title: Diffusion-weighted magnetic resonance imaging can be used in place of positron emission tomography for N staging of non-small cell lung cancer with fewer false-positive results.
abstract: OBJECTIVE
  One of the deficiencies of positron emission tomography for N staging in lung cancer is a false-positive result caused by concurrent lymphadenitis. Recently, diffusion-weighted magnetic resonance imaging has been reported to be able to image tumors of body organs. The aim of this study is to examine the usefulness of diffusion-weighted magnetic resonance imaging for N staging of non-small cell lung cancer compared with positron emission tomography-computed tomography.
  
  
  METHODS
  Both positron emission tomography-computed tomography and diffusion-weighted magnetic resonance imaging were prospectively used in 88 patients before surgical intervention for non-small cell lung cancer to examine 734 lymph node stations. The diagnostic results of positron emission tomography-computed tomography and diffusion-weighted magnetic resonance imaging were compared. The diameters of the metastatic foci within lymph nodes were measured on hematoxylin and eosin-stained sections to compare the detectable size of metastatic foci between positron emission tomography-computed tomography and diffusion-weighted magnetic resonance imaging.
  
  
  RESULTS
  The accuracy of N staging in the 88 patients was 0.89 with diffusion-weighted magnetic resonance imaging, which was significantly higher than the value of 0.78 obtained with positron emission tomography-computed tomography (P = .012), because of less overstaging in the former. Among the 734 lymph node stations examined pathologically, 36 had metastases, and the other 698 did not. Although there was no significant difference in the diagnosis of the 36 metastatic lymph node stations between the 2 methods, diffusion-weighted magnetic resonance imaging was more accurate for diagnosing the 698 nonmetastatic stations than positron emission tomography-computed tomography because of fewer false-positive results (P = .002). The detectable size of metastatic foci within lymph nodes was 4 mm in both positron emission tomography-computed tomography and diffusion-weighted magnetic resonance imaging.
  
  
  CONCLUSIONS
  Diffusion-weighted magnetic resonance imaging can be used in place of positron emission tomography-computed tomography for N staging of non-small cell lung cancer with fewer false-positive results compared with positron emission tomography-computed tomography.
authors: Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. hnomori@qk9.so-net.ne.jp
authors: Hiroaki
authors: H
authors: Nomori
authors: Takeshi
authors: T
authors: Mori
authors: Koei
authors: K
authors: Ikeda
authors: Koichi
authors: K
authors: Kawanaka
authors: Shinya
authors: S
authors: Shiraishi
authors: Kazuhiro
authors: K
authors: Katahira
authors: Yasuyuki
authors: Y
authors: Yamashita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed