title: The correlation of SUVmax with pathological characteristics of primary tumor and the value of Tumor/ Lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients.
abstract: BACKGROUND
  We aimed to investigate the correlation of maximum standardized uptake value (SUVmax) with pathological characteristics of primary tumor and to determine a Tumor/ Lymph node (T/LN) SUVmax ratio predicting metastasis to lymph nodes in NSCLC patients.
  
  
  METHODS
  Eighty-one NSCLC patients who had PET/CT examination at initial staging and subsequently underwent surgical resection were retrospectively evaluated. There were 100 PET/CT positive mediastinal or hilar lymph node stations. Pathological characteristics of the tumor such as largest tumor diameter, tumor histology, differentiation, number of mitosis, degree of stromal inflammation, necrosis; etiology of PET/CT positive lymph node stations; SUVmax of primary tumor and positive lymph node stations were recorded. A T/LN SUVmax ratio was calculated for each lymph node station.
  
  
  RESULTS
  SUVmax of the primary tumor was positively correlated with the largest tumor diameter (p=0.001, r=0.374), number of mitosis (p<0.001, r=0.405), and postoperative pathological stage (p=0.007, r=0.298). Patients with squamous cell carcinoma had a statistically significant higher mean SUVmax, number of mitosis and advanced N stages compared to adenocarcinoma. The etiology of 100 PET/CT positive lymph node stations were metastasis in 14, anthracosis in 40, reactive in 39, granulomatous in 4, and silicosis in 3 patients. A T/LN SUVmax ratio of 5 or lower was suggestive for a malignant lymph node with a sensitivity of 92.8% and specificity of 47%.
  
  
  CONCLUSIONS
  SUVmax of a primary tumor is related to certain pathological characteristics, such as largest diameter, histology, and number of mitosis. A T/LN SUVmax ratio lower than 5 predicts the metastasis to lymph nodes with a high sensitivity.
authors.affiliation: Chest Diseases Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey. dckoksal@gmail.com
authors.forename: Deniz
authors.initials: D
authors.lastname: Koksal
authors.forename: Funda
authors.initials: F
authors.lastname: Demirag
authors.forename: Hulya
authors.initials: H
authors.lastname: Bayiz
authors.forename: Ozlem
authors.initials: O
authors.lastname: Ozmen
authors.forename: Ebru
authors.initials: E
authors.lastname: Tatci
authors.forename: Bahadir
authors.initials: B
authors.lastname: Berktas
authors.forename: Koray
authors.initials: K
authors.lastname: Aydoğdu
authors.forename: Erdal
authors.initials: E
authors.lastname: Yekeler
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009336:Necrosis; D049268:Positron-Emission Tomography; D012372:ROC Curve; D014057:Tomography, X-Ray Computed
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