A comparative evaluation of mediastinal nodal SUVmax and derived ratios from 18F-FDG PET/CT imaging to predict nodal metastases in non-small cell lung cancer

AlRasheedi, M., Han, S. , Thygesen, H., Neilson, M., Hendry, F., Alkarn, A., Maclay, J. D. and Leung, H. Y. (2023) A comparative evaluation of mediastinal nodal SUVmax and derived ratios from 18F-FDG PET/CT imaging to predict nodal metastases in non-small cell lung cancer. Diagnostics, 13(7), 1209. (doi: 10.3390/diagnostics13071209) (PMID:37046427) (PMCID:PMC10093125)

Abstract

18F-FDG positron emission tomography with computed tomography (PET/CT) is a standard imaging modality for the nodal staging of non-small cell lung cancer (NSCLC). To improve the accuracy of pre-operative staging, we compare the staging accuracy of mediastinal lymph node (LN) standard uptake values (SUV) with four derived SUV ratios based on the SUV values of primary tumours (TR), the mediastinal blood pool (MR), liver (LR), and nodal size (SR). In 2015–2017, 53 patients (29 women and 24 men, mean age 67.4 years, range 53–87) receiving surgical resection have pre-operative evidence of mediastinal nodal involvement (cN2). Among these, 114 mediastinal nodes are resected and available for correlative PET/CT analysis. cN2 status accuracy is low, with only 32.5% of the cN2 cases confirmed pathologically. Using receiver operating characteristic (ROC) curve analyses, a SUVmax of N2 LN performs well in predicting the presence of N2 disease (AUC, 0.822). Based on the respective selected thresholds for each ROC curve, normalisation of LN SUVmax to that for mediastinum, liver and tumour improved sensitivities of LN SUVmax from 68% to 81.1–89.2% while maintaining acceptable specificity (68–70.1%). In conclusion, normalised SUV ratios (particularly LR) improve current pre-operative staging performance in detecting mediastinal nodal involvement.

• Item Type: Articles
• Additional Information: M.A. is supported by a scholarship from the Embassy of the State of Kuwait.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Alrasheedi, Maha M S A S and Maclay, Dr John and Leung, Professor Hing and Alkarn, Ahmed Atef Farouk Mohammed and Neilson, Dr Matthew and Thygesen, Dr Helene and Han, Dr Sai and Hendry, Dr Fraser
• Authors: AlRasheedi, M., Han, S., Thygesen, H., Neilson, M., Hendry, F., Alkarn, A., Maclay, J. D., and Leung, H. Y.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Diagnostics
• Publisher: MDPI
• ISSN: 2075-4418
• ISSN (Online): 2075-4418
• Published Online: 23 March 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Diagnostics 13(7): 1209
• Publisher Policy: Reproduced under a Creative Commons License