Chiu Ka Lun, Chow Tsz Kit, Ma Kwok Man, Ma Wai Han
Nuclear Medicine Unit, Department of Radiology and Nuclear Medicine, Tuen Mun Hospital, New Territories, Hong Kong SAR, China.
Nucl Med Commun. 2025 Oct 1;46(10):959-966. doi: 10.1097/MNM.0000000000002018. Epub 2025 Jun 20.
Accurate lymph node staging is essential for treatment planning and prognosis in non-small cell lung cancer (NSCLC). [ 18 F]Fluorodeoxyglucose Positron emission tomography/computed tomography ([ 18 F]FDG PET/CT) is a widely used non-invasive imaging modality. Lymph node size and maximum standardized uptake value (SUVmax) are the most utilized parameters but with known limitations. We hypothesized the lymph node-to-primary tumor SUVmax ratio (N/T SUV ratio) could mitigate the limitations and provide a more reliable diagnostic measure.
This study aims to evaluate the diagnostic accuracy of the N/T SUV ratio in comparison to other PET/CT parameters.
This retrospective study evaluated consecutive patients with [ 18 F]FDG PET/CT done in Tuen Mun Hospital, Hong Kong between January 2023 and December 2023. PET/CT parameters, including SUVmax, N/T SUV ratio, visual score, and lymph node size, were analyzed. Receiver operating characteristic curves were used to determine optimal diagnostic cutoffs. Subgroup analyses were conducted based on lymph node and primary tumor characteristics.
A total of 62 patients with 98 histologically confirmed lymph nodes were included. N/T SUV ratio (cutoff: 0.5) demonstrated the highest diagnostic accuracy (area under curves: 0.924), with a sensitivity of 82.69% and specificity of 95.65%. It remained consistent across patient subgroups and outperformed SUVmax, visual score, and lymph node size in distinguishing metastatic from benign nodes.
N/T SUV ratio (cutoff: 0.5) demonstrates the best consistency and robustness across patient subgroups, mitigating SUVmax variability. Its simplicity and reproducibility make it a valuable parameter for NSCLC nodal staging. Further studies with larger, multicenter prospective cohorts are warranted to validate its application.
准确的淋巴结分期对于非小细胞肺癌（NSCLC）的治疗规划和预后至关重要。[18F]氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（[18F]FDG PET/CT）是一种广泛使用的非侵入性成像方式。淋巴结大小和最大标准化摄取值（SUVmax）是最常用的参数，但存在已知局限性。我们假设淋巴结与原发肿瘤的SUVmax比值（N/T SUV比值）可以减轻这些局限性，并提供更可靠的诊断指标。
本研究旨在评估N/T SUV比值与其他PET/CT参数相比的诊断准确性。
这项回顾性研究评估了2023年1月至2023年12月在香港屯门医院接受[18F]FDG PET/CT检查的连续患者。分析了PET/CT参数，包括SUVmax、N/T SUV比值、视觉评分和淋巴结大小。使用受试者操作特征曲线确定最佳诊断临界值。根据淋巴结和原发肿瘤特征进行亚组分析。
共纳入62例患者，98个经组织学证实的淋巴结。N/T SUV比值（临界值：0.5）显示出最高的诊断准确性（曲线下面积：0.924），敏感性为82.69%，特异性为95.65%。在区分转移淋巴结和良性淋巴结方面，它在各患者亚组中保持一致，且优于SUVmax、视觉评分和淋巴结大小。
N/T SUV比值（临界值：0.5）在各患者亚组中显示出最佳的一致性和稳健性，减轻了SUVmax的变异性。其简单性和可重复性使其成为NSCLC淋巴结分期的有价值参数。有必要进行更大规模的多中心前瞻性队列的进一步研究以验证其应用。
