In:
Nuclear Medicine Communications, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 10 ( 2021-10), p. 1130-1134
Abstract:
Studies demonstrating limited accuracy of ‘positive’ and ‘negative’ lymph nodes on fluorodeoxyglucose (FDG) PET-CT in staging for lung cancer have led to guidelines stating mediastinal nodes enlarged on computed tomography, irrespective of FDG uptake, require endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA). However FDG uptake occurs on a continuous spectrum and the use of standardised uptake value (SUV) max ratios, rather than a binary classification, may have improved diagnostic accuracy. Methods This was a retrospective analysis of patients with lung cancer who had PET-CT and EBUS-TBNA in 2015–2018. Results from EBUS and the SUV max ratio of sampled lymph nodes to mediastinal blood pool (SUV max LN/MBP) were analysed. Results From 99 patients 102 malignant and 54 benign nodes were identified. The SUV max range was 2.5–52 for malignant and 1.6–5.4 for benign nodes. The SUV max LN/MBP was 1.3–23 for malignant and 0.7–2.3 for benign nodes. All nodes with SUV max LN/MBP 〈 1.3 were benign with 100% negative predictive value (NPV). All nodes with SUV max LN/MBP 〉 2.3 were malignant with 100% positive predictive value (PPV). Conclusion In this relatively small sample, SUV max LN/MBP 〈 1.3 had a NPV of 100% for excluding malignant nodes and SUV max LN/MBP 〉 2.3 had a PPV of 100% for diagnosing malignant nodes. Using SUV max ratios could obviate the need for staging EBUS in selected patients with resultant time and cost savings. Selecting different SUV max ratios, chosen to provide high accuracies for the parameter of interest to change management, is a potentially powerful diagnostic tool that is overlooked when FDG uptake is only classified as ‘positive’ or ‘negative’.
Type of Medium:
Online Resource
ISSN:
0143-3636
DOI:
10.1097/MNM.0000000000001441
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
2028880-3
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