18F FDG PET For Mediastinal Staging

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18F FDG PET For Mediastinal Staging

  1. 1. 18F-FDGPET for Mediastinal Staging of Lung Cancer: Which SUV Threshold Makes Sense? Dirk Hellwig et al. Department of Nuclear Medicine, Saarland University Medical Center, Homburg/Saar, Germany J Nucl Med 2007; 48:1761–1766 Resident: Apichaya Claimon, M.D. Advisor: Pongpija Tuchinda, M.D.
  2. 2. Evaluation of mediastinal LN involvement Mediastinoscopy & Excision Gold standard Sen 80%, Spec 100% Invasive
  3. 3. Contrast-enhanced CT & MRI Use size criteria to differentiate between benign & malignant But 21% of metastases are in normal sized LN 40% of enlarged LN are no malignancy
  4. 4. 18F-FDG PET The most accurate noninvasive modality for staging mediastinal LN in lung cancer
  5. 5. Aim of the study To determine optimum SUV threshold for mediastinal LN staging in patients with NSCLC To compare diagnostic performance of SUV analysis with visual interpretation
  6. 6. MATERIALS AND METHODS Retrospective study Patients with suspected NSCLC 18F-FDG PET within 6 wk Mediastinoscopy Total 95 (75 men, 20 woman, age 62+9)
  7. 7. 18F-FDG PET LN evaluation Visual Compare with mediastinal blood pool 6 level (- - - to + + +) SUV max 1.5 cm ROI over visible LN or typical area of LN station
  8. 8. RESULT
  9. 9. Total 95 Lung CA 80 Malig mesothelioma 2 Benign 11 (SCC 39, adeno 31, Malig lymphoma 1 (TB 4, unspecified NSCLC 4, after pneumonia 2, Carcinosarcoma 1, silicosis 2, SCLC 5) MFH 1 sarcoidosis 1) Total 371 nodes biopsy 23/80 patient 70/311 nodes Positive mediastinal LN metastasis (23%) (29%)
  10. 10. 18F-FDG PET in LN staging of lung cancer unaffected lymph nodes (N0) peribronchial or hilar lymph node involvement (N1) ipsilateral mediastinal and subcarinal involvement (N2) contralateral and supraclavicular involvement (N3)
  11. 11. Comparison of SUVmax in mediastinal LN SUVs were higher in metastatic lymph node stations (P < 0.01)
  12. 12. Tumor-free LN with inflammatory changes had SUV = 2.7 + 2.0 (range, 0.8–14.9; n = 146)
  13. 13. Diagnostic performance Using Visual Interpretation Using SUV 2.5 as Cutoff Value
  14. 14. Using Visual Interpretation
  15. 15. Using Visual Interpretation
  16. 16. Using Visual Interpretation
  17. 17. Visual Interpretation vs. SUV Analysis AUC Visual 0.930+0.022 SUV 0.899+0.025 No significant (P = 0.241)
  18. 18. Determination of Optimal SUV Threshold Minimal FNR + FPR at SUV = 2.5 Highest diagnostic accuracy at SUV= 4.5
  19. 19. CONCLUSION
  20. 20. Human observation has higher sensitivity than SUV analysis But SUV has greater value in less experience observer
  21. 21. SUV threshold = 2.5 is feasible For differentiating benign from metastatic mediastinal lymph nodes in lung CA patients Sen = 89%, Spec = 84% False - : small metastasis False + : LN inflammation
  22. 22. High NPV (96%) if PET –ve ; can omit mediastinoscopy Highest diagnostic accuracy at SUV > 4.5 But SUV = 2.5 cannot applied to LN metastasis in other tumor types Because differ 18F-FDG uptake
  23. 23. Using Visual Interpretation

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