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Metabolic parameters using 18F-FDG PET/CT correlate with occult lymph node metastasis in squamous cell lung carcinoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to investigate predictability of occult lymph node metastasis (OLM) using metabolic parameters on pretreatment 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/CT in squamous cell non-small cell lung carcinoma (SC-NSCLC) patients who were clinically node negative (cN0) before surgery.

Methods

A total of 63 cN0 SC-NSCLC patients (M/F = 61/2, mean age 64.1 ± 8.0) who underwent curative surgery with lymph node dissection were enrolled in this study. Metabolic tumor volume (MTV) of the primary tumor was obtained with a standardized uptake value (SUV) threshold of 2.5. Total lesion glycolysis (TLG) was calculated by multiplication of the MTV and its SUVmean. Metabolic parameters (SUVmax, MTV, and TLG) and clinicopathological factors were analyzed for OLM.

Results

Of 63 patients, 12 (19.0 %) had OLM. Significantly higher SUVmax, MTV, TLG, and pathological tumor size were observed in patients with OLM. The optimal cutoff values for prediction of OLM determined using a receiver-operating characteristic (ROC) curve were 8.8 for SUVmax, 18.9 cm3 for MTV, 88.4 for TLG, and 2.8 cm for pathological tumor size. Univariate analysis showed correlation of SUVmax, MTV, and TLG with the rate of OLM. In multivariate analyses, high SUVmax and MTV showed an association with an increased risk of OLM, after adjusting for age, sex, pathological tumor size, T stage, and location.

Conclusion

Metabolic parameters on pretreatment 18F-FDG PET/CT were significant predictors for OLM in cN0 SC-NSCLC patients. Surgical planning can be tailored based on the parameters in order to reduce the risk of hidden residual lymph node metastases in patients.

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Acknowledgments

This work was supported by grants (A111345) from the Korea Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea; a grant from the National Nuclear R&D Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (No.2012M2A2A7014020); a grant from the National Research Foundation of Korea (NRF) grant funded by the Korean government (MEST) (No.2009-0078222, 2009-0078234); a grant from the Medical Cluster R&D Support Project of Daegu Gyeongbuk Medical Innovation Foundation, Republic of Korea (2013).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50, Samduk 2-ga, Jung Gu, Daegu, Republic of Korea, 700-721

    Do-Hoon Kim, Chae Moon Hong, Shin Young Jeong, Sang-Woo Lee, Jaetae Lee & Byeong-Cheol Ahn

  2. Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea

    Bong-Il Song

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  1. Do-Hoon Kim
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Correspondence to Byeong-Cheol Ahn.

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Supplementary Fig. 1

Receiver-operating characteristic curve analyses for SUVmax (a), MTV (b), TLG (c), and tumor size (d) for prediction of occult lymph node metastasis. SUV max maximum standardized uptake value, MTV metabolic tumor volume, TLG total lesion glycolysis, AUC area under the receiver-operating characteristic curve (GIF 92 kb)

High resolution image (TIFF 181 kb)

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Kim, DH., Song, BI., Hong, C.M. et al. Metabolic parameters using 18F-FDG PET/CT correlate with occult lymph node metastasis in squamous cell lung carcinoma. Eur J Nucl Med Mol Imaging 41, 2051–2057 (2014). https://doi.org/10.1007/s00259-014-2831-6

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  • DOI: https://doi.org/10.1007/s00259-014-2831-6

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