Accuracy of 18F-FDG in Detecting Stage I Lung Adenocarcinomas According to IASLC/ATS/ERS Classification

Lococo, Filippo; Guerrera, Francesco; Rena, Ottavio; Ampollini, Luca; Vannucci, Jacopo; Bertoglio, Pietro; Ventura, Luigi; Lybéris, Paraskevas; Marchese, Valentina; Arena, Vincenzo; Filosso, Pier Luigi; Lesca, Adriana; Casadio, Caterina; Viti, Andrea; Paci, Massimiliano; Puma, Francesco; Ruffini, Enrico

doi:10.1016/j.hlc.2021.10.011

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…Previous studies showed a significant correlation between sex, differentiation grade, and histology of the primary tumor [27][28][29]. However, a potential association between LN false positivity in the preoperative screening and histology of the primary lung tumor remains an insufficiently addressed topic [30].…”

Section: Discussionmentioning

confidence: 99%

Histology of the Primary Tumor Correlates with False Positivity of Integrated 18F-FDG-PET/CT Lymph Node Staging in Resectable Lung Cancer Patients

et al. 2023

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This study aimed to evaluate the diagnostic accuracy and false positivity rate of lymph node (LN) staging assessed by integrated 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG-PET/CT) in patients with operable lung cancer to the tumor histology. In total, 129 consecutive patients with non-small-cell lung cancer (NSCLC) undergoing anatomical lung resections were included. Preoperative LN staging was evaluated in the relationship to the histology of the resected specimens (group 1: lung adenocarcinoma/LUAD; group 2: squamous cell carcinoma/SQCA). Statistical analysis was performed by the Mann–Whitney U-test, the chi2 test, and binary logistic regression analysis. To establish an easy-to-use algorithm for the identification of LN false positivity, a decision tree including clinically meaningful parameters was generated. In total, 77 (59.7%) and 52 (40.3%) patients were included in the LUAD and SQCA groups, respectively. SQCA histology, non-G1 tumors, and tumor SUVmax > 12.65 were identified as independent predictors of LN false positivity in the preoperative staging. The corresponding ORs and their 95% CIs were 3.35 [1.10–10.22], p = 0.0339; 4.60 [1.06–19.94], p = 0.0412; and 2.76 [1.01–7.55], and p = 0.0483. The preoperative identification of false-positive LNs is an important aspect of the treatment regimen for patients with operable lung cancer; thus, these preliminary findings should be further evaluated in larger patient cohorts.

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Section: Discussionmentioning

confidence: 99%

Histology of the Primary Tumor Correlates with False Positivity of Integrated 18F-FDG-PET/CT Lymph Node Staging in Resectable Lung Cancer Patients

et al. 2023

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“…Preoperative nodal stage is important for determining the surgical procedure for patients with lung cancer 2 , 3 , 8 . In [ 18 F]FDG-PET false-negative cases with metastatic lymph nodes, surgical resection may be performed despite chemotherapy being the first choice of treatment.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of pyruvate dehydrogenase-E1α expression to determine SUVmax cut-off value of [18F]FDG-PET for predicting lymph node metastasis in lung cancer

Ito

Yashiro²,

Tsukioka

et al. 2023

Sci Rep

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A more accurate cut-off value of maximum standardized uptake value (SUVmax) in [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) is necessary to improve preoperative nodal staging in patients with lung cancer. Overall, 223 patients with lung cancer who had undergone [18F]FDG-PET/CT within 2 months before surgery were enrolled. The expression of glucose transporter-1, pyruvate kinase-M2, pyruvate dehydrogenase-E1α (PDH-E1α), and carbonic anhydrase-9 was evaluated by immunohistochemistry. Clinicopathological background was retrospectively investigated. According to PDH-E1α expression in primary lesion, a significant difference (p = 0.021) in SUVmax of metastatic lymph nodes (3.0 with PDH-positive vs 4.5 with PDH-negative) was found, but not of other enzymes. When the cut-off value of SUVmax was set to 2.5, the sensitivity and specificity were 0.529 and 0.562, respectively, and the positive and negative predictive values were 0.505 and 0.586, respectively. However, when the cut-off value of SUVmax was set according to PDH-E1α expression (2.7 with PDH-positive and 3.2 with PDH-negative), the sensitivity and specificity were 0.441 and 0.868, respectively, and the positive and negative predictive values were 0.738 and 0.648, respectively. The SUVmax cut-off value for metastatic lymph nodes depends on PDH-E1α expression in primary lung cancer. The new SUVmax cut-off value according to PDH-E1α expression showed higher specificity for [18F]FDG-PET in the diagnosis of lymph node metastasis.

