scholarly journals N-staging in large cell neuroendocrine carcinoma of the lung: diagnostic value of [18F]FDG PET/CT compared to the histopathology reference standard

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hubertus Hautzel ◽  
Yazan Alnajdawi ◽  
Wolfgang P. Fendler ◽  
Christoph Rischpler ◽  
Kaid Darwiche ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Neuroendocrine Carcinoma ◽  
Predictive Value ◽  
Fdg Pet ◽  
Interrater Reliability ◽  
Large Cell ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
N Staging

Abstract Background Large cell neuroendocrine carcinoma of the lung (LCNEC) is a rare entity occurring in less than 4% of all lung cancers. Due to its low differentiation and high glucose transporter 1 (GLUT1) expression, LCNEC demonstrates an increased glucose turnover. Thus, PET/CT with 2-[18F]-fluoro-deoxyglucose ([18F]FDG) is suitable for LCNEC staging. Surgery with curative intent is the treatment of choice in early stage LCNEC. Prerequisite for this is correct lymph node staging. This study aimed at evaluating the diagnostic performance of [18F]FDG PET/CT validated by histopathology following surgical resection or mediastinoscopy. N-staging interrater-reliability was assessed to test for robustness of the [18F]FDG PET/CT findings. Methods Between 03/2014 and 12/2020, 46 patients with LCNEC were included in this single center retrospective analysis. All underwent [18F]FDG PET/CT for pre-operative staging and subsequently either surgery (n = 38) or mediastinoscopy (n = 8). Regarding the lymph node involvement, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for [18F]FDG PET/CT using the final histopathological N-staging (pN0 to pN3) as reference. Results Per patient 14 ± 7 (range 4–32) lymph nodes were resected and histologically processed. 31/46 patients had no LCNEC spread into the lymph nodes. In 8/46 patients, the final stage was pN1, in 5/46 pN2 and in 2/46 pN3. [18F]FDG PET/CT diagnosed lymph node metastasis of LCNEC with a sensitivity of 93%, a specificity of 87%, an accuracy of 89%, a PPV of 78% and a NPV of 96%. In the four false positive cases, the [18F]FDG uptake of the lymph nodes was 33 to 67% less in comparison with that of the respective LCNEC primary. Interrater-reliability was high with a strong level of agreement (κ = 0.82). Conclusions In LCNEC N-staging with [18F]FDG PET/CT demonstrates both high sensitivity and specificity, an excellent NPV but a slightly reduced PPV. Accordingly, preoperative invasive mediastinal staging may be omitted in cases with cN0 disease by [18F]FDG PET/CT. In [18F]FDG PET/CT cN1-cN3 stages histological confirmation is warranted, particularly in case of only moderate [18F]FDG uptake as compared to the LCNEC primary.

N-Staging in Large Cell Neuroendocrine Carcinoma of the Lung: Diagnostic Value of FDG PET/CT Compared to the Histopathology Reference Standard

2021 ◽  
Author(s):  
Hubertus Hautzel ◽  
Yazan Alnajdawi ◽  
Wolfgang P Fendler ◽  
Christoph Rischpler ◽  
Kaid Darwiche ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Predictive Value ◽  
Fdg Pet ◽  
Interrater Reliability ◽  
Glucose Turnover ◽  
Glucose Transporter 1 ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
N Staging

