Cho Jaehyuk, Choe Jae Gol, Pahk Kisoo, Choi Sunju, Kwon Hye Ryeong, Eo Jae Seon, Seo Hyo Jung, Kim Chulhan, Kim Sungeun
Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
Nucl Med Mol Imaging. 2017 Jun;51(2):140-146. doi: 10.1007/s13139-016-0447-4. Epub 2016 Sep 1.
Following determination of the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes (SUV-LN) and of the primary tumor (SUV-T) on F-FDG PET/CT in patients with non-small-cell lung cancer (NSCLC), the aim of the study was to determine the value of the SUV-LN/SUV-T ratio in lymph node staging in comparison with that of SUV-LN.
We retrospectively reviewed a total of 289 mediastinal lymph node stations from 98 patients with NSCLC who were examined preoperatively for staging and subsequently underwent pathologic studies of the mediastinal lymph nodes. We determined SUV-LN and SUV-R for each lymph node station on F-FDG PET/CT and then classified each station into one of three groups based on SUV-T (low, medium and high SUV-T groups). Diagnostic performance was assessed based on receiver operating characteristic (ROC) curve analysis, and the optimal cut-off values that would best discriminate metastatic from benign lymph nodes were determined for each method.
The average of SUV-R of malignant lymph nodes was significantly higher than that of benign lymph nodes (0.79 ± 0.45 vs. 0.36 ± 0.23, < 0.0001). In the ROC curve analysis, the area under the curve (AUC) of SUV-R was significantly higher than that of SUV-LN in the low SUV-T group (0.885 vs. 0.810, = 0.019). There were no significant differences between the AUCs of SUV-LN and of SUV-R in the medium and high SUV-T groups. The optimal cut-off value for SUV-R in the low SUV-T group was 0.71 (sensitivity 87.5 %, specificity 85.9 %).
The SUV-R performed well in distinguishing between metastatic and benign lymph nodes. In particular, SUV-R was found to have a better diagnostic performance than SUV-LN in the low SUV-T group.
在非小细胞肺癌（NSCLC）患者的F-FDG PET/CT上测定纵隔淋巴结（SUV-LN）和原发肿瘤（SUV-T）的最大标准化摄取值（SUVmax）后，本研究旨在确定SUV-LN/SUV-T比值在淋巴结分期中的价值，并与SUV-LN进行比较。
我们回顾性分析了98例NSCLC患者术前进行分期检查并随后接受纵隔淋巴结病理研究的289个纵隔淋巴结站。我们在F-FDG PET/CT上测定每个淋巴结站的SUV-LN和SUV-R，然后根据SUV-T将每个站分为三组之一（低、中、高SUV-T组）。基于受试者操作特征（ROC）曲线分析评估诊断性能，并为每种方法确定能最佳区分转移性和良性淋巴结的最佳临界值。
恶性淋巴结的SUV-R平均值显著高于良性淋巴结（0.79±0.45对0.36±0.23，<0.0001）。在ROC曲线分析中，低SUV-T组中SUV-R的曲线下面积（AUC）显著高于SUV-LN（0.885对0.810，=0.019）。中SUV-T组和高SUV-T组中SUV-LN和SUV-R的AUC之间无显著差异。低SUV-T组中SUV-R的最佳临界值为0.71（敏感性87.5%，特异性85.9%）。
SUV-R在区分转移性和良性淋巴结方面表现良好。特别是，在低SUV-T组中，SUV-R的诊断性能优于SUV-LN。
