Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: Analysis of 1145 lymph nodes

Al-Sarraf, Nael; Gately, Kathy; Lucey, Julie; Wilson, Lorraine; McGovern, Eillish; Young, Vincent

doi:10.1016/j.lungcan.2007.08.036

Cited by 69 publications

(51 citation statements)

References 17 publications

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“…This can probably be explained by the lower sensitivity of PET-CT for nodes smaller than 1 cm [11]. On STIR TSE, metastatic nodes have a high signal, while non-metastatic nodes present with a low signal, which influenced Ohno et al [10] to suggest that MRI should be considered as a substitute for PET-CT for the assessment of mediastinal nodes.…”

Section: Mri Assessment Of N-classificationmentioning

confidence: 99%

MRI in lung cancer: a pictorial essay

Hochhegger

Marchiori²,

Sedlaczek³

et al. 2011

BJR

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ABSTRACT. Imaging studies play a critical role in the diagnosis and staging of lung cancer. CT and 18-fluorodeoxyglucose positron emission tomography CT (PET/CT) are widely and routinely used for staging and assessment of treatment response. Many radiologists still use MRI only for the assessment of superior sulcus tumours, and in cases where invasion of the spinal cord canal is suspected. MRI can detect and stage lung cancer, and this method could be an excellent alternative to CT or PET/CT in the investigation of lung malignancies and other diseases. This pictorial essay discusses the use of MRI in the investigation of lung cancer. . The lung remains a challenge for MRI, but this method provides excellent tissue differentiation, and new sequences have increased the temporal resolution [3], expanding the use of MRI beyond its traditional applications. MRI can currently be used for establishing tumour node metastasis (TNM) staging, lung cancer screening and assessing lung nodules for likelihood of being benign or malignant [3]. This pictorial essay discusses the use of MRI in the diagnosis and staging of lung cancer. MRI for detection and characterisation of pulmonary nodulesMultidetector CT (MDCT) is routinely used to confirm and characterise lung lesions [1]. It is a very sensitive method for the detection of pulmonary nodules, and is considered the gold standard for detection of these lesions. The sensitivity of MRI for nodules of 5 to 11 mm is between 85% and 95% [4]. Although MDCT can depict nodules as small as 1 or 2 mm, immediate action is recommended only for lesions larger than 7 or 8 mm, depending on the lung cancer risk stratification. Followup to assess growth pattern is recommended for lesions smaller than 7 mm [5]. Koyama et al [6] reported that non-contrast enhanced pulmonary MRI can effectively detect malignant nodules as thin-section MDCT (Figure 1). The overall detection rate of nodules in each MRI sequence (82.5%) was significantly lower than that of MDCT (97.0%, p,0.05), however detection rates were not significantly different for malignant nodules (p.0.05) (Figure 2). Establishing clinical TNM stageThe overall agreement of clinical TNM (cTNM) staging established by CT compared with post-operative pathological TNM (pTNM) is not significantly better than 50%. Obviously, this comparison does not take into account cases in which the cTNM contraindicates surgery, as it does for the majority of cases. CT and PET-CT are currently the modalities recommended for assessing lung cancer if radical treatment (surgery or other therapeutic modality with curative intent) is suggested [1]. However, the capabilities of MRI have not yet been properly explored. MRI assessment of T-classificationThe T-stage of a tumour is the primary determinant of its resectability [7]. Evaluation of the primary tumour includes an assessment of its size, and the presence and extent of mediastinal or chest wall involvement. Of particular importance is the distinction between T3 and T4 tumours [7]. The definition of a T3 lesion i...

