Factors associated with false-positive staging of lung cancer by positron emission tomography

Roberts, Peter; Follette, David M.; Haag, Derek von; Park, Jason A.; Valk, Peter E.; Pounds, Thomas R.; Hopkins, Donald M.

doi:10.1016/s0003-4975(00)01769-0

Cited by 160 publications

(88 citation statements)

References 17 publications

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“…In addition, several investigators have reported that integrated PET/CT is superior to conventional contrastenhanced CT or 18 F-FDG PET alone for detecting nodal metastasis in patients with non-small cell lung cancer (3,7,8). However, PET/CT staging of lymph node involvement does not replace the need for mediastinoscopy (9,10).…”

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confidence: 99%

The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

Misawa¹,

Demura²,

Ishizaki³

et al. 2008

J Nucl Med

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The purpose of this study was to compare the efficacy of short-t inversion-recovery (STIR) MRI and 18 F-FDG PET/CT for the detection of metastasis in mediastinal and hilar lymph nodes in patients with lung cancer. Methods: Ninety-three patients with known or suspected lung cancer with mediastinal and hilar lymph node swelling underwent STIR MRI and 18 F-FDG PET/CT examinations. STIR MRI scans were obtained with a 2% copper sulfate phantom placed along the back of each patient, with the lymph node-to-phantom ratio calculated for quantitative analysis. For qualitative analysis, the results of all STIR MRI scans were evaluated using a 5-point visual scoring system. To evaluate the diagnostic capabilities of STIR MRI and 18 F-FDG PET/CT, we used receiver-operating-characteristic curve analysis to determine the optimal thresholds for the lymph node-to-phantom ratio, visual score, and maximal standardized uptake value. Further, the capability of each to determine N-stage was compared in each patient using the McNemar test. Results: A total of 137 lymph nodes (82 malignant lesions, 55 benign lesions) were analyzed. When optimal threshold values were adopted, the quantitative and qualitative sensitivity, specificity, and accuracy of STIR MRI were not significantly different from those of 18 F-FDG PET/CT. However, 18 F-FDG PET/CT in combination with qualitative STIR MRI analysis had a significantly higher capability to detect nodal involvement on an individual-patient basis (96.9% specificity, 90.3% accuracy) than did 18 F-FDG PET/CT alone (65.6% specificity, 81.7% accuracy). Conclusion: We found that the diagnostic capability of STIR MRI was not significantly different from that of 18 F-FDG PET/CT. However, when those methods were combined, the diagnostic capability for N-staging was significantly improved.

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confidence: 99%

The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

Misawa¹,

Demura²,

Ishizaki³

et al. 2008

J Nucl Med

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“…25) Recently, the diagnostic capability of MRI has developed and two articles of meta-analysis reported that DWI was effective for the evaluation of N factor of lung cancer. 26,27) Meta-analysis of the MRI by Peerlings et al 26) revealed high diagnostic capability that the sensitivity was 0.87, the specificity 0.88 for nodal assessment in the non-small-cell lung cancer.…”

Section: Resultsmentioning

confidence: 99%

Economic Benefits and Diagnostic Quality of Diffusion-Weighted Magnetic Resonance Imaging for Primary Lung Cancer

Usuda

Funazaki

Maeda

et al. 2017

ATCS

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IntroductionThis paper focuses on the latest research of diffusion-weighted magnetic resonance imaging (DWI), and deals with economic benefits, diagnostic benefits, and prospects of DWI for lung cancer. The medical cost of a magnetic resonance imaging (MRI) is 81%-84% cheaper than that of 18-fluoro-2-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT). DWI is reported to be useful for differential diagnosis of malignancy or benignity for neoplasm in various organs. Diagnostic efficacy by DWI for pulmonary nodules and masses and the evaluation of N factor and M factor in lung cancer are equivalent to or more than that of FDG-PET/CT. The diagnostic capability of wholebody DWI (WB-DWI) for the staging of clinically operable lung cancers is equivalent to that of FDG-PET/CT and brain MRI, and WB-DWI is now becoming a more main stream procedure. Although the diagnostic performance of DWI for lung cancer may be equivalent to that of FDG-PET/CT, prospective randomized controlled trial for comparison of diagnostic efficacy between FDG-PET/CT and DWI for lung cancer is necessary for an accurate comparison. DWI may have an advantage in the aspect of the cost and diagnostic efficacy in lung cancer management.

