title: Evaluation of ¹⁸F-fluorodeoxyglucose uptake in enlarged mediastinal lymph nodes in patients with lung cancer.
abstract: Accurate lymph nodal staging of lung cancer is critical for determining the treatment options. With the help of (18)F-fluorodeoxyglucose positron emission tomography/computer tomography ((18)F-FDG-PET/CT), the clinician can rule out/in the regional lymph nodes positive for metastasis in the patients with lung cancer in a majority of cases. However, a small proportion of cases with false positivity of metastasis have been reported. Transbronchial needle aspirations and mediastinoscopic biopsies are still necessary to determine whether enlarged hypermetabolic mediastinal lymph nodes are positive for lung cancer metastasis. Here we report three intricate cases showing hypermetabolic activity in the mediastinal lymph nodes in the patients with pathologically diagnosed lung cancer on PET/CT. The first patient had squamous cell carcinoma in the left upper lobe of the lung with surrounding necrotizing granulomas and concurrent with silicosis and granulomatous inflammation in the lymph nodes; the second presented with symptoms of viral pneumonia, which was pathologically diagnosed as a lung adenocarcinoma, stage IA, concurrent with sarcoidosis involving the lymph nodes; the last case was diagnosed as squamous cell carcinoma in the right upper lobe of the lung, but lymph nodes showed reactive hyperplasia. These cases suggest that some cases are so complex that avid (18)F-FDG uptake in the mediastinal lymph nodes in the patients with pathologically diagnosed lung cancer should be carefully analyzed based on individual patients' clinical background.
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, P. R. China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Ji
authors.affiliation: Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, P. R. China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Pathology, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, P. R. China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, P. R. China.
authors.forename: Chunhua
authors.initials: C
authors.lastname: Ling
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital & Institute Jinan 250117, Shandong, P. R. China.
authors.forename: Xudong
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, P. R. China.
authors.forename: Yanbin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, P. R. China.
authors.forename: Jianan
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Pathology, The First Affiliated Hospital of Soochow University Suzhou 215006, Jiangsu, P. R. China.
authors.forename: Lingchun
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA Los Angeles, CA 90095, USA.
authors.forename: Haodong
authors.initials: H
authors.lastname: Xu
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG; PET-CT; hypermetabolic; lung cancer; mediastinal lymph nodes