Consideration of serum glucose levels during malignant mediastinal lymph node detection in non-small-cell lung cancer by FDG-PET.
OBJECTIVE
Glucose and FDG compete for uptake by cancers. Here, we undertook to improve diagnostic accuracy of FDG-PET for determining mediastinal lymph node (LN) status in NSCLC by considering serum glucose level.


METHODS
NSCLC patients (n = 70) who underwent curative lung resection and mediastinal LN dissection within 1 month of FDG-PET were enrolled. MaxSUV was calculated using lean body weight and used to determine a new parameter (maxSUV x serum glucose level; maxSUV-GL). Histopathologic LN results were compared with maxSUV and maxSUV-GL values.


RESULTS
Of 71 LN stations whose FDG uptake could be measured, 21 were malignant and 50 benign. MaxSUV of LN had AUC of 0.729 (95% CI: 0.610-0.827) by ROC analysis with sensitivity of 47.6% (10/21), specificity of 94.0% (47/50), and a cutoff value of 3.3. Using maxSUV-GL the corresponding values were; AUC 0.825 (95% CI: 0.716-0.905) and sensitivity 76.2% (16/21), with a cutoff value of 290.4, which represented a significant improvement (P < 0.01) without compromising specificity 88.0% (44/50) (P > 0.05). The exclusion of neo-adjuvant chemotherapeutic and diabetic patients resulted in a similar improvement in diagnostic accuracy.


CONCLUSIONS
By considering serum glucose level during FDG-PET using the new parameter maxSUV-GL, sensitivity for malignant mediastinal LN detection is improved.
Lee
Won Woo
WW
Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea.
Chung
Jin-Haeng
JH
Jang
Sung-June
SJ
Eo
Jae Seon
JS
Park
So Yeon
SY
Sung
Sook Whan
SW
So
Young
Y
Chung
June-Key
JK
Lee
Myung Chul
MC
Kim
Sang Eun
SE
D001786:Blood Glucose / Q000032:analysis*; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000000981:diagnostic imaging* / Q000556:secondary; D048909:Diabetes Complications / Q000097:blood; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008482:Mediastinum; D012372:ROC Curve; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
D001786:Blood Glucose; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18