Value of Dual-Time-Point FDG PET/CT for Mediastinal Nodal Staging in Non-Small-Cell Lung Cancer Patients With Lung Comorbidity

Purpose: To evaluate the efficacy of dual-time-point F-18 fluorodeoxyglucose positron emission tomography (FDG PET)/ computed tomography (CT) for mediastinal nodal staging in non-small-cell lung cancer patients with lung comorbidity. Materials and Methods: Fifty-three pathologically proven non-small-cell lung cancer patients with pulmonary comorbidity and 49 patients as controlled group without comorbidity were enrolled. PET/CT was performed at 1-hour (whole body) post-FDG injection and repeated 2 hours (thoracic) after injection. All patients received radical surgery with system mediastinal lymph node (LN) dissection. The results of LN detection by single-time-point and dual-time-point scan were compared with the histopathologic findings. Results: On a per-patient basis, in patients with pulmonary comorbidity, the sensitivity, specificity, accuracy, and positive predictive values (PPV), and negative predictive values of single-time-point scan were 87.5%, 59.5%, 67.9%, 48.3%, and 91.7%, respectively. Those values of dual-time-point scan were 93.8%, 67.6%, 75.5%, 55.6%, and 96.2%, respectively. In patients without comorbidity, dual-time-point scan was similar in those values to single-time-point. On a per-nodal station basis, the specificity, accuracy, and PPV of dual-time-point scan were better than those of single-time-point with statistically significant differences (P = 0.017, 0.002, and 0.027, respectively) in patients with pulmonary comorbidity, but the difference was not statistically significant in patients with no pulmonary comorbidity. Conclusions: Dual-time-point FDG PET/CT is more effective for mediastinal nodal staging than single-time-point in patients with pulmonary comorbidity. Dual-time-point scan was useful for diagnosis of mediastinal LN metastases in reducing the false-positive results in all patients, but improved specificity, accuracy, and PPV only in patients with pulmonary comorbidity.

[1]  C. Mountain,et al.  Regional lymph node classification for lung cancer staging. , 1997, Chest.

[2]  J. Czernin,et al.  Characterization of hilar lymph node by 18F-fluoro-2-deoxyglucose positron emission tomography in healthy subjects. , 2001, Anticancer research.

[3]  Abass Alavi,et al.  Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. , 2002, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[4]  Thomas Beyer,et al.  Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. , 2003, Radiology.

[5]  Y. Onodera,et al.  Mediastinal Lymph Node Staging by FDG-PET in Patients with Non-Small Cell Lung Cancer: Analysis of False-Positive FDG-PET Findings , 2003, Respiration.

[6]  G. V. von Schulthess,et al.  Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. , 2003, The New England journal of medicine.

[7]  J. Mountz,et al.  The role of FDG-PET scan in staging patients with nonsmall cell carcinoma. , 2003, The Annals of thoracic surgery.

[8]  Alfred A Bartolucci,et al.  The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with nonsmall cell lung cancer. , 2004, The Annals of thoracic surgery.

[9]  Y. Nishiwaki,et al.  Pitfalls in lymph node staging with positron emission tomography in non-small cell lung cancer patients. , 2005, Lung cancer.

[10]  I. Goethals,et al.  Focally enhanced f-18 fluorodeoxyglucose (FDG) uptake in incidentally detected pulmonary embolism on PET/CT scanning. , 2006, Clinical nuclear medicine.

[11]  K. Gately,et al.  Factors causing inaccurate staging of mediastinal nodal involvement in non-small cell lung cancer patients staged by positron emission tomography. , 2007, Interactive cardiovascular and thoracic surgery.

[12]  Kyung Soo Lee,et al.  Mediastinal nodal staging of nonsmall cell lung cancer using integrated 18F‐FDG PET/CT in a tuberculosis‐endemic country , 2007, Cancer.

[13]  T. Ece,et al.  The Additional Value of FDG PET Imaging for Distinguishing N0 or N1 From N2 Stage in Preoperative Staging of Non-small Cell Lung Cancer in Region Where the Prevalence of Inflammatory Lung Disease Is High , 2007, Clinical nuclear medicine.

[14]  Yung‐Chie Lee,et al.  18F-FDG PET for the lymph node staging of non-small cell lung cancer in a tuberculosis-endemic country: Is dual time point imaging worth the effort? , 2008, European Journal of Nuclear Medicine and Molecular Imaging.

[15]  Y. Nishiyama,et al.  Dual-time-point FDG-PET for evaluation of lymph node metastasis in patients with non-small-cell lung cancer , 2008, Annals of nuclear medicine.

[16]  Takeshi Ishizaki,et al.  Evaluation of Dual–Time-Point 18F-FDG PET for Staging in Patients with Lung Cancer , 2008, Journal of Nuclear Medicine.

[17]  Gang Huang,et al.  Optimizing delayed scan time for FDG PET: Comparison of the early and late delayed scan , 2008, Nuclear medicine communications.

[18]  Jinming Yu,et al.  Value of PET/CT versus enhanced CT for locoregional lymph nodes in non-small cell lung cancer. , 2008, Lung cancer.

[19]  Joon-Kee Yoon,et al.  Diagnostic Performance of 18F-FDG PET/CT for Lymph Node Staging in Patients with Operable Non-small-cell Lung Cancer and Inflammatory Lung Disease , 2008, Lung.

[20]  S. Kanazawa,et al.  Dual-Time-Point F-18 FDG PET/CT for Evaluation of Intrathoracic Lymph Nodes in Patients With Non-Small Cell Lung Cancer , 2009, Clinical nuclear medicine.

[21]  K. Suga,et al.  Dual-time point 18F-FDG PET/CT scan for differentiation between 18F-FDG-avid non-small cell lung cancer and benign lesions , 2009, Annals of nuclear medicine.

[22]  Jinming Yu,et al.  Dual-time-point FDG PET for the evaluation of locoregional lymph nodes in thoracic esophageal squamous cell cancer. , 2009, European journal of radiology.

[23]  Hisao Ito,et al.  Dual-time point scanning of integrated FDG PET/CT for the evaluation of mediastinal and hilar lymph nodes in non-small cell lung cancer diagnosed as operable by contrast-enhanced CT. , 2010, European journal of radiology.