Abstract Background:Large cell neuroendocrine carcinomas of the lung (LCNEC) is a rare entity occurring in less than 4% of all lung cancers. Due to its low differentiation and high glucose transporter 1 (GLUT1) expression LCNEC demonstrates an increased glucose turnover. Thus, PET/CT with 2-[18F]-fluoro-deoxyglucose (FDG) is suitable for LCNEC staging. Surgery with curative intent is the treatment of choice in early stage LCNEC. Prerequisite for this is correct lymph node staging. This study aimed at evaluating the diagnostic performance of FDG PET/CT validated by histopathology following surgical resection or mediastinoscopy. N-staging interrater-reliability was assessed to test for robustness of the FDG PET/CT findings.Methods:Between 03/2014 and 12/2020 46 patients with LCNEC were included in this single center retrospective analysis. All underwent FDG PET/CT for pre-operative staging and subsequently either surgery (n=38) or mediastinoscopy (n=8). Regarding the lymph node involvement, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for FDG PET/CT using the final histopathological N-staging (pN0 to pN3) as reference.Results:Per patient 14 ± 7 (range 4 - 32) lymph nodes were resected and histologically processed. 31/46 patients had no LCNEC spread into the lymph nodes. In 8/46 patients final stage was pN1, in 5/46 pN2 and in 2/46 pN3. FDG PET/CT diagnosed lymph node metastasis of LCNEC with a sensitivity of 93%, a specificity of 87%, an accuracy of 89%, a PPV of 78% and a NPV of 96%. Interrater-reliability was high with a strong level of agreement (κ=0.82).Conclusions:In LCNEC N-staging with FDG PET/CT demonstrates both high sensitivity and specificity, an excellent NPV but a slightly reduced PPV. Accordingly, preoperative invasive mediastinal staging may be omitted in cases with cN0 disease by FDG PET/CT. In FDG PET/CT cN1-cN3 stages histological confirmation is warranted, particularly in case of only moderate FDG uptake.

Evaluation of (18F) FDG-PET-CT for preoperative lymph-node staging of bladder cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 275-275 ◽  
Author(s):  
Julius van Essen ◽  
Joachim Grosse ◽  
David J. K. P. Pfister ◽  
Robin Epplen ◽  
Axel Heidenreich
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Predictive Value ◽  
Fdg Pet ◽  
Preoperative Staging ◽  
Lymph Node Staging ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Locoregional Staging

275 Background: Radical cystectomy with extended pelvic lymphadenectomy (EPLA) is the treatment of choice for muscle-invasive bladder cancer. For preoperative staging computed tomography and magnetic resonance imaging of the abdomen and the small pelvis are most commonly used in daily routine.Since the aforementioned methods, have a low sensitivity to detect local lymph node metastasis (LNM) we have prospectively evaluated the role of FDG – PET/CT for locoregional staging. Methods: In 27 patients (n = 27) with known invasive urothelial carcinoma or squamous cell carcinoma of the bladder a staging FDG – PET - CT was performed 1-2 days prior to radical cystectomy with EPLA. Subsequently, the results of the histopathological work-up of lymph node specimens and their anatomical localisations were correlated to the FDG-PET/CT findings. Total of 452 lymph nodes were removed, on average ≈ 16.7 per patient. Results: In 3/27 (11.1%) patients LNM were detected in histopathology. 2 patients showed one positive lymph node, 1 patient had two LNM. In two of these patients, the FDG-PET/CT showed an increased enrichment of FDG in projection to the corresponding histologically positive LN. One false negative and one false positive result of FDG-PET/CT were found. Calculated based on the patient population, the following statistics were calculated: Sensitivity (SENS) 66%, specificity (SPEC) 95.8%, positive predictive value (PPV) 66%, negative predictive value (NPV) 95.8%. Related to the absolute number of LN (n = 452), the following numbers were calculated: SENS 75% SPEC 98.7, PPV 37.5%, NPV 99.7%. Conclusions: To date, few studies have been conducted with regard to FDG-PET/CT and its role in locoregional staging. The reported specificity and NPV was between 86% and 100%, sensitivity and PPV were between 50% and 100%. Our results demonstrate specificity and NPV values of larger than 90% and make FDG-PET/CT a valuable staging tool to potentially identify patients with negative nodes in whom EPLA could be safely ommitted. Curently, routine use of PET CT scans can not be recommended and it is currently tested in a prospective multicenter study including a larger patient cohort.

