Occult Nodal Metastasis Defined by PET-CT Identifies a Unique Clinical Subtype of Lung Cancer: A Retrospective Multicenter Study

Abstract PurposeTo investigate the surgical prognosis and efficacy of adjuvant therapy in non-small cell lung cancer (NSCLC) with occult lymph node metastasis (ONM) defined by positron emission tomography-computed tomography (PET-CT).MethodsA total of 3537 NSCLC patients receiving surgical resection were included in this study. The prognosis between patients with ONM and evident nodal metastasis, ONM patients with and without adjuvant therapy were compared, respectively.ResultsONM was associated with significantly better prognosis than evident nodal metastasis whether for patients with N1 (5-year OS: 56.8% versus 52.3%, adjusted p value=0.267; 5-year RFS: 44.7% versus 33.2%, adjusted p value=0.031) or N2 metastasis (5-year OS: 42.8% versus 32.3%, adjusted p value=0.010; 5-year RFS: 31.3% versus 21.6%, adjusted p value=0.025). In ONM population, patients receiving adjuvant therapy yielded better prognosis comparing to those without adjuvant therapy (5-year OS: 50.1% versus 33.5%, adjusted p value<0.001; 5-year RFS: 38.4% versus 22.1%, adjusted p value<0.001). ConclusionsONM defined by PET-CT identifies a unique clinical subtype of lung cancer, ONM is a favorable prognostic factor whether for pathological N1 or N2 NSCLC and adjuvant therapy could provide additional survival benefits for ONM patients.

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Accuracy of positron emission tomography and computed tomography (PET/CT) in detecting nodal metastasis according to histology of non-small cell lung cancer

Updates in Surgery ◽

10.1007/s13304-019-00680-x ◽

2019 ◽

Vol 71 (4) ◽

pp. 741-746

Author(s):

David E. Smith ◽

Julian Fernandez Aramburu ◽

Alejandro Da Lozzo ◽

Juan A. Montagne ◽

Enrique Beveraggi ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Positron Emission Tomography ◽

Small Cell Lung Cancer ◽

Nodal Metastasis ◽

Small Cell ◽

Emission Tomography ◽

Small Cell Lung ◽

Positron Emission ◽

Pet Ct

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Convolutional Neural Networks Promising in Lung Cancer T-Parameter Assessment on Baseline FDG-PET/CT

Contrast Media & Molecular Imaging ◽

10.1155/2018/1382309 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Margarita Kirienko ◽

Martina Sollini ◽

Giorgia Silvestri ◽

Serena Mognetti ◽

Emanuele Voulaz ◽

...

Keyword(s):

Lung Cancer ◽

Fdg Pet ◽

Area Under The Curve ◽

Ct Images ◽

Tnm System ◽

Positron Emission ◽

Pet Ct ◽

Test Sets ◽

Fdg Pet Ct

Aim. To develop an algorithm, based on convolutional neural network (CNN), for the classification of lung cancer lesions as T1-T2 or T3-T4 on staging fluorodeoxyglucose positron emission tomography (FDG-PET)/CT images. Methods. We retrospectively selected a cohort of 472 patients (divided in the training, validation, and test sets) submitted to staging FDG-PET/CT within 60 days before biopsy or surgery. TNM system seventh edition was used as reference. Postprocessing was performed to generate an adequate dataset. The input of CNNs was a bounding box on both PET and CT images, cropped around the lesion centre. The results were classified as Correct (concordance between reference and prediction) and Incorrect (discordance between reference and prediction). Accuracy (Correct/[Correct + Incorrect]), recall (Correctly predicted T3-T4/[all T3-T4]), and specificity (Correctly predicted T1-T2/[all T1-T2]), as commonly defined in deep learning models, were used to evaluate CNN performance. The area under the curve (AUC) was calculated for the final model. Results. The algorithm, composed of two networks (a “feature extractor” and a “classifier”), developed and tested achieved an accuracy, recall, specificity, and AUC of 87%, 69%, 69%, and 0.83; 86%, 77%, 70%, and 0.73; and 90%, 47%, 67%, and 0.68 in the training, validation, and test sets, respectively. Conclusion. We obtained proof of concept that CNNs can be used as a tool to assist in the staging of patients affected by lung cancer.

