Till Alexander Heusner MD, Presenter: Nothing to Disclose

Jon Treffert, Abstract Co-Author: Nothing to Disclose

Bernhard Geiger, Abstract Co-Author: Employee, Siemens AG

Michael Christian Herbrik MD, Abstract Co-Author: Nothing to Disclose

Andreas Bockisch, Abstract Co-Author: Nothing to Disclose

Gerald Antoch MD, Abstract Co-Author: Nothing to Disclose

Bronchoscopically-guided lymph node biopsy is a common procedure in bronchial carcinoma patients. To plan those biopsies a virtual “fly-through” 3D FDG-PET/CT bronchoscopy may be helpful. The aim of this study was to determine: (a) the diagnostic accuracy of a FDG-PET/CT bronchoscopy for the detection of mediastinal and hilar lymph node metastases in non small cell lung cancer (NSCLC); (b) differences in the SUVmax, the short axis diameter, and the distance to the airways when comparing true positive (tp), false positive (fp), true negative (tn), and false negative (fn) lymph nodes; (c) the smallest bronchus diameter accessible by virtual bronchoscopy.  

61 consecutive NSCLC patients (mean age: 58 +/- 10y) underwent whole-body FDG-PET/CT. From these source data virtual FDG-PET/CT bronchoscopys were reconstructed. The diagnostic accuracy of FDG-PET/CT bronchoscopy for the detection of regional lymph node metastases was evaluated on a lesion basis. Axial FDG-PET/CT scans served as the standard of reference. The SUVmax, the short axis diameter, and the distance to the airways of regional lymph nodes were measured. Lymph nodes were classified as tp, fp, tn, and fn. The smallest bronchus diameter accessible by FDG-PET/CT bronchoscopy was measured.

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of virtual FDG-PET/CT bronchoscopy for the detection of lymph node metastases was 76%, 87%, 85%, 79%, and 81 %. The differences between the SUVmax, the short axis diameter, and the distance to the airways of tp and fp as well as tn and fn lymph nodes were statistically significant (p<0.05). The smallest diameter of accessible bronchi by FDG-PET/CT bronchoscopy was 2 mm.

Virtual “fly-through” 3D FDG-PET/CT bronchoscopy is feasible in clinical routine, yields a relatively high diagnostic accuracy for the detection of regional lymph node metastases and has access to bronchi even in the periphery of the lung. High SUVmax, large small axis diameter, and short distance to the airways aid detection of lymph node metastases with FDG-PET/CT bronchoscopy.

PET/CT bronchoscopy may serve as a tool for planning of endoscopically-guided lymph node biopsy.

Heusner, T, Treffert, J, Geiger, B, Herbrik, M, Bockisch, A, Antoch, G, Diagnostic Accuracy of Virtual 3D FDG-PET/CT Bronchoscopy for the Detection of Lymph Node Metastases in Non-Small Cell Lung Cancer Patients.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012161.html