421P - Diagnosis of right upper lobar lymph node metastasis by modified TLG

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Staging procedures (clinical staging)
Thoracic malignancies
Presenter Hitoshi Dejima
Citation Annals of Oncology (2016) 27 (suppl_9): ix132-ix133. 10.1093/annonc/mdw591
Authors H. Dejima, H. Kuroda, K. Seto, S. Sakata, T. Mizuno, N. Sakakura, Y. Sakao
  • Thoracic Surgery, Aichi Cancer Center Hospital, 464-8681 - Nagoya/JP



The diagnostic criteria of preoperative hilar lymph node metastasis in primary lung cancer have not been clearly established. We investigated the presence of hilar lymph node metastasis by combining the findings of chest-CT and FDG-PET.


Patients were identified as having undergone both HRCT and FDG-PET before surgery and curative resection for primary lung cancer of right upper lobe from April 2012 through April 2016. We have defined modified total lesion glycolysis (mTLG), as (mean of standardized uptake value (SUV mean) on FDG-PET) × (volume in mm3 of right upper lobe lymph node). We retrospectively analyzed the correlation between mTLG and pathological findings.


We identified a total of 127 patients. Sixteen patients (13%) had right upper lobar lymph node metastasis. The mTLG values of pathological node metastasis were higher than in the node negative group (p = 0.04). When using a cut-off value obtained on the ROC curve, nine of sixteen cases were positive (sensitivity: 56%, specificity: 89%). The node positive cases with less than the cut-off value were a case of small cell carcinoma, four cases with EGFR mutation, a case with HER2 mutation, and a case with K-ras mutation. The values of AUC for several other examinations were mTLG: 0.76, TLG: 0.64, SUVmax: 0.66, minor axis of lymph node on HRCT: 0.70, major axis of tumor on HRCT (lung window): 0.61, major axis of tumor on HRCT (mediastinal window): 0.71 and CEA: 0.29.


In this study, mTLG was useful for diagnosis of lymph node metastasis. However, the possibility that lymph node metastasis might escape detection in patients with driver mutations, such as EGFR, HER2 and K-ras was also established.

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All authors have declared no conflicts of interest.