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Section: Mri Assessment Of N-classificationmentioning

confidence: 99%

MRI in lung cancer: a pictorial essay

Hochhegger

Marchiori²,

Sedlaczek³

et al. 2011

BJR

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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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“…Generally, SUVmax values are lower than other types of lung cancer with lower tumour metabolism, such as in epithelioidtype MPM or adenocarcinoma, in contrast, infectious or granulomatosus diseases can cause false-positive results without malignancy on PET. 19,20,21 Four patients with a false-positive PET result were diagnosed with infectious pleuritis, and one was diagnosed with tuberculosis in the pleural thickening group. We think that the false-negative PET/CT results are due to the low tumour metabolism of MPM, and that the false-positive PET/CT results are due to the infectious process.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of 18-FDG PET/CT in the Differential Diagnosis of Malignant and Benign Pleural Diseases

Ceylan¹

2013

UHOD

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Integrated whole-body 18-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT) is a non-invasive imaging technique for identifying several types of malignant diseases. We evaluated the role of PET/CT in distinguishing malignant from benign pleural diseases. Thirty patients, who had pleural abnormalities on computed tomography (CT), such as thickening, fluid with suspicion of malignant pleural mesothelioma or any other malignancy underwent PET/CT. Maximum standardized uptake values (SUVmax) were calculated separately for pleural thickening and pleural fluid and compared with pathological results obtained by video thoracoscopy. Twenty-two patients with pleural thickening and 25 patients with pleural fluid were assessed with regard to the accuracy of PET/CT. The overall sensitivity,specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT was 81.8%, 54.5%, 64.3%, 75%, and 68.2% for pleural thickening and it was 100%, 56.5%, 41.1%, 100%, and 60% for patients with pleural fluid. When the pleural thickening was evaluated, the SUVmax values were higher in the malignant pleural diseases than in the benign pleural diseases but the difference was not statistically significantly (p = 0.063). When the pleural fluid was evaluated, the SUVmax values were also higher in the malignant pleural diseases than in the benign pleural diseases and the difference was statistically significantly (p= 0.03). The accuracy of PET/CT for detecting malignant pleural fluids was high. However, PET/CT was not adequate to make the differential diagnosis of pleural malignancies especially in case of pleural thickening because of its relatively low sensitivity,specificity,PPV, and NPV. A tissue biopsy is necessary to determine the diagnosis. Keywords: 18-fluorodeoxiglucose-positron emission tomography, Pleural Disease ÖZET Malign ve Benign Plevral Hastal›klar›n Ay›r›c› Tan›s›nda 18-FDG PET/BT'nin Etkinli¤iTüm vücut 18-florodeoksiglukoz pozitron emisyon tomografi /bilgisayarl› tomografisi (PET / BT) birçok malign hastal›¤›n tan›s›nda kullan›lan non-invaziv bir hibrid görüntüleme tekni¤idir. Çal›flmam›zda malign ve benign plevral hastal›klar›n ay›r›c› tan›s›nda PET / BT'nin etkinli¤i de¤erlendirildi. Bilgisayarl› tomografide malign plevral mezotelyoma ve di¤er malignite flüphesi oluflturan plevral kal›nlaflma veya plevral s›v›s› saptanan 30 hastaya PET / BT uyguland›. SUVmax de¤erleri plevral kal›nlaflma ve plevral s›v› için ayr› ayr› hesaplanarak video torakoskopi ile elde edilen patoloji sonuçlar› ile karfl›laflt›r›ld›. Plevral kal›nlaflmas› olan 22 hasta ve plevral s›v›s› olan 25 hasta PET / BT etkinli¤i aç›s›ndan de¤erlendirildi. Plevral kal›nlaflma için duyarl›l›k, özgüllük, pozitif prediktif de¤er (PPV), negatif prediktif de¤eri (NPD) ve PET / BT'nin etkinlik oran› s›ras›yla %81.8, %54.5, %64.3, %75 ve %68.2, plevra s›v› için s›ras›yla %100, %56.5, %41.1, %100 ve %60 idi. Plevral kal›nlaflma için bak›ld›¤›nda SUVmax de¤erleri malign hastalarda daha yüksek olmakla beraber...

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Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: Analysis of 1145 lymph nodes

Cited by 69 publications

References 17 publications

MRI in lung cancer: a pictorial essay

MRI in lung cancer: a pictorial essay

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

Accuracy of 18-FDG PET/CT in the Differential Diagnosis of Malignant and Benign Pleural Diseases

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Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: Analysis of 1145 lymph nodes

Cited by 69 publications

References 17 publications

MRI in lung cancer: a pictorial essay

MRI in lung cancer: a pictorial essay

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

Accuracy of 18-FDG PET/CT in the Differential Diagnosis of Malignant and Benign Pleural Diseases

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