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Mediastinal Staging for Lung Cancer

Canadian Respiratory Journal ◽

10.1155/2014/890108 ◽

2014 ◽

Vol 21 (3) ◽

pp. 159-161 ◽

Cited By ~ 8

Author(s):

Jacob Gelberg ◽

Sean Grondin ◽

Alain Tremblay

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Positron Emission Tomography ◽

Lymph Nodes ◽

Emission Tomography ◽

Mediastinal Staging ◽

Positron Emission ◽

Pet Ct ◽

Diagnosis Of Cancer ◽

Rule Out

Staging of the mediastinal and hilar lymph nodes plays a crucial role in identifying the best treatment option for patients with confirmed or suspected lung cancer and, in many cases, can simultaneously confirm a diagnosis of cancer. Noninvasive modalities, such as computed tomography (CT), positron emission tomography (PET) and PET-CT, are an important first step in this assessment. Ultimately, invasive staging is frequently required to confirm or rule out the presence of metastatic disease within the lymph nodes. The present focused review describes and compares noninvasive and invasive modalities for mediastinal staging in lung cancer.

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Potential clinical value of PET/CT in predicting occult nodal metastasis in T1-T2N0M0 lung cancer patients staged by PET/CT

Oncotarget ◽

10.18632/oncotarget.19535 ◽

2017 ◽

Vol 8 (47) ◽

pp. 82437-82445 ◽

Cited By ~ 4

Author(s):

Xiang Zhou ◽

Ruohua Chen ◽

Gang Huang ◽

Jianjun Liu

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Nodal Metastasis ◽

Clinical Value ◽

Lung Cancer Patients ◽

Pet Ct

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Etiology of Solitary Extrapulmonary Positron Emission Tomography and Computed Tomography Findings in Patients With Lung Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.10.116 ◽

2005 ◽

Vol 23 (28) ◽

pp. 6846-6853 ◽

Cited By ~ 87

Author(s):

Didier Lardinois ◽

Walter Weder ◽

Marina Roudas ◽

Gustav K. von Schulthess ◽

Michaela Tutic ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Positron Emission Tomography ◽

Ct Imaging ◽

Emission Tomography ◽

Whole Body ◽

Benign Tumors ◽

Positron Emission ◽

Pet Ct ◽

The Impact

Purpose The aim of this prospective study was to assess the incidence and the nature of solitary extrapulmonary [18F] fluorodeoxyglucose (FDG) accumulations in patients with non–small-cell lung cancer (NSCLC) staged with integrated positron emission tomography and computed tomography (PET/CT) and to evaluate the impact on management. Patients and Methods A total of 350 patients with NSCLC underwent whole-body PET/CT imaging. All solitary extrapulmonary FDG accumulations were evaluated by histopathology, further imaging, or clinical follow-up. Results PET/CT imaging revealed extrapulmonary lesions in 110 patients. In 72 patients (21%), solitary lesions were present. A diagnosis was obtained in 69 of these patients, including 37 (54%) with solitary metastases and 32 (46%) with lesions unrelated to the lung primary. Histopathologic examinations of these 32 lesions revealed a second clinically unsuspected malignancy or a recurrence of a previous diagnosed carcinoma in six patients (19%) and a benign tumor or inflammatory lesion in 26 patients (81%). The six malignancies consisted of carcinoma of the breast in two patients, and carcinoma of the orbit, esophagus, prostate, and non-Hodgkin's lymphoma in one patient each. Benign tumors and inflammatory lesions included eight colon adenomas, four Warthin's tumors, one granuloma of the lower jaw, one adenoma of the thyroid gland, one compensatory muscle activity due to vocal chord palsy, two occurrences of arthritis, three occurrences of reflux esophagitis, two occurrences of pancreatitis, two occurrences of diverticulitis, one hemorrhoidal inflammation, and one rib fracture. Conclusion Solitary extrapulmonary FDG accumulations in patients with newly diagnosed lung cancer should be analyzed critically for correct staging and optimal therapy, given that up to half of the lesions may represent unrelated malignancies or benign disease.

