Tassei Nakagawa MD, Presenter: Nothing to Disclose

Jun Matsumoto, Abstract Co-Author: Nothing to Disclose

Haruhisa Saito, Abstract Co-Author: Nothing to Disclose

Isao Umehara, Abstract Co-Author: Nothing to Disclose

Katsuya Yoshida MD, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to evaluate 18F-FDG uptake in primary non-small cell lung carcinoma (NSCLC) in comparison with vessel invasion and nodal metastasis.

We retrospectively reviewed surgically resected 145 primary NSCLCs from 143 patients who underwent 18F-FDG PET/CT prior to the surgery including mediastinal node dissection. The tracer uptake period was 120 minutes. Maximum standardized uptake value (SUVmax) of 18F-FDG in each primary lesion was measured and plotted on the vertical axis against the maximum diameter on the horizontal axis. Then the lesions were evaluated by using regression lines by subdivisions according to vessel invasion (lymphatic and vein) and nodal metastasis.

Positive correlations between SUVmax and the diameter were statistically significant in subdivisions of non-invasion (P<.0001, r=.508), only lymphatic invasion (p=.0027, r=.609), nodal metastasis (p=.0011, r=.496), double angiolymphatic invasion (p=.008, r=.440), and only vascular invasion (p=.0021, r=.792). SUV at given diameters of the regression lines were increasing by this order in the first 4 subdivisions and the line of nodal metastasis was crossed with the last line at 3.15cm. If the regression line of non-invasion was used as cutoff for vascular invasion; sensitivity, specificity and accuracy were 91.0%, 58.9%, and 78.6% respectively.   If the regression line of negative node was used as cutoff for nodal metastasis; sensitivity, specificity and accuracy in small lesions (≤3cm) were 71.4%, 75.9%, and 75.0% respectively. The corresponding values estimated by nodal SUV in the same population were 21.4%, 97.1%, and 84.1% respectively by patient basis. If the regression line by subdivision of non-invasion and only lymphatic invasion with negative node was used as cutoff for nodal metastasis or vascular invasion; sensitivity, specificity, and accuracy among lesions over 3cm in diameter were 90.9%, 57.9%, and 81.0% respectively.  

18F-FDG uptake in NSCLC reflects vessel invasion and nodal metastasis. The regression lines of SUV against diameter by lesions divided according to invasive factors have the potential to predict vessel invasion.

18F-FDG PET/CT for clinical non-metastatic NSCLC is useful for predicting nodal and hematogenous metastasis and helpful for planning operation and neoadjuvant chemotherapy.

Nakagawa, T, Matsumoto, J, Saito, H, Umehara, I, Yoshida, K, 18F-FDG Uptake in Operable Non-small Cell Lung Carcinoma in Comparison with Pathological Vessel Invasion and Nodal Metastasis.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6020744.html