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

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.

Download Full-text

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

EJNMMI Research ◽

10.1186/s13550-021-00811-9 ◽

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.

Download Full-text

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

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.275 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 275-275 ◽

Cited By ~ 2

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.

Download Full-text

Predictive value of volumetric parameters measured by F-18 FDG PET/CT for lymph node status in patients with surgically resected rectal cancer

Annals of Nuclear Medicine ◽

10.1007/s12149-014-0809-x ◽

2014 ◽

Vol 28 (3) ◽

pp. 196-202 ◽

Cited By ~ 5

Author(s):

Hong Jae Jo ◽

Seong-Jang Kim ◽

In Joo Kim ◽

Sojung Kim

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Predictive Value ◽

Fdg Pet ◽

Lymph Node Status ◽

Node Status ◽

Pet Ct ◽

Fdg Pet Ct

Download Full-text

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

BJR|case reports ◽

10.1259/bjrcr.20210040 ◽

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.

Download Full-text

Prediction of macrometastasis in axillary lymph nodes of patients with invasive breast cancer and the utility of the SUV lymph node/tumor ratio using FDG-PET/CT

World Journal of Surgical Oncology ◽

10.1186/s12957-014-0424-2 ◽

2015 ◽

Vol 13 (1) ◽

pp. 49 ◽

Cited By ~ 12

Author(s):

Manabu Futamura ◽

Takahiko Asano ◽

Kazuhiro Kobayashi ◽

Kasumi Morimitsu ◽

Masahito Nawa ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Invasive Breast Cancer ◽

Fdg Pet ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Pet Ct ◽

Fdg Pet Ct

Download Full-text

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.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1124 ◽

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.

Download Full-text

FDG-PET/CT and Para-Aortic Staging in Endometrial Cancer. A French Multicentric Study

Journal of Clinical Medicine ◽

10.3390/jcm10081746 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1746

Author(s):

Camille Sallée ◽

François Margueritte ◽

Sébastien Gouy ◽

Antoine Tardieu ◽

Jérémie Belghiti ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

High Risk ◽

Predictive Value ◽

Fdg Pet ◽

Histological Type ◽

Multicentric Study ◽

Pet Ct ◽

Overall Performance ◽

Fdg Pet Ct

Background: FDG-PET/CT is a noninvasive examination that could be helpful for the management of endometrial cancer. The aim of this study was to evaluate the performance of FDG-PET/CT in assessing para-aortic lymph-node involvement in high-risk endometrial cancer. Methods: We performed a retrospective multicenter study including all patients who had a high-risk endometrial cancer with a preoperative FDG-PET/CT and a para-aortic lymphadenectomy (PAL) between 2009 and 2019. The main objective was to evaluate the overall performance of FDG-PET/CT. The secondary objectives were to evaluate its performances according to the histological type and according to FDG-PET/CT date (before or after hysterectomy), and to compare its overall performance with that of the MRI scan. Results: We included 200 patients from six different centers. After the false positive FDG-PET/CT was reread by nuclear physicians, FDG-PET/CT had a sensitivity of 61.8%, a specificity of 89.7%, a positive predictive value of 69.4%, a negative predictive value of 86.1%, and an AUC of 0.76. There were no statistically significant differences in the performances according to either histological type and or FDG-PET/CT date. The sensitivity of FDG-PET/CT was better than that of MRI (p < 0.01), but the specificity was not (p = 0.82). Conclusion: Currently, FDG-PET/CT alone cannot replace PAL for the lymph node evaluation of high-risk endometrial cancers. It seems essential to reread it in multidisciplinary meetings before validating the therapeutic management of patients, particularly in the case of isolated para-aortic involvement.

Download Full-text

Comparison of [68Ga]Ga-DOTA-FAPI-04 PET/CT with [18F]FDG PET/CT for Nodule Characterization and Staging in NSCLC Patients

10.21203/rs.3.rs-455463/v1 ◽

2021 ◽

Author(s):

Xin Zhou ◽

Shuailiang Wang ◽

Xiaoxia Xu ◽

Xiangxi Meng ◽

Huiyuan Zhang ◽

...

Keyword(s):

Lymph Nodes ◽

Fdg Pet ◽

Lesion Detection ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Imaging Characteristics ◽

Pet Ct ◽

Fdg Pet Ct ◽

Nsclc Patients ◽

N Staging

Abstract Purpose:The aim of this study is to explore the nodule characterization and staging efficacy of [68Ga]Ga-DOTA-FAPI-04 PET/CT in non-small cell lung cancer (NSCLC) patients and to compare with that of [18F]FDG PET/CT lesion-by-lesion.Methods:Sixty-five patients with clinically diagnosed or suspected NSCLC were enrolled in this prospective study (ChiCTR2000038080). All patients received both [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 PET/CT, and they were assigned into three groups by different research directions as nodule characterization, node (N) staging and metastatic (M) staging. Imaging characteristics in PET/CT of lung nodules and suspected metastatic lesions were obtained and analyzed.Results:In the nodule characterization group, [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 SUVmax ≥ 2.5 was set as the predictor of NSCLC, and the diagnostic sensitivity of [68Ga]Ga-DOTA-FAPI-04 was higher than [18F]FDG (0.88 vs. 0.67). And for adenocarcinoma with partial-solid density, SUVmax of 68Ga-DOTA-FAPI-04 was higher than [18F]FDG with significant differences (4.8 ± 2.8 vs. 2.1 ± 1.1). In N staging group, lymph nodes SUVmax of [68Ga]Ga-DOTA-FAPI-04 was lower than [18F]FDG in nonmetastatic group (3.1 ± 1.3 vs. 6.1 ± 2.3) and higher than [18F]FDG (10.7 ± 4.7 vs. 6.5 ± 3.3) in metastatic group. Set 6 and 1.1 as the cut-off value for [68Ga]Ga-DOTA-FAPI-04 SUVmax and [68Ga]Ga-DOTA-FAPI-04 SUVmax/FDG SUVmax, diagnostic accuracy of metastatic lymph nodes using each criterion and their combination was 95%, 93% and 97% respectively. In multi-metastatic NSCLC patients, [68Ga]Ga-DOTA-FAPI-04 identified more lesions than [18F]FDG (206 vs. 106 lesions) and the uptake value of [68Ga]Ga-DOTA-FAPI-04 was higher too, but no patients’ staging was changed.Conclusion:Compared with [18F]FDG, [68Ga]Ga-DOTA-FAPI-04 PET/CT imaging has higher sensitivity in primary and metastatic lesion detection of NSCLC patients, it also increases the specificity of metastatic lymph nodes diagnosis.

Download Full-text