Abstract
We evaluated the usefulness of fluorine-18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) in the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer and then compared the findings with the results of X-ray CT by region based on the histological diagnoses. We examined 29 patients with non-small cell lung cancer. One hundred and thirty-two mediastinal lymph nodes were surgically removed and the histological diagnoses were confirmed. FDG PET images, including 146 mediastinal regions, were visually analysed and the mediastinal lymph nodes were scored as positive when the FDG uptake was higher than that in the other mediastinal structures. On the X-ray CT scans, any mediastinal lymph nodes with a diameter of 10 mm or larger were scored as positive. All three examinations were successfully performed on 71 regions. For FDG PET, we found a sensitivity of 76%, a specificity of 98% and an accuracy of 93%. On the other hand, for X-ray CT a sensitivity of 65%, a specificity of 87% and an accuracy of 82% were observed. A significant difference was observed in respect of both specificity and accuracy (P<0.05). Based on the above findings, FDG PET is suggested to be superior to X-ray CT when used for the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer.
Similar content being viewed by others
References
Watanabe Y, Shimizu J, Oda M, Hayashi Y, Watanabe S, Tatsuzawa Y, Iwa T, Suzuki M, Takashima T. Aggressive surgical intervention in N2 non-small cell cancer of the lung.Ann Thorac Surg 1991; 51: 253–261.
Staples CA, Müller NL, Miller RR, Evans KG, Nelems B. Mediastinal nodes in bronchogenic carcinoma: comparison between CT and mediastinoscopy.Radiology 1988; 167: 367–372.
Webb WR, Gatsonis C, Zerhouni EA, Heelan RT, Glazer GM, Francis IR, McNeil BJ. CT and MR imaging in staging nonsmall cell bronchogenic carcinoma: report of the radiologic diagnostic oncology group.Radiology 1991; 178: 705–713.
McLoud TC, Bourgouin PM, Greenberg RW, Kosiuk JP, Templeton PA, Shepard JAO, Moore EH, Wain JC, Mathisen DJ, Grillo H. Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling.Radiology 1992; 182: 319–323.
Wahl RL, Quint LE, Greenough RL, Meyer CR, White RI, Orringer MB. Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluation.Radiology 1994; 191; 371–377.
Musset D, Grenier P, Carette MF, Frija G, Hauuy MP, Desbleds MT, Girard P, Bigot JM, Lallemand D. Primary lung cancer staging: prospective comparative study of MR imaging with CT.Radiology 1986; 160: 607–611.
Poon PY, Bronskill MJ, Henkelman RM, Rideout DF, Shulman HS, Weisbrod GL, Steinhardt MI, Dunlap HJ, Ginsberg RJ, Feld R, Sutcliffe SB, Williams JI. Mediastinal lymph node metastases from bronchogenic carcinoma: detection with MR imaging and CT.Radiology 1987; 162: 651–656.
Nolop KB, Rhodes CG, Brudin LH, Beaney RP, Krausz T, Jones T, Hughes JMB. Glucose utilization in vivo by human pulmonary neoplasms.Cancer 1987; 60: 2682–2689.
Kubota K, Matsuzawa T, Fujiwara T, Ito M, Hatazawa J, Ishiwata K, Iwata R, Ido T. Differential diagnosis of lung tumor with positron emission tomography: a prospective study.J Nucl Med 1990; 31: 1927–1933.
Gupta NC, Frank AR, Dewan NA, Redepenning LS, Rothberg ML, Mailliard JA, Phalen JJ, Sunderland JJ, Frick MP. Solitary pulmonary nodules: detection of malignancy with PET with 2-[F-18]-fluoro-2-deoxy-d-glucose.Radiology 1992; 184: 441–444.
Ichiya Y, Kuwabara Y, Otsuka M, Tahara T, Yoshikai T, Fukumura T, Jingu K, Masuda K. Assessment of response to cancer therapy using fluorine-18-fluorodeoxyglucose and positron emission tomography.J Nucl Med 1991; 32: 1655–1660.
The Japan Lung Cancer Society. General rules for clinical and pathological records of lung cancer. Tokyo: Kanahara, 1987.
Kanno I, Miura S, Yamamoto S, Iida H, Murakami M, Takahashi K, Uemura K. Design and evaluation of a positron emission tomogram: Headtome III.J Comput Assist Tomogr 1985; 9: 931–939.
Akashi Y, Ichiya Y, Kuwabara Y, Sasaki M, Yoshida T, Fukumura T, Masuda K. The partial volume effect correction for pulmonary mass lesions using68Ga/68Ge transmission scan in PET study. [in Japanese].Jpn J Nucl Med 1994; 31: 1511–1517.
Friedman PJ. Lung cancer: update on staging classification.AJR 1988; 150: 261–264.
Som P, Atkins HL, Bandoypadhyay D, Fowler JS, MacGregor RR, Matsui K, Oster ZH, Sacker DF, Shine CY, Turner H, Wan C-N, Wolf AP, Zabinski SV. A fluorinated glucose analog, 2-fluoro-2-deoxy-d-glucose (F-18): non-toxic tracer for rapid tumor detection.J Nucl Med 1980; 21: 670–675.
Tahara T, Ichiya Y, Kuwabara Y, Otsuka M, Miyake Y, Masuda K. High [18F]fluorodeoxyglucose uptake in abdominal abscess: a PET study.J Comput Assist Tomogr 1989; 13: 829–831.
Sasaki M, Ichiya Y, Kuwabara Y, Otsuka M, Tahara T, Fukumura T, Gunasekera R, Masuda K. Ringlike uptake of [18F]FDG in brain abscess: a PET study. J Comput Assisst Tomogr 1990; 14: 486–487.
Brudin LH, Valind S-O, Rhodes CG, Pantin CF, Sweatman M, Jones T, Hughes JMB. Fluorine-18 deoxyglucose uptake in sarcoidosis measured with positron emission tomography.Eur J Nucl Med 1994; 21: 297–305.
Lewis PJ, Salama A. Uptake of fluorine-18-deoxyglucose in sarcoidosis.J Nucl Med 1994; 35: 1647–1649.
Yamada S, Kubota K, Kubota R, Ido T, Tamahashi N. High accumulation of fluorine-18-fluorodeoxyglucose in turpentine-induced inflammatory tissue.J Nucl Med 1995; 36: 1301–1306.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sasaki, M., Ichiya, Y., Kuwabara, Y. et al. The usefulness of FDG positron emission tomography for the detection of mediastinal lymph node metastases in patients with non-small cell lung cancer: a comparative study with X-ray computed tomography. Eur J Nucl Med 23, 741–747 (1996). https://doi.org/10.1007/BF00843701
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00843701