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The diagnostic ability of 18F-FDG PET/CT for mediastinal lymph node staging using 18F-FDG uptake and volumetric CT histogram analysis in non-small cell lung cancer

 Jeong Won Lee  ;  Eun Young Kim  ;  Dae Joon Kim  ;  Jae-Hoon Lee  ;  Won Jun Kang  ;  Jong Doo Lee  ;  Mijin Yun 
 European Radiology, Vol.26(12) : 4515-4523, 2016 
Journal Title
 European Radiology 
Issue Date
OBJECTIVES: To evaluate the clinical implications of lymph node (LN) density on 18F-FDG PET/CT for mediastinal LN characterization in non-small cell lung cancer (NSCLC). METHODS: One hundred and fifty-two patients with 271 mediastinal LNs who underwent PET/CT and endobronchial ultrasound-guided transbronchial needle aspiration for staging were enrolled. Maximum standardized uptake value (SUVmax), short axis diameter, LN-to-primary cancer ratio of SUVmax, and median Hounsfield unit (HU) based on CT histogram were correlated to histopathology. RESULTS: Of 271 nodes, 162 (59.8 %) were malignant. SUVmax, short axis diameter, and LPR of malignant LNs were higher than those of benign nodes. Among malignant LNs, 71.0 % had median HU between 25 and 45, while 78.9 % of benign LNs had values <25 HU or >45 HU. Using a cutoff value of 4.0, SUVmax showed the highest diagnostic ability for detecting malignant LNs with a specificity of 94.5 %, but showing a sensitivity of 70.4 %. Using additional density criteria (median HU 25-45) in LNs with 2.0< SUVmax ≤4.0, the sensitivity increased to 88.3 % with the specificity of 82.6 %. CONCLUSIONS: LN density is useful for the characterization of LNs with mild 18F-FDG uptake. The risk of mediastinal LN metastasis in NSCLC patients could be further stratified using both 18F-FDG uptake and LN density. KEY POINTS: ? SUVmax showed the highest diagnostic ability for detecting malignant LNs. ? LN density was useful in characterization of LNs with mild FDG uptake. ? SUVmax and LN density together could stratify the risk of LN metastasis.
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1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
강원준(Kang, Won Jun) ORCID logo https://orcid.org/0000-0002-2107-8160
김대준(Kim, Dae Joon)
김은영(Kim, Eun Young) ORCID logo https://orcid.org/0000-0002-3281-5744
윤미진(Yun, Mi Jin) ORCID logo https://orcid.org/0000-0002-1712-163X
이재훈(Lee, Jae Hoon) ORCID logo https://orcid.org/0000-0002-9898-9886
이종두(Lee, Jong Doo)
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