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“…Several previous studies have reported that the causes of false-positive accumulation of FDG in lymph nodes may be the infiltration of activated macrophages and inflammatory cells in conditions such as active tuberculosis and granuloma (11)(12)(13). Lymphoid follicular hyperplasia is a type of chronic lymphadenopathy and Chung JH et al (14) reported that the overexpression of glucose transporter 1 (Glut 1), which is known to be related to FDG uptake, was recognized in lymph nodes with the finding of lymphoid follicular hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of the presence of lymph node metastasis and decision of operative indication using fluorodeoxyglucose-positron emission tomography and computed tomography in patients with primary lung cancer

et al. 2010

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: Objectives : We evaluate whether integrated fluorodeoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT) scan can diagnose the presence of lymph node metastasis more accurately than computed tomography (CT) scan alone. Methods : Forty-two patients with lung cancer preoperatively underwent integrated PET/CT scan using FDG and CT scan and underwent pulmonary resection and lymph node dissection. We judged cases as lymph node metastasis if the lymph node visually accumulated FDG at PET/CT scan and measured 1 cm or greater in the short axis at CT scan. We retrospectively analyzed whether our judgments in each modality were consistent with the pathological diagnosis. Results : Two-hundred and seventeen stations of lymph node were dissected and 21 stations (9.7% %) were histologically diagnosed as positive metastasis. Thirty-two stations of lymph node visually accumulated FDG at PET/CT scan and 17 stations measured 1 cm or greater in the short axis at CT scan. Concerning the diagnosis of lymph node metastasis, PET/CT scan showed significantly higher sensitivity than CT scan (81% % vs. 48% %, p=0.024). The false-positive rate was significantly high in PET-positive lymph nodes measuring less than 1 cm in diameter. There were 4 falsenegative lymph nodes with both scans. All of these were less than 7 mm in diameter and had a low percentage of metastatic foci in the lymph node. Concerning the diagnosis of N staging, there was no significant difference between PET/CT scan and CT scan (83% vs. 69% %, p=0.124). However, the identification of N2 disease at PET/CT scan was significantly more accurate than that at CT scan (100% % vs. 38% %, p=0.031). Conclusions : PET/CT is superior to CT scan in lymph node staging. However, because the false-positive rate is high in PET-positive lymph nodes measuring less than 1 cm in diameter, we think that clinical background should be considered and other modalities or histological examinations should be undertaken if necessary. J. Med. Invest. 57 : 305-313, August, 2010

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Factors associated with false-positive staging of lung cancer by positron emission tomography

Cited by 160 publications

References 17 publications

The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

Economic Benefits and Diagnostic Quality of Diffusion-Weighted Magnetic Resonance Imaging for Primary Lung Cancer

Diagnosis of the presence of lymph node metastasis and decision of operative indication using fluorodeoxyglucose-positron emission tomography and computed tomography in patients with primary lung cancer

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Factors associated with false-positive staging of lung cancer by positron emission tomography

Cited by 160 publications

References 17 publications

The Effectiveness of 18F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

The Effectiveness of 18F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

Economic Benefits and Diagnostic Quality of Diffusion-Weighted Magnetic Resonance Imaging for Primary Lung Cancer

Diagnosis of the presence of lymph node metastasis and decision of operative indication using fluorodeoxyglucose-positron emission tomography and computed tomography in patients with primary lung cancer

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The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax