Identification of false‐negative and false‐positive diagnoses of lymph node metastases in non‐small cell lung cancer patients staged by integrated ^18F‐fluorodeoxyglucose‐positron emission tomography/computed tomography: A retrospective cohort study

Abstract

BackgroundThe aim of this study was to evaluate the diagnostic accuracy of integrated 18 F‐fluorodeoxyglucose positron emission tomography/computed tomography (FDG‐PET/CT) in hilar and mediastinal lymph node (HMLN) staging of non‐small cell lung cancer (NSCLC), and to investigate potential risk factors for false‐negative and false‐positive HMLN metastases.MethodsWe examined the data of 388 surgically resected NSCLC patients preoperatively staged by integrated FDG‐PET/CT. Risk factors for false‐negative and false‐positive HMLN metastases were analyzed using univariate and multivariate analyses of clinicopathological factors.ResultsThe sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of integrated FDG‐PET/CT in detecting HMLN metastases were 47.4%, 91.0%, 56.3%, 87.7%, and 82.5%, respectively. On multivariate analysis, the maximum standardized uptake value (SUVmax) of the tumor (P = 0.042), adenocarcinoma (P = 0.003), and tumor size (P = 0.017) were risk factors for false‐negative HMLN metastases, and history of lung disease (P = 0.006) and tumor location (central; P = 0.025) were risk factors for false‐positive HMLN metastases.ConclusionsThe present study identified risk factors for false‐negative and false‐positive HMLN metastases in NSCLC patients staged by preoperative integrated FDG‐PET/CT. These findings would be helpful in selecting appropriate candidates for mediastinoscopy or endobronchial ultrasound‐guided transbronchial needle aspiration.

Texture Analysis and Synthesis of Malignant and Benign Mediastinal Lymph Nodes in Patients with Lung Cancer on Computed Tomography

“…A study 5 found that the false negative rate (1-specificity) of lymph-node metastasis of NSCLC was 13.2%, whereas 45.5% patients were pathologically confirmed as false positive (1-sensitivity), and concluded that lymph node staging using PET-CT is far from being equal to pathological staging. Other findings 6 on the specificity and sensitivity of PET/CT in detecting HMLN metastases in NSCLC patients were 91.0% and 47.4%, respectively. A recent survey 7 showed a wide range of the sensitivity of PET-CT in mediastinal LN staging, varying from 40–86.3%, reported by different research groups 8 9 10 11 12 13 14 15 , which suggested the limitation of PET-CT for the direct assessment of lymph nodes; and therefore, novel methods are needed to be developed to enhance the reliable evaluation of LN staging of NSCLC 7 .…”

Contrast‑enhanced magnetic resonance imaging with a novel nano‑size contrast agent for the clinical diagnosis of patients with lung cancer

“…Early diagnosis of lung cancer allows for the implementation of cancer treatments that may improve the overall survival rate of patients (32)(33)(34). A previous study has demonstrated that CEMRI was able to identify patients who would benefit from bevacizumab and erlotinib treatment compared with CT based on molecular imaging for an earlier diagnosis (35).…”

Current role of standardized uptake valuemax-derived ratios in N2 fluorine-18 fluorodeoxyglucose positron-emission tomography non-small cell lung cancer

“…In a study by Park et al (22) involving 144 patients with cN0 NSCLC who underwent preoperative PET/CT, the frequency of nodal upstaging was 14.3%; the actual frequencies of N1 and N2 involvement were 9.5% and 4.8% respectively, while Casiraghi et al (23) highlighted a 13% rate of occult nodal metastases (29 pN+ of 190 NSCLC cN0 patients). However, among the risk factors for false positives results, the history of lung disease (P<0.001) and central tumor location (P=0.021) were recognized (20).…”