title: Diagnostic value of FDG-PET for lymph node metastasis and outcome of surgery for biliary cancer.
abstract: OBJECTIVE
  Histopathologically confirmed lymph node metastasis is a prognostic factor in the surgical treatment of biliary tract cancer, however, preoperative diagnosis is still difficult even with computed tomography. FDG-PET has been used for the diagnosis of cancer and metastatic lesions. Herein, we retrospectively evaluated the utility of FDG-PET for detection of lymph node metastasis in biliary tract cancer.
  
  
  METHODS
  We measured SUV(max) at each 190 surgically dissected lymph node area in 36 patients, and compared the values with histopathological diagnosis. The cutoff values for SUV(max) were defined from the ROC curve and the mean plus two standard deviations then used for detection of metastatic lymph node and prognostic value, compared with CT diagnosis.
  
  
  RESULTS
  The sensitivity, specificity, and positive predictive value of FDG-PET were better than CT diagnosis (86%, 74%, 43% for SUV(max) ≥ 2.0, and 37%, 97%, 72% for SUV(max) ≥ 2.8, respectively). There was no relationship between SUV(max) and CT-determined lymph node dimensions. The presence of SUV(max) ≥ 2.8 lymph nodes was an independent determinant of prognosis after surgical treatment.
  
  
  CONCLUSIONS
  The detection of metastatic lymph nodes by FDG-PET is limited, but better than CT. SUV(max) for lymph nodes seems useful for clinical decision-making regarding treatment strategy including surgery.
authors.affiliation: Department of Surgery, Osaka University, Suita, Osaka, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Hoshino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanemura
authors.forename: Tonsok
authors.initials: T
authors.lastname: Kim
authors.forename: Eku
authors.initials: E
authors.lastname: Shimosegawa
authors.forename: Jun
authors.initials: J
authors.lastname: Hatazawa
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18