Respiration

Clinical Investigations

Mediastinal Lymph Node Staging by FDG-PET in Patients with Non-Small Cell Lung Cancer: Analysis of False-Positive FDG-PET Findings

Konishi J.a · Yamazaki K.a · Tsukamoto E.b · Tamaki N.b · Onodera Y.c · Otake T.d · Morikawa T.d · Kinoshita I.a · Dosaka-Akita H.e · Nishimura M.a

Author affiliations

aFirst Department of Medicine, and Departments of bNuclear Medicine and cRadiology, Hokkaido University School of Medicine, and dDepartment of Surgical Oncology, Division of Cancer Medicine, and eDepartment of Medical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Keywords: FDG-PETNon-small cell lung cancerTumor stagingMediastinal lymph nodeHilar lymph node

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Respiration 2003;70:500–506
https://doi.org/10.1159/000074207

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Article / Publication Details

First-Page Preview
Abstract of Clinical Investigations

Received: January 24, 2003
Accepted: April 30, 2003
Published online: December 05, 2003
Issue release date: September – October

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 5

ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)

For additional information: https://www.karger.com/RES

Abstract

Background: Accurate staging of mediastinal and hilar lymph nodes is a critical factor determining operability in patients with non-small cell lung cancer (NSCLC). Positron emission tomography with 2-[18F] fluoro-2-deoxy-D-glucose as a tracer (FDG-PET) has recently been reported to be more effective in detecting tumor involvement in mediastinal and hilar lymph nodes than computed tomography (CT). Objective: In this study, we analyzed the accuracy of FDG-PET in mediastinal and hilar lymph node staging in patients with NSCLC and the factors associated with false-positive or false-negative FDG-PET findings in mediastinal and hilar lymph node staging. Methods: Fifty-four patients with NSCLC who underwent preoperative analysis including chest CT and whole-body FDG-PET were evaluated retrospectively. Using FDG-PET, lesions were considered to be positive if a definite, localized area of higher uptake, excluding physiologic uptake, than in surrounding normal tissue was present. On CT findings, lymph nodes were considered to be positive if they were >10 mm in short-axis diameter, except subcarinal lymph nodes (#7), which were considered to be positive if they were >15 mm in short-axis diameter. All patients underwent surgical resection of primary tumors and mediastinal and hilar lymph nodes between 1999 and 2001 in our institute. Resected lymph nodes were histologically examined for the existence of tumor cells. Results: A total of 306 lymph nodes were resected and used for analysis. The sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET were 73, 98, 70 and 98%, while those of CT were 55, 96, 55 and 96%, respectively. When pre-operative nodal staging was compared with post-operative histopathological staging, 44 patients (81%) were correctly staged, 7 (13%) were overstaged and 3 (6%) were understaged by FDG-PET, while 39 patients (72%) were correctly staged, 8 (15%) were overstaged and 7 (13%) were understaged by CT. All 7 overstaged patients by FDG-PET had other pulmonary complications, including interstitial pneumonitis (n = 2), previous pulmonary tuberculosis (n = 3), silicosis (n = 1) and emphysema (n = 1), although they were not in the active stage. In 3 understaged patients by FDG-PET, lymph nodes were also undetectable by CT. Conclusion: FDG-PET is superior to CT in mediastinal and hilar lymph node staging of patients with NSCLC. However, care should be taken in lymph node staging for patients who have other pulmonary complications, including interstitial pneumonitis, previous pulmonary tuberculosis and silicosis.

