Is FDG-PET/CT used correctly in the combined approach for nodal staging in NSCLC patients?

Background: The most widely accepted approach nowadays in nodal staging of non-small cell lung cancer (NSCLC) is the combined use of 18-Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). However,...

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Published in:	Nigerian journal of clinical practice Vol. 23; no. 6; pp. 842 - 847
Main Authors:	Simsek, F, Comak, A, Asik, M, Kuslu, D, Balci, T, Ulutas, H, Koroglu, R, Kekilli, E, Akatli, A, Elmali, F, Yalcin, N, Akyol, H
Format:	Journal Article
Language:	English
Published:	India Wolters Kluwer India Pvt. Ltd 01-06-2020 Medknow Publications and Media Pvt. Ltd
Subjects:	Adult Aged Biopsy, Fine-Needle Cancer staging Carcinoma, Non-Small-Cell Lung - diagnostic imaging Carcinoma, Non-Small-Cell Lung - metabolism Carcinoma, Non-Small-Cell Lung - pathology Endosonography - methods Female Fluorodeoxyglucose F18 - metabolism Humans Lung Neoplasms - diagnostic imaging Lung Neoplasms - metabolism Lung Neoplasms - pathology Lymph Nodes - diagnostic imaging Lymph Nodes - pathology Lymphatic Metastasis - pathology Male Mediastinum - pathology Middle Aged Multimodal Imaging Neoplasm Staging - methods Non-small cell lung cancer Positron emission tomography Positron Emission Tomography Computed Tomography - methods Radiopharmaceuticals - administration & dosage Radiopharmaceuticals - metabolism Retrospective Studies Sensitivity and Specificity Tomography, X-Ray Computed - methods FDG-PET/CT NSCLC staging EBUS-TBNA
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Summary:	Background: The most widely accepted approach nowadays in nodal staging of non-small cell lung cancer (NSCLC) is the combined use of 18-Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). However, this approach may not be sufficient, especially for early stages. Aims: Our aim was to assess whether more satisfactory results can be obtained with standardized uptake value maximum lymph node/standardized uptake value mean mediastinal blood pool (SUVmax LN/SUVmean MBP), SUVmax LN/Primary tumor, or a novel cut-off value to SUVmax in this special group. Subjects and Methods: Patients with diagnosed NSCLC and underwent FDG-PET/CT were reviewed retrospectively. 168 LNs of 52 early stage NSCLC patients were evaluated. The LNs identified in surgery/pathology reports were found in the FDG-PET/CT images. Anatomic and metabolic parameters were measured. Statistical analysis was performed by using of MedCalc Statistical Software. Results: Regardless of LNs size; sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SUVmax >2.5 were 91.5%, 65.9%, 58.2%, and 95.1%, respectively. Optimum cut-off value of SUVmax was >4.0. Sensitivity, specificity, PPV, and NPV were found as 81.0%, 90.0%, 81.0%, and 90.0% respectively. Optimum cut-off value of SUVmax LN/SUVmean MBP was >1.71. Sensitivity, specificity, PPV, and NPV were found as 94.7%, 80.0%, 71.1%, and 96.7%, respectively. Optimum cut-off value of SUVmax LN/Primary tumor was >0.28. Sensitivity, specificity, PPV, and NPV were found as 81.1%, 85.1%, 72.9% and 90.1%, respectively. Conclusion: SUVmax LN/SUVmean MBP >1.71 has higher PPV than currently used, with similar NPV and sensitivity. This can provide increase in the accuracy of combined approach. In this way, faster nodal staging/treatment decisions, cost savings for healthcare system and time saving of medical professionals can be obtained.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1119-3077
DOI:	10.4103/njcp.njcp_2_19