Lymph Node Staging in Lung Cancer Using [¹⁸F]FDG-PET

Abstract

IntroductionEarly diagnosis and correct staging are crucial for the stage-appropriate therapy of lung cancer as both reflect patients prognosis. The primary detection of lymph node metastases or distant metastases is decisive in planning patients management. Staging of non-small-cell lung cancer (NSCLC) is governed by the International System for Staging Lung Cancer, most recently revised in 1997 [1,2]. Studies have shown a very clear relationship between tumor stage and survival. Thus, patients with small tumors but no nodal or distant spread have a 60 ± 80 % five-year survival, whereas patients with disseminated metastatic disease have a less than 5 % chance of five-year survival [3].Computed tomography (CT) is one of the most common staging investigations performed and has been widely investigated. In the assessment of nodal stage, particularly for the mediastinum, the standard criterion for an involved mediastinal lymph node has varied but generally is regarded as a lymph node > 1 cm in the short axis and transverse plane [4]. Central to this rule is that malignant involvement of a lymph node causes an enlargement of respective lymph node and that there are no other causes for mediastinal lymph node enlargement [4]. This, however, is not always the case and, in one series, it was found that 13% of normal-sized lymph nodes (> 1 cm in diameter) contained malignant cells, while 25% of lymph nodes with diameters of 1.0 ± 1.9 cm had tumor, and only 37% of lymph nodes > 2 cm contained Abstract Background: Mediastinal lymph node staging is essential to determine treatment options in patients with NSCLC. Positron emission tomography (PET) detects increased glucose uptake in malignant tissue using the glucose analogue 2-[ 18 F]fluoro-2-deoxy-D-glucose (FDG). Patients and Methods: In the present study were evaluated 155 patients with focal pulmonary tumors who underwent both preoperative computed tomography (CT) and FDG-PET scanning (116 malignant and 39 benign lesions). Results: Findings in 155 patients included 116 malignant and 39 benign lesions. For N-staging, FDG-PET showed a sensitivity of 88%, a specificity of 91%, and an accuracy of 89%. Corresponding figures for CT were 77%, 76%, and 77%, respectively. Conclusions: FDG-PET is an effective, noninvasive method for staging thoracic lymph nodes in patients with lung cancer and is superior to CT scanning in the assessment of hilar and mediastinal nodal metastases. With regard to operability, FDG-PET could differentiate reliable between patients with N1/N2 disease and those with unresectable N3 disease.

Correlation of hypoxia inducible transcription factor in breast cancer and SUVmax of F-18 FDG PET/CT

“…HIF-1a protein is specifically induced by hypoxia in a graded response dependent on the oxygen concentration [5]. Determination of malignant lesions with PET/CT is based on their glucose metabolism [20,21]. The overexpression of Glut1 is closely related to FDG uptake in human cancer [20,21].…”

“…Determination of malignant lesions with PET/CT is based on their glucose metabolism [20,21]. The overexpression of Glut1 is closely related to FDG uptake in human cancer [20,21]. Glut1 is thought to be a possible intrinsic marker of hypoxia, and its expression is regulated by hypoxia via HIF-1 [22,23].…”

The maximum standardized FDG uptake on PET-CT in patients with non-small cell lung cancer

“…Many reports have suggested that FDG-PET-CT is superior to CT in the accuracy of N-staging for lung cancer [21-26]. Therefore, FDG-PET-CT is now regarded as the most accurate imaging modality for N-staging of lung cancer.…”

Diagnostic Performance of 18F-FDG PET/CT for Lymph Node Staging in Patients with Operable Non-small-cell Lung Cancer and Inflammatory Lung Disease

“…Both PET and integrated PET/CT have shown higher accuracy in lymph node staging of lung cancer than conventional CT [5,[9][10][11][12][13]. However, 18 F-FDG is not tumor-specific, therefore, it can be taken up by various physiologic changes or benign pathologic lesions [14].…”