Prognostic impact of preoperative FDG-PET positive lymph nodes in lung cancer
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ORIGINAL ARTICLE
Prognostic impact of preoperative FDG‑PET positive lymph nodes in lung cancer Hideki Endoh1 · Akihiro Ichikawa2 · Ryohei Yamamoto1 · Satoshi Shiozawa3 · Nobuhiro Nishizawa1 · Yukitoshi Satoh4 · Noboru Oriuchi5,6 Received: 20 May 2020 / Accepted: 5 September 2020 © Japan Society of Clinical Oncology 2020
Abstract Background 2-[18F] Fluoro-D-deoxyglucose positron emission tomography (FDG-PET) is an appropriate diagnostic procedure for staging lung cancer. However, accurate evaluation of lymph node (LN) metastases by PET is controversial owing to false-positive/-negative FDG uptake results. The prognostic significance of both false-negative and false-positive LNs on FDG-PET remains to be determined. Methods A total of 235 patients with lung cancer were retrospectively analyzed. Maximum standardized uptake values (SUVmax) of the lymph nodes were compared with pathological LN metastases to correlate PET findings with clinicopathological variables and patients’ outcomes. Results When SUVmax ≥ 4 was defined as PET-positive for LN metastasis, sensitivity, specificity, and accuracy were 46.0%, 79.5%, and 72.3%, respectively. False-negative cases and pathological n0 cases were significantly younger, had primary tumors that were smaller or lower SUVmax, and adenocarcinomas compared with false-positive and pathological n + cases. The difference in survival time between patients with abnormal FDG uptake in the LN and those without was larger than that between pathological LN metastases and no pathological metastases in patients with adenocarcinoma. Multivariate analysis by the Cox proportional hazard model identified smoker, EGFR/ALK negative and LN positive on PET as significant adverse prognostic factors, rather than pathological n-stage. Conclusions Abnormal FDG uptake in the LN is an important prognostic factor. Increased glucose metabolism on FDGPET appears to be a more efficient postoperative prognostic marker than pathological n-stage in patients with lung cancer. Keywords Lung cancer · FDG-PET · Prognosis · Lymph node metastasis · EGFR
* Hideki Endoh [email protected] 1
Department of Thoracic Surgery, Saku Central Hospital Advanced Care Center, 3400‑28 Nakagomi, Saku, Nagano 385‑0051, Japan
2
High Functional Diagnosis Center, Saku Central Hospital Advanced Care Center, 3400‑28 Nakagomi, Saku, Nagano 385‑0051, Japan
3
Department of Pathological Diagnostics, Saku Central Hospital Advanced Care Center, 3400‑28 Nakagomi, Saku, Nagano 385‑0051, Japan
4
Department of Thoracic Surgery, Kitasato University Hospital, 1‑15‑1 Kitasato, Minami, Sagamihara, Kanagawa 252‑0375, Japan
5
Advanced Clinical Research Center, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960‑1295, Japan
6
Department of Nuclear Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960‑1295, Japan
Introduction 2-[18F] Fluoro-D-deoxyglucose positron emission tomography (FDG-PET) is an indispensable diagnostic procedure for non-invasive staging of non-small-cell lung cancer (NSCLC).
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