Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes.

Arita, Tomohiro; Kuramitsu, T; Kawamura, Masaki; Matsumoto, Tsuneo; Matsunaga, Naofumi; Sugi, Kazuro; Esato, Kensuke

doi:10.1136/thx.50.12.1267

Cited by 101 publications

(33 citation statements)

References 14 publications

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“…2 and 3) and chemotherapy (according to standard ACO, EPI-CO, VIP-E and VIC-E protocols) (pts. 1,3,4,7,19). All therapeutic measures were stopped at least 1 month prior to the PET study.…”

Section: Resultsmentioning

confidence: 99%

FDG-PET imaging for the staging and follow-up of small cell lung cancer

et al. 2001

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The staging procedures for small cell lung cancer do not differ appreciably from those for other forms of lung cancer. For practical purposes, the TNM stages are usually collapsed into a simple binary classification: limited disease and extensive disease. This study was performed to answer the question of whether fluorine-18 labelled 2-deoxy-2-D-glucose positron emission tomography (FDG-PET) imaging permits appropriate work-up (including both primary and follow-up staging) of patients presenting with small cell lung cancer, as compared with currently recommended staging procedures. Thirty-six FDG-PET examinations were performed in 30 patients with histologically proven small cell lung cancer. Twenty-four patients were examined for primary staging while four were imaged for therapy follow-up only. Two patients underwent both primary staging and up to four examinations for therapy follow-up. Static PET imaging was performed according to a standard protocol. Image reconstruction was based on an ordered subset expectation maximization algorithm including post-injection segmented attenuation correction. Results of FDG-PET were compared with those of the sum of other staging procedures. Identical results from FDG-PET and the sum of the other staging procedures were obtained in 23 of 36 examinations (6x limited disease, 12x extensive disease, 5x no evidence of disease). In contrast to the results of conventional staging, FDG-PET indicated extensive disease resulting in an up-staging in seven patients. In one patient in whom there was no evidence for tumour on conventional investigations following treatment, FDG-PET was suggestive of residual viability of the primary tumour. Furthermore, discordant results were observed in five patients with respect to lung, bone, liver and adrenal gland findings, although in these cases the results did not affect staging as limited or extensive disease. Moreover, FDG-PET appeared to be more sensitive for the detection of metastatic mediastinal and hilar lymph nodes and bone metastases. Finally, all findings considered suspicious for tumour involvement on the other staging procedures were also detected by FDG-PET. It is concluded that FDG-PET has potential for use as a simplified staging tool for small cell lung cancer.

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“…2 and 3) and chemotherapy (according to standard ACO, EPI-CO, VIP-E and VIC-E protocols) (pts. 1,3,4,7,19). All therapeutic measures were stopped at least 1 month prior to the PET study.…”

Section: Resultsmentioning

confidence: 99%

FDG-PET imaging for the staging and follow-up of small cell lung cancer

et al. 2001

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“…Therefore, the CT scan will miss small metastases that do not result in node enlargement. To address this issue, Arita et al 229 specifically examined lung cancer metastases to normal-sized mediastinal lymph nodes in 90 patients and found an incidence of 16% false-negative chest CT scans with histologic identification of occult N2 or N3 disease.…”

Section: Additional Pretreatment Evaluationmentioning

confidence: 99%

Non–Small Cell Lung Cancer

Ettinger

Akerley

Bepler

et al. 2010

J Natl Compr Canc Netw

604

371

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“…The diagnostic performance of CT in mediastinal nodal staging is limited because of the use of size criteria to differentiate between benign and malignant lesions. Histopathologic studies showed that 21% of the metastases are in normalsized lymph nodes (8), whereas no malignancy is found in 40% of the enlarged lymph nodes, especially in patients with poststenotic pneumonia (9). The use of MRI provides no improvement over CT (10), even with new superparamagnetic contrast agents (11).…”

mentioning

confidence: 99%

18F-FDG PET for Mediastinal Staging of Lung Cancer: Which SUV Threshold Makes Sense?

Hellwig

Graeter²,

Ukena

et al. 2007

Journal of Nuclear Medicine

173

111

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18 F-FDG PET is the most accurate noninvasive modality for staging mediastinal lymph nodes in lung cancer. Besides using visual image interpretation, some institutions use standardized uptake value (SUV) measurements in lymph nodes. Mostly, an SUV of 2.5 is used as the cutoff, but this choice was never deduced from respective studies. Receiver operating characteristic (ROC) analyses demonstrated that SUV thresholds of more than 4 resulted in the highest accuracy. But these high cutoffs imply high false-negative rates (FNRs). The aim of our evaluation was to determine an optimal SUV threshold and to compare its diagnostic performance with the results of visual interpretation. Methods: This retrospective study included 95 patients with suspected lung cancer who underwent mediastinoscopy/mediastinal lymphadenectomy after 18 F-FDG PET (90-150 min after 250 MBq of 18 F-FDG). Maximum SUV was measured in 371 lymph node regions biopsied afterward and visually interpreted using a 6-level score (2 2 2 through 1 1 1). Diagnostic performance was assessed by ROC analysis. FNR and false-positive rate (FPR), the sum of both error rates (FNR 1 FPR), and diagnostic accuracy were plotted against a hypothetical SUV threshold to determine the optimum SUV threshold. Results: SUVs in metastatic lymph nodes were higher (mean 6 SD, 7.1 6 4.5; range, 1.4-26.9; n 5 70) than in tumor-free lymph node stations (2.4 6 1.7; range, 0.6-14.9; n 5 301; P , 0.01). Inflammatory lymph nodes exhibited slightly increased SUVs (2.7 6 2.0; range, 0.8-14.9; n 5 146). The plot of error rates featured a minimum of the sum FNR 1 FPR for an SUV of 2.5. With increasing SUV threshold, the FPR decreased most prominently up to that value whereas a continuous rise of FNR was noticed. Highest diagnostic accuracy was achieved with an SUV of 4.5. The areas under the ROC curves demonstrated that visual interpretation tends to be more accurate than SUV quantification (visual, 0.930 6 0.022; SUV, 0.899 6 0.025; P 5 0.241). Using an SUV of 2.5 as the threshold, the resulting sensitivity, specificity, and negative predictive value were 89%, 84%, and 96%, respectively. Conclusion: For mediastinal staging, the choice of an SUV of 2.5 as the threshold is justified because FNR 1 FPR is minimized. The resulting high negative predictive value of 96% allows the omission of mediastinoscopy in patients with negative mediastinal findings on 18 F-FDG PET images. For the experienced observer, visual analysis should be relied on primarily, with calculation of the SUV used, at most, as a secondary aid. For the less experienced observer, the SUV may be of greater value.

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Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes.

Cited by 101 publications

References 14 publications

FDG-PET imaging for the staging and follow-up of small cell lung cancer

FDG-PET imaging for the staging and follow-up of small cell lung cancer

Non–Small Cell Lung Cancer

18F-FDG PET for Mediastinal Staging of Lung Cancer: Which SUV Threshold Makes Sense?

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