title: Predictive value of 18F-fluorodeoxyglucose positron emission tomography - computed tomography compared to postoperative pathological findings for patients with non-small-cell lung cancer.
abstract: This study was conducted to investigate the predictive value of18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in patients with non-small-cell lung cancer (NSCLC), compared to that of postoperative pathological findings, for T and N staging and the associations of the metabolic parameters of the primary tumor with histological type and differentiation. The preoperative contrast-enhanced CT and18F-FDG PET-CT and postoperative pathological findings of 112 NSCLC patients treated with lobectomy or pneumonectomy combined with systematic mediastinal lymphadenectomy were retrospectively reviewed. Compared to the postoperative pathological findings, the effect of contrast-enhanced CT and18F-FDG PET-CT on T and N staging were evaluated. The metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) of the primary tumor were measured. The associations between these metabolic parameters and histological type and differentiation were also evaluated. The differences in the accuracy in overall staging and T staging between PET-CT and contrast-enhanced CT were significant (91.1 vs. 69.6%, P=0.000; and 92.9 vs. 76.8%, P=0.000, respectively). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of regional lymph node metastasis detection were 91.7, 93.0, 86.5, 95.8 and 92.6%, respectively, with PET-CT; and 71.3, 77.2, 60.6, 84.5 and 75.2%, respectively, with contrast-enhanced CT. The SUVmax (7.29±1.83 vs. 5.91±1.65, t=4.15, P=0.000) and MTV (48.20±22.47 vs. 30.21±19.72 cm3, t=4.48, P=0.000) were significantly higher for squamous cell carcinoma (SCC) compared to those for adenocarcinoma (AC). There was a positive correlation between the MTV and SUVmax of the primary tumor (Pearson's r=0.838, P=0.000). Significant differences were observed among differentiation subgroups in the SUVmax and MTV of the primary tumor for both SCC and AC. In conclusion, compared to the postoperative pathological findings, the predictive value of18F-FDG PET-CT for T and N staging in NSCLC was higher compared to that of contrast-enhanced CT. The FDG uptake of the primary tumor was associated with histological type and differentiation and the difference was statistically significant. Therefore, the SUVmax and MTV of the primary tumor may be valuable indices to partly predict the histological type and grade of differentiation of NSCLC.
authors.affiliation: Department of Oncology, The Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, Shandong 250031, P.R. China ; School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong 250022, P.R. China.
authors.forename: Jie
authors.initials: J
authors.lastname: Xue
authors.affiliation: Departments of Nuclear Medicine, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China.
authors.forename: Jinsong
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Departments of Thoracic Surgery and Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Guo
authors.affiliation: Departments of Nuclear Medicine, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Wang
authors.affiliation: Departments of Radiation Oncology and Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China ; Departments of Key Laboratory of Radiation Oncology of Shandong Province, Shandong Cancer Hospital, Jinan, Shandong 250117, P.R. China.
authors.forename: Anqin
authors.initials: A
authors.lastname: Han
keywords: computed tomography; metabolic tumor volume; non-small-cell lung cancer; positron emission tomography; staging; standardized uptake value