Integrated positron emission tomography/computed tomography for evaluation of mediastinal lymph node staging of non-small-cell lung cancer in a tuberculosis-endemic area: A 5-year prospective observational study

Abstract

Background. Integrated positron emission tomography/computed tomography (PET-CT) is a well-validated modality for assessing mediastinal lymph node metastasis in non-small-cell lung cancer (NSCLC), which determines management and predicts survival. Tuberculosis (TB) is known to lead to false-positive PET-CT findings. Objectives. To assess the diagnostic accuracy of PET-CT in identifying mediastinal lymph node involvement of NSCLC in a high TB-endemic area. Methods. Patients who underwent both PET-CT and lymph node tissue sampling for the investigation of suspected NSCLC were prospectively included in this observational study. Results were analysed per patient and per lymph node stage. A post-hoc analysis was performed to test the validity of a maximum standardised uptake value (SUV max) cut-off for lymph node positivity. Results. PET-CT had a sensitivity of 92.6%, specificity of 48.6%, positive predictive value of 56.8% and negative predictive value (NPV) of 90.0% in the per-patient analysis. Diagnostic accuracy was 67.2%. Similar values were obtained in the per-lymph node stage analysis. TB was responsible for 21.1% of false-positive results. A SUVmax cut-off of 4.5 yielded an improvement in diagnostic accuracy from 64.0% to 84.7% compared with a cut-off of 2.5, but at the cost of decreasing the NPV from 90.6% to 83.5%. Conclusion. In a high TB-endemic area, PET-CT remains a valuable method for excluding mediastinal lymph node involvement in NSCLC. Patients with a negative PET-CT may proceed to definitive management without further invasive procedures. However, PET-CT-positive lymph nodes require pathological confirmation, and the possibility of TB must be considered.

Fructose-1,6-Bisphosphatase 1 Reduces18F FDG Uptake in Hepatocellular Carcinoma

“…Fluorine 18 ( 18 F) fluorodeoxyglucose (FDG) combined positron emission tomography (PET) and computed tomography (CT) (hereafter, PET/CT) is based on the abnormally high rate of glucose metabolism found in cancer cells, and it is widely used in diagnostic imaging of many malignant tumors (3)(4)(5). Increased 18 F FDG uptake has been associated with poor prognosis in patients with HCC (6).…”

“…Chen et al in several cancers (3)(4)(5). Investigators have reported that the sensitivity of 18 F FDG PET is low in the detection of HCC (12)(13)(14)(15), but the underlying mechanism for relatively low 18 F FDG accumulation in some patients with HCC is still unclear.…”

The diagnostic accuracy of integrated positron emission tomography/computed tomography in the evaluation of pulmonary mass lesions in a tuberculosis-endemic area

“…[2] The majority of studies on PET-CT have been conducted in areas with a low or moderate prevalence of TB, a disease which is well known to cause false-positive results. [3,4] Developing regions, particularly TB-endemic areas, therefore face a potential challenge of interpreting PET-CT images as false positive. [5,6] The aim of this study was to assess the sensitivity, specificity, and diagnostic accuracy of integrated PET-CT in the evaluation of SPNs and masses in an area with a very high TB incidence.…”

Retrospective analysis for the false positive diagnosis of PET-CT scan in lung cancer patients

“…However, the PET-CT positive results required pathological verification, to exclude the potential possibility of tuberculosis. [ 25 ] Therefore, tuberculosis is known cause for to false-positive PET-CT findings. To enhance the control of tuberculosis in tuberculosis-endemic countries, such as India, Indonesia, China, and so on, may help improve the diagnostic accuracy of PET-CT in lung cancer.…”

“…Shaw et al reported that compared with a cut-off of 2.5, a SUV max cut-off of 4.5 yielded could promote the diagnostic accuracy from 64.0% to 84.7%. [ 25 ] Thus, to progress in tuberculosis control and optimize the standard of PET-CT technique may be promising approaches to reduce the false positive rate of PET-CT in lung cancer.…”