title: Diagnostic accuracy of virtual 18F-FDG PET/CT bronchoscopy for the detection of lymph node metastases in non-small cell lung cancer patients.
abstract: The aim of this study was to determine the diagnostic accuracy of (18)F-FDG PET/CT bronchoscopy for the detection of regional lymph node metastases in non-small cell lung cancer (NSCLC) patients; potential differences in the maximum standardized uptake value (SUVmax), mean SUV (SUVmean), short-axis diameter, and distance to the airways when comparing true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) lymph nodes; the smallest bronchus diameter accessible by virtual bronchoscopy; and the duration from the start of the virtual (18)F-FDG PET/CT bronchoscopy viewing tool until the images were displayed.
  
  
  METHODS
  Sixty-one consecutive NSCLC patients (mean age ± SD, 58 ± 10 y) underwent whole-body (18)F-FDG PET/CT. From these data, virtual (18)F-FDG PET/CT bronchoscopies were reconstructed. The duration from the start of the tool until the display of virtual bronchoscopy images was determined. The diagnostic accuracy of (18)F-FDG PET/CT bronchoscopy for the detection of regional lymph node metastases was evaluated on a lesion basis. Axial (18)F-FDG PET/CT scans served as the standard of reference. The SUVmax, SUVmean, short-axis diameter, and 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 (18)F-FDG PET/CT bronchoscopy was measured.
  
  
  RESULTS
  The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of virtual (18)F-FDG PET/CT bronchoscopy for the detection of lymph node metastases were 76%, 87%, 85%, 79%, and 81%, respectively. The differences between the SUVmax, SUVmean, short-axis diameter, and distance to the airways of TP and FP as well as TN and FN lymph nodes were statistically significant (P < 0.05). The mean smallest diameter of accessible bronchi by (18)F-FDG PET/CT bronchoscopy was 3 mm. The mean time duration from the start of the virtual (18)F-FDG PET/CT bronchoscopy tool until the display of the images was 22 ± 7 s.
  
  
  CONCLUSIONS
  Virtual fly-through 3-dimensional (18)F-FDG PET/CT bronchoscopy yields a 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, high SUVmean, large small-axis diameter, and short distance to the airways aid detection of lymph node metastases with (18)F-FDG PET/CT bronchoscopy.
authors: Departments of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors: Michael
authors: M
authors: Herbrik
authors: Jon
authors: J
authors: Treffert
authors: Bernhard
authors: B
authors: Geiger
authors: Carolin
authors: C
authors: Riegger
authors: Verena
authors: V
authors: Hartung
authors: Sandra Julia
authors: SJ
authors: Rosenbaum-Krumme
authors: Michael
authors: M
authors: Forsting
authors: Gerald
authors: G
authors: Antoch
authors: Till A
authors: TA
authors: Heusner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods* / Q000706:statistics & numerical data; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000556:secondary*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000706:statistics & numerical data; D014584:User-Computer Interface
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18