Reduced Specificity and Positive Predictive Value of Surveillance FDG-PET/CT for Diffuse Large Cell B Cell Lymphoma in the Rituximab Era

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1576-1576
Author(s):  
Irit Avivi ◽  
Ariel Zilberlicht ◽  
Eldad J Dann ◽  
Jacob M. Rowe ◽  
Ronit Leiba ◽  
...  
Keyword(s):  
B Cell ◽  
Predictive Value ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large Cell ◽  
Pet Ct ◽  
Group 2 ◽  
Fdg Pet Ct ◽  
Group 1

Abstract Abstract 1576 Background: Surveillance PET is reported to allow the detection of asymptomatic relapses in a substantial number of patients with diffuse large cell B cell lymphoma (DLBCL). Recent data suggest that rituximab (R) administration results in a higher incidence of false positive (FP)“end-therapy” scans. However, the predictive value (PV) of surveillance PET in patients receiving R versus chemotherapy has not been fully explored. Objectives: The current study compared the PV of surveillance PET in patients with DLBCL receiving CHOP-R therapy versus CHOP alone. Patients and Methods: This retrospective study was approved by the IRB of the Rambam Health Care Campus (Haifa, Israel). The institutional database was searched for all newly diagnosed adult patients with DLBCL, treated with the CHOP or CHOP-R between January 1995–2008, who achieved complete remission (CR), had at least one follow-up (FU) FDG PET/CT during remission and were followed until relapse/death, or for at least 12 months after the last FU scan. The routine FU protocol included PET scans, performed at 3, 6, 12, 18, 24, 36, 48 and 60 months after CR. Demographic, clinical and imaging data at disease staging, during FU and at recurrence were collected and analyzed separately for patients treated with CHOP alone (group 1) and for those receiving CHOP-R (group 2). The ability of PET-FU to detect recurrence was assessed for the whole cohort, depending on rituximab administration, duration of CR, and location of suspicious findings. All scans were originally reviewed by 2 PET specialists, and positive scans were re-evaluated using the same criteria as those employed to report initial findings. PET-FU was considered positive in the presence of an uptake unrelated to physiological bio-distribution or a known benign process. PET-FU results were confirmed by biopsy or further imaging and clinical FU. Results: 119 patients, 35 treated with CHOP and 84 with CHOP-R, were analyzed. Median age was 59 years (24–88); 59% presented with an advanced stage (III-IV) and 45% had an IPI score ≥2. There were no statistically significant differences in patient characteristics in the 2 groups, except for a shorter median FU period for patients receiving R (2.9 vs 6.4 years, p<0.0001). Within a median FU of 3.4 years (0.6–8.6), 31 patients relapsed (17 confirmed histologically), 14 in the CHOP-R group (15%) vs 17 in the CHOP cohort (47%), (p=0.02). Nine (29%) relapses were initially detected by PET-FU in asymptomatic patients, with no difference in the incidence of these relapses between the 2 groups. Relapse involved the original sites in 85% of cases, with no differences between the groups. A total of 422 PET studies were performed; 113 in group 1 and 309 in group 2. Eighty three studies were judged to be positive, 23 in group 1 and 60 in group 2. However, in the CHOP-R group, only 23% (14/60) were truly positive compared to 74% (17/23) in the CHOP group (p=0.001).The median time to FP PET was significantly longer for patients receiving CHOP-R (1.3 vs 0.6 years, p=0.03). Specificity and positive PV (PPV) were significantly lower for patients receiving CHOP-R compared to those treated with CHOP only (Table 1). An FDG uptake involving head and neck lymph nodes was more likely to be FP, especially in group 2 (88% vs 4%, p=0.0004). Furthermore, age younger than 60 years and earlier disease stage were also found to be significantly associated with an increased incidence of FP results, particularly in patients receiving R. Conclusions: Surveillance PET in patients with DLBCL is highly sensitive for the detection of recurrence, providing the first indication of relapse in 29% of patients. However, comparative analysis shows that specificity of PET-FU is significantly lower in the R era, yielding a PPV of only 23%. Interestingly, late FP PET, involving nodal sites, uniquely observed in patients receiving R, is assumed to reflect lymph node “recovery” following the R-induced B cell depletion. The emerging data emphasize the limitations of surveillance PET in the R era and the need for an efficient algorithm for its use in this setting. Disclosures: No relevant conflicts of interest to declare.

