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Ann Thorac Surg 2006;82:417-423
© 2006 The Society of Thoracic Surgeons

Original article: General thoracic

Maximum Standard Uptake Value of Mediastinal Lymph Nodes on Integrated FDG-PET-CT Predicts Pathology in Patients with Non-Small Cell Lung Cancer

Ayesha S. Bryant, MSPH, MDa,*, Robert J. Cerfolio, MD, FACSb,c, Katrin M. Klemm, MDd, Buddhiwardhan Ojha, MDe

a Department of Surgery, Emory University, Atlanta, Georgia
b Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
c Division of Cardiothoracic Surgery, Department of Surgery, Birmingham Veterans Administration Hospital, Birmingham, Alabama
d Department of Pathology, Birmingham, Alabama
e Division of Nuclear Radiology, University of Alabama at Birmingham Hospital, Birmingham, Alabama

Accepted for publication December 13, 2005.

* Address correspondence to Dr Bryant, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 1900 University Blvd., THT 712, Birmingham, AL 35294 (Email: abryant{at}uab.edu).

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

BACKGROUND: Positron emission tomography (PET) scans often help direct biopsies of mediastinal lymph nodes in patients with non-small cell lung cancer (NSCLC), but the maximum standard uptake value (maxSUV) of individual nodes has not been evaluated.

METHODS: This is a prospective study of consecutive patients with NSCLC, all of whom underwent integrated fluorodeoxyglucose-positron emission-computed tomography (FDG-PET-CT) and had biopsy or resection of their mediastinal lymph nodes.

RESULTS: There were 397 patients. One-hundred and forty-three patients had N2 disease and 1,252 N2 nodes were pathologically examined. The median maxSUV of the nodes that had metastatic disease were the following: for the 2R node, 10.4 (range, 0–18.6); for 4R, 8.6 (range, 0–18.3); for 5, 8.9 (range, 0–26.3); for 6, 7.6 (range, 0–19.6); for 7, 7.7 (range, 0–14); for 8 and 9, 5.4 (range, 0–8.9). The median maxSUV for all of the N2 nodes that were benign was 0 (range, 0–18.8) (p < 0.05 for all stations except for nodes 8 and 9). When a maxSUV of 5.3 is used the accuracy of integrated FDG-PET-CT for each N2 nodal station is maximized and is at least 92% for each.

CONCLUSIONS: The maxSUV of individual mediastinal lymph nodes is a predictor of malignancy. There is overlap between false and true positives. Definitive biopsies are required to prove cancer irrespective of the maxSUV value. However, when a maxSUV of 5.3 is used instead of the traditional value of 2.5, the accuracy for FDG-PET-CT for each N2 nodal station increases to at least 92%.




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