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BMC Pulmonary Medicine

, 16:177

Cancer

Abstract

BackgroundStaging of mediastinal lymph nodes in non-small cell lung cancer NSCLC is mandatory. The maximum Standard Uptake Value SUVmax obtained using F-18 fluorodeoxyglucose positron emission tomography FDG-PET is the best non-invasive technique available for this evaluation, but its performance varies from center to center. The aim of the present study was to identify FDG-PET predictors of mediastinal malignancy that are able to minimize intercenter variability and improve the selection of subsequent staging procedures.

MethodA multicenter study of NSCLC patients staged through FDG-PET and endobronchial ultrasonography with needle aspiration EBUS-NA was performed using therapeutic surgery with systematic nodal dissection as gold standard. Intercenter variability and predictive power for mediastinal malignancy of different FDG-PET measures were assessed, as well as the role of these measures for selecting additional staging procedures.

ResultsOne hundred and twenty-one NSCLC patients, of whom 94 72% had ≥1 hypermetabolic spots in the mediastinum, were included in the study. Mean SUVmax of the primary tumor was 12.3 SD 6.3, and median SUVmax of the highest hypermetabolic spots in the mediastinum was 3.9 IQR 2.4-7. Variability of FDG-PET measures between hospitals was statistically significant p = 0.016 and p < 0.001 respectively, but lost significance when SUVmax in the mediastinum was expressed as a ratio or a subtraction from the primary tumor SUVmax mediastinum-tumor, p = 0.083; and SUVmax mediastinum - tumor, p = 0.428 respectively. SUVmax mediastinum-tumor showed higher accuracy in the ROC analysis AUC 0.77 CI 0.68-0.85, p < 0.001, and showed predictive power for mediastinal malignancy when using a 0.4 cutoff OR 6.62, 95%CI 2.98-14.69. Sensitivities and negative predictive values of clinical staging through EBUS-NA attained values ranging between 57% and 92% after FDG-PET, which improved with additional techniques when the tumor had a diameter >3 cm and-or a SUVmax mediastinum-tumor ratio >0.4.

ConclusionThe SUVmax mediastinum-tumor ratio is a good predictor of regional tumor extension in NSCLC. This measure is not influenced by intercenter variability and has an accuracy of over 70% for the identification of malignancy when using a 0.4 cutoff.

KeywordsFDG-PET F-18 fluorodeoxyglucose positron emission tomography Lung cancer NSCLC EBUS-NA Endobronchial ultrasonography with needle aspiration AbbreviationsAUCArea under the curve

CTcomputed tomography

EBUS-NAEndobronchial ultrasonography with needle aspiration

EUS-NAesophageal ultrasound with needle aspiration

FDG-PETF-18 fluorodeoxyglucose positron emission tomography

IQRinterquartile range

NPVnegative predictive value

ROCReceiver Operating Characteristic

SUVmaxmaximum Standard Uptake Value

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Autor: M. Serra Fortuny - M. Gallego - Ll Berna - C. Montón - L. Vigil - M. J. Masdeu - A. Fernández-Villar - M. I. Botana -

Fuente: https://link.springer.com/



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