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“…False negative results can be observed with carcinoid tumors and some cases of early-stage disease (preinvasive and minimally invasive lung adenocarcinoma) [17] (Figures 5 and 6). In a study of 550 patients with stage I lung adenocarcinoma, using maximal standardized uptake value (SUVmax) cutoff of 2.5 to discriminate a positive from a negative result on FGD PET/CT, 17.6% of patients had a false negative FDG PET result where the primary tumor had SUVmax of less than 2.5 [17]. Lung adenocarcinoma with a lepidic pattern on pathology have a tendency toward false negative FDG PET findings [17].…”

Section: T Classificationmentioning

confidence: 99%

“…In a study of 550 patients with stage I lung adenocarcinoma, using maximal standardized uptake value (SUVmax) cutoff of 2.5 to discriminate a positive from a negative result on FGD PET/CT, 17.6% of patients had a false negative FDG PET result where the primary tumor had SUVmax of less than 2.5 [17]. Lung adenocarcinoma with a lepidic pattern on pathology have a tendency toward false negative FDG PET findings [17]. There is evidence that focal FDG uptake correlates with tumor invasion in both pure ground-glass and part-solid malignancies, although many pre-invasive and minimally invasive adenocarcinomas may be below the resolution of PET due to their small size [18,19].…”

Section: T Classificationmentioning

confidence: 99%

Lung Cancer Staging: Imaging and Potential Pitfalls

Erasmus,

Strange,

Agrawal

et al. 2023

Diagnostics

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Lung cancer is the leading cause of cancer deaths in men and women in the United States. Accurate staging is needed to determine prognosis and devise effective treatment plans. The International Association for the Study of Lung Cancer (IASLC) has made multiple revisions to the tumor, node, metastasis (TNM) staging system used by the Union for International Cancer Control and the American Joint Committee on Cancer to stage lung cancer. The eighth edition of this staging system includes modifications to the T classification with cut points of 1 cm increments in tumor size, grouping of lung cancers associated with partial or complete lung atelectasis or pneumonitis, grouping of tumors with involvement of a main bronchus regardless of distance from the carina, and upstaging of diaphragmatic invasion to T4. The N classification describes the spread to regional lymph nodes and no changes were proposed for TNM-8. In the M classification, metastatic disease is divided into intra- versus extrathoracic metastasis, and single versus multiple metastases. In order to optimize patient outcomes, it is important to understand the nuances of the TNM staging system, the strengths and weaknesses of various imaging modalities used in lung cancer staging, and potential pitfalls in image interpretation.

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Accuracy of 18F-FDG in Detecting Stage I Lung Adenocarcinomas According to IASLC/ATS/ERS Classification

Cited by 7 publications

References 25 publications

Histology of the Primary Tumor Correlates with False Positivity of Integrated 18F-FDG-PET/CT Lymph Node Staging in Resectable Lung Cancer Patients

Histology of the Primary Tumor Correlates with False Positivity of Integrated 18F-FDG-PET/CT Lymph Node Staging in Resectable Lung Cancer Patients

Usefulness of pyruvate dehydrogenase-E1α expression to determine SUVmax cut-off value of [18F]FDG-PET for predicting lymph node metastasis in lung cancer

Lung Cancer Staging: Imaging and Potential Pitfalls

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