Clinical significance of PET/CT uptake for peripheral clinical N0 non‐small cell lung cancer

Abstract

Objective In this cohort study, we determined the clinical value of the maximum standardized uptake value (SUVmax) of primary tumors in non‐small cell lung cancer (NSCLC). Study Design A retrospective review of NSCLC patients was performed from January 2011 to December 2017. Peripheral cN0 NSCLC patients with tumor size ≤2 cm were included. SUVmax was calculated as a continuous variable for semiquantitative analyses. A receiver operating characteristic curve was analyzed to assess the cutoff threshold of SUVmax on pathological (p) nodal metastasis. We further evaluated the clinical relevance of SUVmax in peripheral cN0 NSCLC patients. Results A total of 670 peripheral NSCLC patients with tumor size ≤2 cm were deemed cN0 by preoperative PET/CT scan. Statistical analyses suggested significant correlations of SUVmax with smoking status (P = .026), tumor volume (P = .001), pathology type (P = .008), tumor differentiation (P < .001), vessel invasion (P = .001), plural invasion (P < .001), pT stage (P < .001), nodal involvement (P < .001), and pathological tumor node metastasis stage (P < .001). A cutoff point of SUVmax of 3.8 (P < .001) could be used to predict pathological nodal metastasis. Multivariable analyses indicated that preoperative SUVmax >3.8 (odds ratio, 12.149; P < .001) was an independent predictor of nodal metastasis. Overall survival analyses further suggested that SUVmax was an independent prognostic indicator (hazard ratio, 2.050; P = .017). Conclusion Preoperative SUVmax is a predictor of pathological nodal metastasis and prognosis for peripheral cN0 NSCLC patients with tumor size ≤2 cm. Our results indicate that assessment of PET SUVmax could improve stratification of these patients.

Preoperative 18F-FDG SUVmax >6.3 or Size >2.3 cm of primary lesions predict lymph nodes metastasis with higher negative predictive value in peripheral cT1 non-small-cell lung cancer

“…[11] also proved that this standard was uselessness in squamous cell carcinoma. In our subgroup analysis, we found that the cut-off values of SUV max and size of adenocarcinoma were smaller than those of squamous cell carcinoma, which was part consist with Wang’s research [8]. Besides, not all the peripheral cT1 NSCLC patients could get preoperative pathological results in China, and our research also confirmed that the pathological type was not an independent risk factor for peripheral cT1 NSCLC LNM.…”

Predictive Value of 18F-Fluorodeoxyglucose Positron Emission Tomography or Positron Emission Tomography/Computed Tomography for Assessment of Occult Lymph Node Metastasis in Non-Small Cell Lung Cancer

“…The remaining 16 full-text articles were assessed for eligibility and 2 articles were excluded due to insufficient data for the calculation of sensitivity and specificity of F-18 FDG PET or PET/CT for the prediction of OLNM in NSCLC patients. Finally, 14 studies were selected and were eligible for the systematic review and meta-analysis and no additional studies were found screening the references of these articles [13-26]. The characteristics of the included studies are presented in Table 1.…”

“…All studies enrolled patients retrospectively. Eight studies came from China [14, 19, 21-26]. Other 6 studies were performed by non-China investigators [13, 15-18, 20].…”

“…Four studies used volumetric parameters of the primary tumor for the interpretation of F-18 FDG PET or PET/CT for the prediction of OLNM in NSCLC patients [16, 17, 21, 24]. Another 10 studies used SUV values of the primary tumor of F-18 FDG PET or PET/CT images [18, 20, 25, 26]. Clinical N0 disease by F-18 FDG PET or PET/CT was defined as lymph nodes with FDG uptake no greater than normal background activity in two studies [21, 24], FDG uptake was not higher than the mediastinal blood pool in one study [13], lymph node SUV max <2.5 in eight studies [14, 15, 18-20, 25, 26] and ambiguous criteria in three studies [16, 17, 23].…”

“…Even though randomized trials have proven that PET-CT is more accurate and more sensitive for the staging of NSCLC than the conventional staging regimen, preoperative PET-CT was not associated with improved overall survival in patients with NSCLC [29]. Several previous reports have shown that pathologically confirmed lymph node involvement cases after systematic lymph node dissection were not detected by preoperative F-18 FDG PET or PET/CT [13-26]. Thus, a better understanding of the OLNM in NSCLC is crucial especially when lack of definite pathologic nodal staging is being considered.…”