50P - Usefulness of F-18 FDG PET/CT to identify metastatic mediastinal lymph node in NSCLC patients with bilateral benign mediastinal lymph node hyperplasia

Date 07 May 2017
Event ELCC 2017
Session Poster Display Session
Topics Staging procedures (clinical staging)
Thoracic malignancies
Non-small-cell lung cancer
Basic Principles in the Management and Treatment (of cancer)
Presenter Yun Seong Kim
Citation Annals of Oncology (2017) 28 (suppl_2): ii14-ii16. 10.1093/annonc/mdx086
Authors Y.S. Kim1, S.H. Yoon1, B.S. Son2, D.H. Kim2, K. Kim3, S. Kim4
  • 1Pulmonology, Pusan National University Yangsan Hospital, 50612 - Yangsan/KR
  • 2Thoracic Surgery, Pusan National University Yangsan Hospital, 50612 - Yangsan/KR
  • 3Nuclear Medicine, Pusan National University Hospital, 49241 - Busan/KR
  • 4Nuclear Medicine, Pusan National University Yangsan Hospital, 50612 - Yangsan/KR



F-18 FDG PET/CT is superior to CT imaging in identifying metastatic mediastinal lymph node (MLN) involvement in NSCLC. However, the accuracy of F-18 FDG PET in nodal staging is substantially reduced by false increases in F-18 FDG uptake in the inflammatory nodes. The efficacy of this technique is controversial because of reactively increased F-18 FDG uptake in the mediastinum, especially in regions endemic for the granulomatous disease. Here, we determined the qualitative and quantitative parameters of F-18 FDG-PET/CT for evaluation of mediastinal nodes to distinguish between malignant and benign lesions.


27 patients with pathologically documented NSCLC who showed bilateral F-18 FDG-avid MLNs on pre-treatment staging PET/CT image were included. 104 MLNs were pathologically analysed through EBUS-TBNA or MLN dissection. The MLN with prominent F-18 FDG uptake compared with other F-18 FDG-avid LNs via visual assessment was qualitatively considered as metastasis. The maximum standardized uptake value (SUVmax) of LN and SUVmax of LN to the liver and blood pool were calculated for quantifying F-18 FDG uptake. SUVmax/contra was obtained to identify metastatic MLNs.


The qualitative evaluation showed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for separating metastatic LN from benign reactive hyperplasia of 66.7%, 87.0%, 74.3%, and 88.2%, respectively. SUVmax of LN and normalized SUVmax of LN to the liver and blood pool did not significantly differ; however, SUVmax/contra was significantly higher for metastatic LNs than benign lesions. Receiver-operating-characteristic derived SUVmax/contra cut-off was 1.18 (AUC, 0.734). The quantitative evaluation showed sensitivity, specificity, PPV, and NPV of 66.7%, 75.3%, 77.4%, and 86.4%, respectively.


Qualitative interpretation of F-18 FDG PET/CT was superior to quantitative parameters in discriminating metastatic LNs from benign reactive hyperplasia in patients with bilateral F-18 FDG-avid mediastinal LNs. We suggest SUVmax/contra may aid in the interpretation of mediastinal nodal staging in patients with NSCLC.

Clinical trial identification

Legal entity responsible for the study





All authors have declared no conflicts of interest.