© 2003 S. Karger AG, Basel



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References

  1. Miller DL, McManus KG, Allen MS, Ilstrup DM, Deschamps C, Trastek VF, Daly RC, Pairolero PC: Results of surgical resection in patients with N2 non-small cell lung cancer. Ann Thorac Surg 1994;57:1095–1101.
    External Resources
  2. Little AG, DeMeester TR, Ferguson MK, Skinner DB, Hoffman PC, Skosey C, Blough RR, Golomb HM: Modified stage I (T1N0M0, T2N0M0), nonsmall cell lung cancer: Treatment results, recurrence patterns, and adjuvant immunotherapy. Surgery 1986;100:621–628.
    External Resources
  3. Glazer GM, Orringer MB, Gross BH, Quint LE: The mediastinum in non-small cell lung cancer: CT-surgical correlation. Am J Roentgenol 1984;142:1101–1105.
    External Resources
  4. Arita T, Kuramitsu T, Kawamura M, Matsumoto T, Matsunaga N, Sugi K, Esato K: Bronchogenic carcinoma: Incidence of metastases to normal sized lymph nodes. Thorax 1995;50:1267–1269.
    External Resources
  5. Arita T, Matsumoto T, Kuramitsu T, Kawamura M, Matsunaga N, Sugi K, Esato K: Is it possible to differentiate malignant mediastinal nodes from benign nodes by size? Re-evaluation by CT, transesophageal echocardiography, and nodal specimen. Chest 1996;110:1004–1008.
    External Resources
  6. McLoud TC, Bourgouin PM, Greenberg RW, Kosiuk JP, Templeton PA, Shepard JAO, Moore EH, Wain JC, Mathisen DJ, Grillo HC: Bronchogenic carcinoma: Analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. Radiology 1992;82:319–323.
  7. Cascade PN, Gross BH, Kazerooni EA, Quint LE, Francis IR, Strawderman M, Korobkin M: Variability in the detection of enlarged mediastinal lymph nodes in staging lung cancer: A comparison of contrast-enhanced and unenhanced CT. Am J Roentgenol 1998;170:927–931.
    External Resources
  8. Vansteenkiste JF, Stroobants SG, Dupont PJ, De Leyn PR, Verbeken EK, Deneffe GJ, Mortelmans LA, Demeats MG, the Leuven Lung Cancer Group: Prognostic importance of the standardized uptake value on 18F-fluoro-2-deoxy-glucose-positron emission tomography scan in non-small-cell lung cancer: An analysis of 125 cases. J Clin Oncol 1999;17:3201–3206.
    External Resources
  9. Pieterman RM, Putten JWG, Meuzelaar JJ, Mooyaart EL, Vaalburg W, Koëter GH, Fidler V, Pruim J, Groen HJM: Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med 2000;343:254–261.
    External Resources
  10. Dahlbom M, Hoffman EJ, Hoh CK, Schiepers C, Rosenqvist G, Hawkins RA, Phelps ME: Whole-body positron emission tomography: I. Methods and performance characteristics. J Nucl Med 1992;33:1191–1199.
    External Resources
  11. Nolop KB, Rhodes CG, Brudin LH, Beaney RP, Krausz T, Jones T, Hughes JMB: Glucose utilization in vivo by human pulmonary neoplasms. Cancer 1987;60:2682–2689.
    External Resources
  12. Wahl RL, Hutchins GD, Buchsbaum DJ, Liebert M, Grossman HB, Fisher S: 18F-2-deoxy-2-fluoro-D-glucose uptake into human tumor xenografts. Cancer 1991;67:1544–1550.
    External Resources
  13. Vansteenkiste JF, Stroobants SG, Leyn PR, Dupont PJ, Verschakelen JA, Nackaerts KL, Mortelmans LA, and the Leuven Lung Cancer Group: Mediastinal lymph node staging with FDG-PET scan in patients with potentially operable non-small cell lung cancer. A prospective analysis of 50 cases. Chest 1997;112:1480–1486.
    External Resources
  14. Vansteenkiste JF, Stroobants SG, Dupont PJ, Leyn PR, Wever WF, Verbeken EK, Nuyts JL, Maes FP, Bogaert JG, and the Leuven Lung Cancer Group: FDG-PET scan in potentially operable non-small cell lung cancer: Do anatometabolic PET-CT fusion images improve the localisation of regional lymph node metastases? Eur J Nucl Med 1998;25:1495–1501.
    External Resources
  15. Steinert HC, Hauser M, Allemann F, Engel H, Berthold T, Schulthess GK, Weder W: Non-small cell lung cancer: Nodal staging with FDG PET versus CT with correlative lymph node mapping and sampling. Radiology 1997;202:441–446.
    External Resources
  16. Farrell MA, McAdams HP, Herndon JE, Patz EF: Non-small cell lung cancer: FDG PET for nodal staging in patients with stage I disease. Radiology 2000;215:886–890.
    External Resources
  17. Guhlmann A, Storck M, Kotzerke J, Moog F, Sunder-Plassmann L, Reske SN: Lymph node staging in non-small cell lung cancer: Evaluation by [18F] FDG positron emission tomography (PET). Thorax 1997;52:438–441.
    External Resources
  18. Gupta NC, Graeber GM, Bishop HA: Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (<1 cm), intermediate (1 to 3 cm), and large (>3 cm) lymph node lesions. Chest 2000;117:773–778.
    External Resources
  19. Bakheet SM, Powe J: Benign causes of 18-FDG uptake on whole body imaging. Semin Nucl Med 1998;28:352–358.
    External Resources
  20. Roberts PF, Follette DM, Haag D, Park JA, Valk PE, Pounds TR, Hopkins DM: Factors associated with false-positive staging of lung cancer by positron emission tomography. Ann Thorac Surg 2000;70:1154–1160.
    External Resources
  21. The World Health Organization histological typing of lung tumors, ed 2. Am J Clin Pathol 1982;77:123–136.
    External Resources
  22. American Joint Committee on Cancer: Lung; in Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ (eds): Manual for Staging of Cancer. Philadelphia, Lippincott, 1992, pp 115–122.
  23. Shiga T, Tsukamoto E, Nakada K, Morita K, Kato T, Mabuchi M, Yoshinaga K, Katoh C, Kuge Y, Tamaki N: Comparison of 18F-FDG, 131I-Na, and 201TI in diagnosis of recurrent or metastatic thyroid carcinoma. J Nucl Med 2001;42:414–419.
    External Resources
  24. Kato T, Tsukamoto E, Kuge Y, Katoh C, Nambu T, Nobuta A, Kondo S, Asaka M, Tamaki N: Clinical role of 18F-FDG PET for initial staging of patients with extrahepatic bile duct cancer. Eur J Nucl Med 2002;29:1047–1054.
    External Resources
  25. Vansteenkiste JF, Stroobants SG, Leyn PR, Dupont PJ, Bogaert J, Maes A, Deneffe GJ, Nackaerts KL, Verschakelen JA, Lerut TE, Mortelmans LA, Demedts MG: Lymph node staging in non-small-cell lung cancer with FDG-PET scan: A prospective study on 690 lymph node stations from 68 patients. J Clin Oncol 1998;16:2142–2149.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of Clinical Investigations

Received: January 24, 2003
Accepted: April 30, 2003
Published online: December 05, 2003
Issue release date: September – October

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 5

ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)

For additional information: https://www.karger.com/RES

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