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Supraclavicular Lymph Nodes Detected by 18F-FDG PET/CT in Cancer Patients: Assessment With 18F-FDG PET/CT and Sonography

 Jae-hoon Lee  ;  Jinna Kim  ;  Hee Jung Moon  ;  Arthur Cho  ;  Mijin Yun  ;  Jong Doo Lee  ;  Won Jun Kang 
 AMERICAN JOURNAL OF ROENTGENOLOGY, Vol.198(1) : 187-193, 2012 
Journal Title
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Adult ; Aged ; Biopsy, Fine-Needle ; Clavicle ; Contrast Media ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18 ; Humans ; Iohexol/analogs & derivatives ; Lymphatic Metastasis/diagnostic imaging* ; Male ; Middle Aged ; Multimodal Imaging/methods* ; Neoplasms/pathology* ; Positron-Emission Tomography* ; Predictive Value of Tests ; ROC Curve ; Radiopharmaceuticals ; Retrospective Studies ; Tomography, X-Ray Computed* ; Ultrasonography, Interventional
cancer ; FDG PET ; oncologic imaging ; sonography ; standardized uptake value ; supraclavicular lymph node
OBJECTIVE: The purposes of this study were to assess the diagnostic accuracy of 18F-FDG PET (FDG PET) for the detection of metastatic supraclavicular lymph nodes (LNs) and to propose an optimal diagnostic strategy with additional sonography, contrast-enhanced CT (CECT), or both. MATERIALS AND METHODS: One hundred supraclavicular LNs initially detected using FDG PET were examined using sonography. Regardless of the imaging findings, all 100 supraclavicular LNs underwent sonography-guided fine-needle aspiration biopsy. The maximum standardized uptake values (SUVsmax) of the supraclavicular LNs were measured, and a receiver operating characteristic (ROC) analysis was performed to determine the cutoff SUVmax. Then we evaluated the diagnostic performance of FDG PET and figured out the optimal combination of FDG PET and sonography or CECT to improve the diagnostic accuracy of the imaging studies and minimize procedures. RESULTS: In total, 86 of 100 PET-detected supraclavicular LNs were malignant. With application of the cutoff value obtained by ROC analysis (SUVmax=3.0), the diagnostic accuracy of FDG PET was 75.0% with a sensitivity of 74.4% and specificity of 78.6%. For supraclavicular LNs with an SUVmax of more than 3.0, FDG PET showed a positive predictive value of 95.5%; for supraclavicular LNs with an SUVmax of 3.0 or less, sonography excluded all false-negative FDG PET cases and showed a high negative predictive value of 100%. When sonography was selectively applied to cases with an SUVmax of 3.0 or less, the overall diagnostic accuracy increased to 92%. CONCLUSION: Our study revealed a high incidence rate of metastasis in PET-detected supraclavicular LNs in cancer patients. We believe that our proposed diagnostic workflow could decrease unnecessary diagnostic procedures in the evaluation of PET-positive supraclavicular LNs in cancer patients with reliability.
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1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Won Jun(강원준) ORCID logo https://orcid.org/0000-0002-2107-8160
Kim, Jinna(김진아) ORCID logo https://orcid.org/0000-0002-9978-4356
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Lee, Jae Hoon(이재훈) ORCID logo https://orcid.org/0000-0002-9898-9886
Lee, Jong Doo(이종두)
Cho, Arthur Eung Hyuck(조응혁) ORCID logo https://orcid.org/0000-0001-8670-2473
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