Ratio of lymph node to primary tumor SUV on PET/CT accurately predicts nodal malignancy in non-small-cell lung cancer Journal Article


Authors: Mattes, M. D.; Moshchinsky, A. B.; Ahsanuddin, S.; Rizk, N. P.; Foster, A.; Wu, A. J.; Ashamalla, H.; Weber, W. A.; Rimner, A.
Article Title: Ratio of lymph node to primary tumor SUV on PET/CT accurately predicts nodal malignancy in non-small-cell lung cancer
Abstract: Introduction/Background Among non-small-cell lung cancers with appreciable functional activity, positron emission tomography/computed tomography (PET/CT) is the most accurate imaging modality for clinical staging. However, lymph nodes (LN) with marginally elevated standardized uptake value (SUV) present a diagnostic challenge. In this retrospective study, we hypothesized that normalizing the LN SUV by using the ratio of the LN to primary tumor SUVmax (SUVN/T) may be a better predictor of nodal malignancy than using SUVmax alone for nodes with low to intermediate SUV. Patients and Methods We identified 172 patients with newly diagnosed non-small-cell lung cancer who underwent pathologic LN staging and PET/CT within 31 days before biopsy. Receiver operating characteristic curves with area under the curve (AUC) calculations were used to evaluate SUVmax and SUVN/T for their ability to predict nodal malignancy for both the entire cohort of 504 LNs and a subset of 132 LNs from 85 patients who had both primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0. Results In patients with primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0, SUVN/T was significantly more accurate in predicting nodal malignancy (AUC, 0.846; 95% confidence interval, 0.775-0.917) than SUVmax (AUC, 0.653; 95% confidence interval, 0.548-0.759). The optimal cutoff value of SUVN/T to predict nodal malignancy was 0.28 (90% sensitivity, 68% specificity). Sensitivity was > 95% for SUVN/T < 0.21, whereas specificity was > 95% for SUVN/T > 0.50. Conclusion The ratio of LN SUV to primary tumor SUV on PET/CT is more accurate than SUVmax when assessing nodes of low to intermediate SUV. © 2015 Elsevier Inc. All rights reserved.
Keywords: adult; human tissue; aged; primary tumor; major clinical study; histopathology; area under the curve; cancer staging; staging; diagnostic accuracy; sensitivity and specificity; image analysis; clinical assessment; retrospective study; lymph node; lymphoma; computer assisted emission tomography; clinical evaluation; pet; lung biopsy; receiver operating characteristic; calculation; non small cell lung cancer; nsclc; diagnostic test accuracy study; ratio; oncological parameters; human; article; pet-ct scanner; lymph node to primary tumor ratio
Journal Title: Clinical Lung Cancer
Volume: 16
Issue: 6
ISSN: 1525-7304
Publisher: Elsevier Inc.  
Date Published: 2015-11-01
Start Page: e253
End Page: e258
Language: English
DOI: 10.1016/j.cllc.2015.06.001
PROVIDER: scopus
PUBMED: 26163919
DOI/URL:
Notes: Export Date: 2 November 2015 -- Source: Scopus
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MSK Authors
  1. Nabil Rizk
    137 Rizk
  2. Andreas Rimner
    286 Rimner
  3. Abraham Jing-Ching Wu
    225 Wu
  4. Amanda Foster
    62 Foster
  5. Wolfgang Andreas Weber
    158 Weber