Impact of 18F-FDG PET/CT, CT and EBUS/TBNA on preoperative mediastinal nodal staging of NSCLC

BMC Medical Imaging

Asem Mansour¹  Kamal Alrabi²  Feras Hawari³  Akram Al-Ibraheem⁴  Ula Al-Rasheed⁴  Stefano Fanti⁵  Fawzi Abuhijla⁶  Riad Abdeljalil⁷  Nader Hirmas⁸  Diana Paez⁹  Dalia Al-Rimawi^1,10 

[1] Department of Diagnostic Radiology, King Hussein Cancer Center, P.O. Box 1269, Queen Rania Al-Abdullah Street 202, Amman, Jordan;Department of Internal Medicine, Hematology and Oncology, King Hussein Cancer Center, P.O. Box 1269, Queen Rania Al-Abdullah Street 202, Amman, Jordan;Department of Medicine, Section of Pulmonary and Critical Care, King Hussein Cancer Center, P.O. Box 1269, Queen Rania Al-Abdullah Street 202, Amman, Jordan;Department of Nuclear Medicine, King Hussein Cancer Center, P.O. Box 1269, Queen Rania Al-Abdullah Street 202, Amman, Jordan;Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Bologna, Italy;Department of Radiation Oncology, King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman, Jordan;Department of Surgery, King Hussein Cancer Center, P.O. Box 1269, Queen Rania Al-Abdullah Street 202, Amman, Jordan;Nuclear Medicine Clinic, Essen University Hospital, Hufelandstrasse 55, 45147, Essen, Germany;Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria;Office of Scientific and Academic Research (OSAR), King Hussein Cancer Center, Queen Rania Al-Abdullah Street 202, Amman, Jordan;

关键词: NSCLC;    F-FDG PET/CT;    EBUS/TBNA;    Mediastinal lymph node staging;    NPV;   

DOI  :  10.1186/s12880-021-00580-w

来源: Springer

【 摘 要 】

BackgroundStaging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC.MethodsWe identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories.Results18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3% vs. 54.6%), and better specificity (60.5% vs. 43.6%, p = 0.01) overall and in patients with histopathological confirmation in MLN staging (60.6% vs. 38.2%). Negative predictive value of mediastinoscopy, EBUS/TBNA, and 18F-FDG PET/CT were (87.1%), (90.91%), and (83.33%) respectively. The overall accuracy was highest for mediastinoscopy (88.6%) and EBUS/TBNA (88.2%), followed by 18F-FDG PET/CT (70.2%). Dividing patients into N1 disease vs. those with N2/N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA in patients with histopathological confirmation shows 28 correlated true positive and true negative findings with final N-staging. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise remained undiscovered by EBUS/TBNA alone. Lymph nodes with a maximal standardized uptake value (SUVmax) more than 3 were significantly more likely to be true-positive.ConclusionMultimodality staging of the MLNs in NSCLC is essential to provide accurate staging and the appropriate treatment. 18F-FDG PET/CT has better overall diagnostic utility when compared to the CT scan. The NPV of 18F-FDG PET/CT in MLNs is reliable and comparable to the NPV of EBUS/TBNA. SUVmax of MLNs can help in predicting metastases, but nevertheless, a positive 18F-FDG PET/CT MLNs particularly if such a result would change the treatment plan, should be verified histopathologically.

【 授权许可】

CC BY