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
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 differentiati...
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| Veröffentlicht in: | Annals of nuclear medicine 2009-08, Vol.23 (6), p.523-531 |
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| creator | Suga, Kazuyoshi Kawakami, Yasuhiko Hiyama, Atsuto Sugi, Kazurou Okabe, Kazutomo Matsumoto, Tsuneo Ueda, Kazuhiro Tanaka, Nobuyuki Matsunaga, Naofumi |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.1007/s12149-009-0268-y |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 0914-7187</identifier><identifier>EISSN: 1864-6433</identifier><identifier>DOI: 10.1007/s12149-009-0268-y</identifier><identifier>PMID: 19444550</identifier><language>eng</language><publisher>Japan</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung - diagnostic imaging ; Carcinoma, Non-Small-Cell Lung - metabolism ; Carcinoma, Non-Small-Cell Lung - pathology ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18 - metabolism ; Humans ; Kinetics ; Lung Neoplasms - diagnostic imaging ; Lung Neoplasms - metabolism ; Lung Neoplasms - pathology ; Lymph Nodes - diagnostic imaging ; Lymph Nodes - metabolism ; Lymph Nodes - pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Positron-Emission Tomography ; Retrospective Studies ; ROC Curve ; Time Factors ; Tomography, X-Ray Computed</subject><ispartof>Annals of nuclear medicine, 2009-08, Vol.23 (6), p.523-531</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19444550$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suga, Kazuyoshi</creatorcontrib><creatorcontrib>Kawakami, Yasuhiko</creatorcontrib><creatorcontrib>Hiyama, Atsuto</creatorcontrib><creatorcontrib>Sugi, Kazurou</creatorcontrib><creatorcontrib>Okabe, Kazutomo</creatorcontrib><creatorcontrib>Matsumoto, Tsuneo</creatorcontrib><creatorcontrib>Ueda, Kazuhiro</creatorcontrib><creatorcontrib>Tanaka, Nobuyuki</creatorcontrib><creatorcontrib>Matsunaga, Naofumi</creatorcontrib><title>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</title><title>Annals of nuclear medicine</title><addtitle>Ann Nucl Med</addtitle><description>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.
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.
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.
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carcinoma, Non-Small-Cell Lung - diagnostic imaging</subject><subject>Carcinoma, Non-Small-Cell Lung - metabolism</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Fluorodeoxyglucose F18 - metabolism</subject><subject>Humans</subject><subject>Kinetics</subject><subject>Lung Neoplasms - diagnostic imaging</subject><subject>Lung Neoplasms - metabolism</subject><subject>Lung Neoplasms - pathology</subject><subject>Lymph Nodes - diagnostic imaging</subject><subject>Lymph Nodes - metabolism</subject><subject>Lymph Nodes - pathology</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Positron-Emission Tomography</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed</subject><issn>0914-7187</issn><issn>1864-6433</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOwzAQRS0EouXxAWyQVzwWpn4ldpaoL5AqwaKsIzt2ilHilNgB9Tf4YowoWxYzcxdnru4MABcE3xGMxSQQSniBME5Fc4l2B2BMZM5Rzhk7BGNcEI4EkWIETkJ4w5jKTNJjMCIF5zzL8Bh8zVxd29766FQDjVMb3wUXoLbx01oPb4i8XaDFbInUhzOwtVGFqKKrYLNrt6_Qd8YG6HwSHoVWNQ2sbGrN4DewUr6yPVTeJD_vNn6Pdx6aQTUoutbCbed8hM_z9WS6hiGtnIGjWjXBnu_nKXhZzNfTB7R6Wj5O71fIE5lFpBnGWCpOKUkXVlxoS7HUda6M4kbzzDBOK0GMqgljmeBcaky1zqyoaaELdgquf323ffc-2BDL1oWf8MrbbgilYKzIueAikVf_kikBZULQBF7uwUG31pTb3rWq35V__2bftSWCSQ</recordid><startdate>200908</startdate><enddate>200908</enddate><creator>Suga, Kazuyoshi</creator><creator>Kawakami, Yasuhiko</creator><creator>Hiyama, Atsuto</creator><creator>Sugi, Kazurou</creator><creator>Okabe, Kazutomo</creator><creator>Matsumoto, Tsuneo</creator><creator>Ueda, Kazuhiro</creator><creator>Tanaka, Nobuyuki</creator><creator>Matsunaga, Naofumi</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QO</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>200908</creationdate><title>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</title><author>Suga, Kazuyoshi ; Kawakami, Yasuhiko ; Hiyama, Atsuto ; Sugi, Kazurou ; Okabe, Kazutomo ; Matsumoto, Tsuneo ; Ueda, Kazuhiro ; Tanaka, Nobuyuki ; Matsunaga, Naofumi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-n185t-b30008a4221187c47be208bf6ada4db45d342c71daf13357448b02bb5e7f29b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carcinoma, Non-Small-Cell Lung - diagnostic imaging</topic><topic>Carcinoma, Non-Small-Cell Lung - metabolism</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Fluorodeoxyglucose F18 - metabolism</topic><topic>Humans</topic><topic>Kinetics</topic><topic>Lung Neoplasms - diagnostic imaging</topic><topic>Lung Neoplasms - metabolism</topic><topic>Lung Neoplasms - pathology</topic><topic>Lymph Nodes - diagnostic imaging</topic><topic>Lymph Nodes - metabolism</topic><topic>Lymph Nodes - pathology</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Positron-Emission Tomography</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suga, Kazuyoshi</creatorcontrib><creatorcontrib>Kawakami, Yasuhiko</creatorcontrib><creatorcontrib>Hiyama, Atsuto</creatorcontrib><creatorcontrib>Sugi, Kazurou</creatorcontrib><creatorcontrib>Okabe, Kazutomo</creatorcontrib><creatorcontrib>Matsumoto, Tsuneo</creatorcontrib><creatorcontrib>Ueda, Kazuhiro</creatorcontrib><creatorcontrib>Tanaka, Nobuyuki</creatorcontrib><creatorcontrib>Matsunaga, Naofumi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of nuclear medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suga, Kazuyoshi</au><au>Kawakami, Yasuhiko</au><au>Hiyama, Atsuto</au><au>Sugi, Kazurou</au><au>Okabe, Kazutomo</au><au>Matsumoto, Tsuneo</au><au>Ueda, Kazuhiro</au><au>Tanaka, Nobuyuki</au><au>Matsunaga, Naofumi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Annals of nuclear medicine</jtitle><addtitle>Ann Nucl Med</addtitle><date>2009-08</date><risdate>2009</risdate><volume>23</volume><issue>6</issue><spage>523</spage><epage>531</epage><pages>523-531</pages><issn>0914-7187</issn><eissn>1864-6433</eissn><abstract>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.
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.
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.
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.</abstract><cop>Japan</cop><pmid>19444550</pmid><doi>10.1007/s12149-009-0268-y</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Carcinoma, Non-Small-Cell Lung - diagnostic imaging Carcinoma, Non-Small-Cell Lung - metabolism Carcinoma, Non-Small-Cell Lung - pathology Diagnosis, Differential Female Fluorodeoxyglucose F18 - metabolism Humans Kinetics Lung Neoplasms - diagnostic imaging Lung Neoplasms - metabolism Lung Neoplasms - pathology Lymph Nodes - diagnostic imaging Lymph Nodes - metabolism Lymph Nodes - pathology Lymphatic Metastasis Male Middle Aged Positron-Emission Tomography Retrospective Studies ROC Curve Time Factors Tomography, X-Ray Computed |
| title | 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 |
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