Abstract
We assessed the clinical value of 2-fluoro-2-deoxyglucose (18F-FDG) PET/CT imaging for predicting occult nodal metastasis in non-small cell lung cancer (NSCLC) patients. This retrospective study included 54 patients with T1-2N0M0 NSCLC who had undergone 18F-FDG PET/CT before surgery. Occult nodal metastasis was detected in 25.9% (14/54) of the patients. Immunohistochemical analysis revealed that increased glucose transporter 1 expression was associated with occult nodal metastasis, but hexokinase 2 expression was not. Compared to the negative nodal metastasis group, the positive nodal metastasis group was associated with increased maximum standardized uptake value (SUVmax) and tumor size. Multivariate analysis indicated that SUVmax and tumor size were associated with nodal metastasis. Nodal metastasis could be predicted with a sensitivity of 92.9% and a specificity of 55.0% when the SUVmax cutoff was 4.35. When patients were divided into low-risk (tumor size ≤ 2.5 cm and SUVmax ≤ 4.35), moderate-risk (tumor size ≤ 2.5 cm and SUVmax > 4.35 or tumor size > 2.5 cm and SUVmax ≤ 4.35) and high-risk (tumor size > 2.5 cm and SUVmax > 4.35) groups, the lymph node metastasis rates were 4.3%, 22.7%, and 88.9%, respectively. These results indicate that the combination of SUVmax and tumor size has potential clinical value for predicting occult nodal metastasis in NSCLC patients.
Highlights
Lung cancer is the leading cause of cancer deaths worldwide in both men and women
Occult nodal metastasis was detected in 25.9% (14/54) of the patients
These results indicate that the combination of SUVmax and tumor size has potential clinical value for predicting occult nodal metastasis in non-small cell lung cancer (NSCLC) patients
Summary
Lung cancer is the leading cause of cancer deaths worldwide in both men and women. Non-small cell lung cancer (NSCLC) accounts for 80%–85% of all cases of lung cancers [1]. Accurate assessment of lymph node metastasis (N stage) is critical in lung cancer, as it determines the type of surgery. PET-CT imaging with the glucose analogue 2-fluoro2-deoxyglucose (18F-FDG) takes advantage of the high glucose metabolism of lung cancer cells and metastatic lesions to visualize tumors and local lymph node metastasis and other distant metastases. In comparison, integrated 18F-FDGPET/CT is a much better predictor of nodal disease, with a sensitivity of 79–85% and a specificity of 87–92% [7, 8]. Despite these advantages, the rate of falsepositive and false-negative results with PET remains an issue that needs to be resolved.
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