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Endobronchial ultrasound guided biopsy (EBUS–TBNA) for staging of patients with lung cancer without mediastinal involvement at positron emission tomography-computed tomography (PET-CT)

10.1183/13993003.congress-2016.pa2041 ◽

2016 ◽

Cited By ~ 1

Author(s):

Therese Maria Henriette Naur ◽

Lars Konge ◽

Paul Frost Clementsen

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Positron Emission Tomography ◽

Emission Tomography ◽

Endobronchial Ultrasound ◽

Ultrasound Guided ◽

Positron Emission ◽

Pet Ct ◽

Mediastinal Involvement ◽

Ultrasound Guided Biopsy

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Clinical Application of Positron Emission Tomography (PET) in Designing Radiation Fields in Non-Small Cell Lung Cancer (NSCLC) Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2005.07.174 ◽

2005 ◽

Vol 63 ◽

pp. S101-S102 ◽

Cited By ~ 1

Author(s):

C.G. Wood ◽

C.E. Hill ◽

L.R. Kaiser ◽

J.M. Metz

Keyword(s):

Lung Cancer ◽

Positron Emission Tomography ◽

Small Cell Lung Cancer ◽

Clinical Application ◽

Small Cell ◽

Emission Tomography ◽

Small Cell Lung ◽

Radiation Fields ◽

Positron Emission ◽

Nsclc Patients

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Volumetric and dosimetric comparison of computerised radiotherapy treatment plan between using positron emission tomography/computed tomography (PET/CT) and CT images for target delineation in non-small cell lung cancer patients

Journal of Radiotherapy in Practice ◽

10.1017/s1460396916000078 ◽

2016 ◽

Vol 15 (2) ◽

pp. 161-169

Author(s):

Sanphat Sangudsup ◽

Tawika Kaewchur ◽

Waralee Teeyasoontranon ◽

Pitchayaponne Klunklin ◽

Nisa Chawapun ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Positron Emission Tomography ◽

Organs At Risk ◽

Small Cell ◽

Emission Tomography ◽

Target Coverage ◽

Small Cell Lung ◽

Positron Emission ◽

Pet Ct

AbstractPurposeTo compare intensity-modulated radiation therapy (IMRT) treatment planning between using positron emission tomography/computed tomography (PET/CT) and CT for target volume delineation in patients with non-small cell lung cancer (NSCLC).MethodsNine NSCLC patients with PET/CT images were enrolled into this study. Gross tumour volumes (GTVs) were delineated by the PET visual assessment (PETvis), the automated PET (PETauto), standardised uptake value (SUV)>2·5 (PET2·5) and threshold 40% SUVmax (PET40), and CT-based method. For each patient, two IMRT treatment plans based on CT and PET/CT delineation were performed. The target coverage and the dose–volume parameters for organs at risk were analysed.ResultsThe PETauto referred to PET40 when SUVmax<7 and PET2·5 when SUVmax≥7. The mean GTVs were 15·04, 15·7 and 15·14 cc for PETauto, PETvis and CT based, respectively. The GTV of PETauto was not different from PETvis (p=0·441) and CT based (p=0·594). Based on CT delineation in IMRT planning, only 34% of the cases had sufficient PET/CT planning target volumes coverage, whereas the organs at risk dose parameters were not statistically significant (p>0·05).ConclusionsPET/CT enables more accurate assessment of tumour delineation for NSCLC, therefore improve target coverage in IMRT plan.

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