Abstract
BackgroundPatients with small-sized peripheral non-small cell lung cancer (NSCLC), but without lymph node metastasis, may be optimal candidates for sublobar resection. We aim to identify the predictors of occult lymph node metastasis (OLNM) using F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in clinically node-negative, small-sized NSCLC.MethodsOne hundred thirty nine patients with small-sized NSCLC (of less than 3 cm in diameter) who underwent surgical resection with mediastinal lymph node dissection were evaluated. The maximum standardized uptake value (SUVmax), metabolic total volume (MTV) and total lesion glycolysis (TLG) of the primary tumor were measured on pretreatment PET/CT. These metabolic parameters and pathological variables were analyzed for OLNM.ResultsThe mean tumor size was 2.11 ± 0.63 cm, and the mean number of dissected lymph nodes was 19.74 ± 12.86. Adenocarcinoma occurred in 106 patients (76.3 %). Twenty-four patients (17.2 %) had lymph node metastasis. The mean SUVmax, MTV and TLG were 4.61 ± 3.99 (0.5 ~ 17.8), 4.18 ± 6.39 (0 ~ 34.6) and 16.13 ± 28.86 (0 ~ 164.2), respectively. On receiver operating characteristic (ROC) curve analysis, the areas under the curve (AUC) for SUVmax, MTV and TLG for node metastasis were 0.753, 0.783 and 0.775, respectively. On multivariate analysis, SUVmax (Odds ratio [OR] = 1.120, p = 0.044) and MTV (OR = 1.117, p = 0.007) were found to be risk factors for OLNM. The concordance index of MTV was 0.763, which was slightly higher than that of SUVmax.ConclusionSUVmax and volume-based parameters are significant risk factors for OLNM in small peripheral NSCLC. MTV showed a better predictive performance than that of the other PET parameters; therefore, MTV may be a possible indicator for sublobar resection in clinically node-negative small-sized NSCLC.
Highlights
Patients with small-sized peripheral non-small cell lung cancer (NSCLC), but without lymph node metastasis, may be optimal candidates for sublobar resection
Several studies have reported that the survival duration is similar between patients with small peripheral NSCLC treated with segmentectomy versus lobectomy [4,5,6,7]
Patients We retrospectively reviewed the medical records of 440 consecutive NSCLC patients who underwent both pretreatment FDG positron emission tomography/computed tomography (PET/computed tomography (CT)) and surgery between January 2010 and June 2015 at the Ajou Medical Center
Summary
Patients with small-sized peripheral non-small cell lung cancer (NSCLC), but without lymph node metastasis, may be optimal candidates for sublobar resection. Recent studies have shown that volume parameters are a significant prognostic factor in early stage NSCLC [12,13,14]. The most recent study reported the prognostic role of TLG in stage IA NSCLC [14] Based on these previous studies regarding PET volume parameters, we hypothesized that the volume parameter of FDG PET can predict node metastasis in early NSCLC. Even though several studies have reported that the SUVmax of a primary tumor is a significant predictor of node metastasis in clinical stage IA lung cancer [8, 15], there have been few studies using volume-based parameters for detecting occult node metastasis in early-stage lung cancer
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