Issue 5 (20th January 2022)

• Record Type: Journal Article
• Authors: Kameyama, Komei; Imai, Kazuhiro; Ishiyama, Koichi; Takashima, Shinogu; Kuriyama, Shoji; Atari, Maiko; Ishii, Yoshiaki; Kobayashi, Akihito; Takahashi, Shugo; Kobayashi, Mirai; Harata, Yuzu; Sato, Yusuke; Motoyama, Satoru; Hashimoto, Manabu; Nomura, Kyoko; Minamiya, Yoshihiro
• Is Part Of: Thoracic cancer. Volume 13:Issue 5(2022)
• Page Start: 708
• Page End: 715
• Publication Date: 2022-01-20
• Subjects: computed tomography -- lung cancer -- lymph node -- metastasis -- positron‐emission tomography; Chest -- Cancer -- Periodicals; Chest -- Cancer -- Treatment -- Periodicals; Chest -- Surgery -- Periodicals; 616.99494005
• DOI: 10.1111/1759-7714.14302
• Languages: English
• ISSNs: 1759-7706

Abstract

Abstract: Background: The aim of the present study was to use surgical and histological results to develop a simple noninvasive technique to improve nodal staging using preoperative PET/CT in patients with resectable lung cancer. Methods: Preoperative PET/CT findings (pStage IB–III 182 patients) and pathological diagnoses after surgical resection were evaluated. Using PET/CT images to determine the standardized uptake value (SUV) ratio, the SUVmax of a contralateral hilar lymph node (on the side of the chest opposite to the primary tumor) was measured simultaneously. The I/C‐SUV ratio was calculated as ipsilateral hilar node SUV/contralateral hilar node SUV. Receiver operating characteristic (ROC) curves were then used to analyze those data. Results: Based on ROC analyses, the cutoff I/C‐SUV ratio for diagnosis of lymph node metastasis was 1.34. With a tumor ipsilateral lymph node SUVmax ≥2.5, an IC‐SUV ratio ≥1.34 had the highest accuracy for predicting N1/N2 metastasis; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of nodal staging were 60.66, 85.11, 84.09, 62.5 and 71.29%, respectively. Conclusions: When diagnosing nodal stage, a lymph node I/C‐SUV ratio ≥1.34 can be an effective criterion for determining surgical indications in advanced lung cancer. Abstract : In a situation where bilateral N1 nodes are not enlarged but 18 F fluorodeoxyglucose uptake is high in PET/CT, nodal staging must be assessed intraoperatively. New I/C SUV ratio ≥1.34, which calculated as ipsilateral/contralateral hilar node standardized uptake value, improved clinical nodal staging even in this situation. I/C ratio has the potential to resolve the misinterpretation as cancer progression by bilateral diffuse FDG (pseudo‐) activity due to chronic inflammation.