87P - Qualitative and quantitative interpretation of F-18 FDG PET/CT to differentiate metastatic mediastinal lymph node in non-small cell lung carcinoma...

Date 15 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Poster lunch
Topics Staging procedures (clinical staging)
Thoracic malignancies
Basic Principles in the Management and Treatment (of cancer)
Presenter Yun Seong Kim
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors Y.S. Kim1, S.H. Yoon1, B.S. Son2, D.H. Kim2, K. Kim3, I. 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 Yangsan Hospital, 50612 - Yangsan/KR
  • 4Internal Medicine, Pusan National University Hospital, 49241 - Busan/KR



The efficacy of F-18 FDG PET/CT is controversial in regions endemic for granulomatous disease. The accuracy and specificity of F-18 FDG PET are substantially reduced because of falsely increased F-18 FDG uptake in inflammatory nodes. The aim of this study was to evaluate qualitative interpretation of F-18 FDG-PET/CT for evaluation of mediastinal nodes to distinguish between malignant and benign lesions compared with qualitative F-18 FDG-PET/CT parameters.


Sixty-five patients with pathologically documented non-small cell lung carcinoma who showed bilateral F-18 FDG avid mediastinal lymph nodes on pre-treatment staging F-18 FDG PET/CT image were included in a prospective cohort study. Seventy-nine mediastinal nodes were pathologically analyzed through endobronchial ultrasound transbronchial needle aspiration or lymph node dissection. SUVmax, SUVmax/liver, SUVmax/blood pool and SUVmax/contra (SUVmax of significantly hypermetabolic lymph node adjusted to SUVmax of contralateral interlobar or hilar lymph node with increased glucose metabolism) were obtained as quantitative parameters to identify metastatic mediastinal nodes.


Qualitative evaluation showed sensitivity, specificity, positive predictive value and negative predictive value for separating metastatic lymph node from benign reactive hyperplasia of 97%, 97%, 96%, 85%. SUVmax and normalized SUVmax to liver and blood pool did not significantly differentiate between benign and metastatic lesions. However, SUVmax/contra was significantly higher for metastatic lesion than benign lesions. (p 


Qualitative interpretation of F-18 FDG PET/CT was superior to quantitative parameters in discriminating metastatic lymph nodes from benign reactive hyperplasia in patients with bilateral F-18 FDG avid mediastinal lymph nodes. SUVmax/contra has better sensitivity and specificity than SUVmax, SUVmax/liver and SUVmax/blood pool.

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All authors have declared no conflicts of interest.