scholarly journals COVID-19 vaccine-related lymph node activation – patterns of uptake on PET-CT

2021 ◽  
pp. 20210040
Author(s):  
Sweni Shah ◽  
Thomas Wagner ◽  
Malavika Nathan ◽  
Teresa Szyszko
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Fdg Pet ◽  
Deltoid Muscle ◽  
Time Interval ◽  
Case Review ◽  
Diagnostic Dilemma ◽  
Immunization Programme ◽  
Pet Ct ◽  
Fdg Pet Ct

In a bid to end the current COVID-19 crisis, many countries including UK have begun a mass immunization programme. Immunization can cause transient inflammation thereby causing increased metabolic activity at injection site and hypermetabolic lymph nodes. Various vaccinations and local injections have been known to cause diagnostic dilemma due to false-positive uptake on FDG PET-CT. In this pictorial case review, we present five cases demonstrating various patterns of uptake including an ipsilateral deltoid muscle, axillary, supraclavicular, and subpectoral lymph nodes post COVID-19 vaccination. A careful history of COVID-19 vaccination and normal size and morphology of lymph node on unenhanced low-dose CT will aid the diagnosis. All patients undergoing FDG PET-CT will require detailed documentation of the vaccination history including the time interval since vaccination. Knowledge about these patterns of uptake on PET-CT will ensure accurate interpretation by Nuclear Medicine physicians and radiologists during the current vaccination drive.

Volume-based parameters on FDG-PET/CT as early predictors of disease recurrence in postmastectomy breast cancer patients with one to three positive axillary lymph nodes without adjuvant radiotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1124-1124
Author(s):  
Naomi Nakajima ◽  
Masaaki Kataoka ◽  
Atsushi Nishikawa ◽  
Yoshifumi Sugawara ◽  
Shinya Sakai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Pet Ct ◽  
Fdg Pet Ct

1124 Background: The indication for postmastectomy radiotherapy (PMRT) in patients with 1-3 lymph node metastases in the axilla have been controversial, despite the recommendation that PMRT should be applied. In the current study, we focused our study on volume-based parameters of pretreatment FDG-PET/CT, with the aim of investigating a measurement that could help identify high-risk populations for recurrence. Methods: We retrospectively analyzed 88 patients of breast cancer treated with modified radical mastectomy and were found to have 1-3 metastatic axillary lymph nodes between 2006 and 2010. All of them were studied with FDG-PET/CT for initial staging. We evaluated the relationship between clinicopathologic factors or PET parameters including the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) and recurrence. MTV and TLG of the primary tumor and metastatic lymph node were measured by using semi-automatically delineated volume of interest (VOI) with an isocontour threshold of 40 % of the SUVmax. The optimal cutoffs of PET parameters were determined by ROC curve analysis. Results: The median follow up duration was 39 months. Median MTV was 21.1and median TLG was 42.7. Recurrence was observed in 10 patients. The area under the ROC curve of MTV and TLG for DFS was 0.82 and 0.85, respectively. In Cox univariate analysis, estrogen receptor status (HR = 6.8, p = 0.003), triple negativity (HR = 10.4, p = 0.0008), SUVmax (HR = 71.1, p = 0.001), MTV (HR = 130.3, p < 0.0001), and TLG (HR = 234.1, p = 0.0001) were significantly related to disease free survival (DFS). The estimated 3-year DFS rates were 96.4 % for the lower MTV group (< 31.8) and 71.4% for the higher MTV group (≥ 31.8, p = 0.0005). The estimated 3-year DFS rates were 95.8 % for the lower TLG group (< 109.6) and 50.0 % for the higher TLG group (≥ 109.6, p < 0.0001). On multivariate analysis, TLG was an independent prognostic factor of DFS (HR = 8.5, p = 0.005). Conclusions: Volume-based parameters on FDG-PET/CT were significant predictors of DFS in postmastectomy breast cancer patients with 1-3 metastatic axillary lymph nodes.

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