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

• 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
• DOI: 10.4103/njcp.njcp_2_19
• ISSN: 1119-3077

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.