Abstract
Objective To study the FDG SUVmax cutoff values in detection of metastases in mediastinal lymph nodes (MLN) and hilar/intralobar lymph nodes (HILN) in pre-operative patients with N0-2 stage NSCLC. Methods A total of 69 patients with stage N0-2 NSCLC (40 males, 29 females, age 36-87 years) were included in this retrospective study. 18F-FDG PET/CT was performed and followed by lung cancer resection with lymph node dissection in 1 month. The excised lymph nodes were compared one by one between their SUVmax and histopathology. The SUVmax cutoff value in detection of lymph node metastases was determined by the ROC curve. Mann-Whitney u test, χ2 test, and Fisher exact test were used for data analysis. Results Metastatic MLN and (or) HILN were found in 21 of 69 NSCLC patients. The histopathologic results demonstrated metastases in 61 of 339 lymph nodes. The SUVmax of metastatic lymph nodes (4.95(3.46, 7.19)) was significantly higher than that of benign lymph nodes (2.10(1.59, 3.22); z=-7.576, P 0.05), while the specificities and accuracies between the two groups were significantly different (χ2 values: 96.7 and 56.1, both P<0.05). According to ROC curves, cutoff values of SUVmax in detecting metastatic MLN and metastatic HILN were 2.78 and 4.93. With the specific cutoff value, the sensitivity, specificity and accuracy in detection of metastatic MLN were 71.0%(22/31), 87.1%(175/201)and 84.9%(197/232), respectively. The corresponding data in detection of metastatic HILN were 73.3%(22/30), 77.9%(60/77) and 76.6%(82/107). Conclusion Different cutoff values of SUVmax in detecting metastatic MLN and metastatic HILN should be considered for more accurate lymph nodes staging in patients with NSCLC. Key words: Carcinoma, non-small-cell lung; Neoplasm metastasis; Lymph nodes; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose
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