title: Ratio between maximum standardized uptake value of N1 lymph nodes and tumor predicts N2 disease in patients with non-small cell lung cancer in 18F-FDG PET-CT scan.
abstract: OBJECTIVE
  F-18 fluorodeoxyglucose integrated PET-CT scan is commonly used in the work-up of lung cancer to improve preoperative disease stage. The aim of the study was to analyze the ratio between SUVmax of N1 lymph nodes and primary lung cancer to establish prediction of mediastinal disease (N2) in patients operated on non-small cell lung cancer.
  
  
  METHODS
  This is a retrospective study of a prospective database. Patients operated on non-small cell lung cancer (NSCLC) with N1 disease by PET-CT scan were included. None of them had previous induction treatment, but they underwent standard surgical resection plus systematic lymphadenectomy.
  
  
  RESULTS
  There were 51 patients with FDG-PET-CT scan N1 disease. 44 (86.3%) patients were male with a mean age of 64.1±10.8 years. Type of resection: pneumonectomy=4 (7.9%), lobectomy/bilobectomy=44 (86.2%), segmentectomy=3 (5.9%).
  
  
  RESULTS
  adenocarcinoma=26 (51.0%), squamous=23 (45.1%), adenosquamous=2 (3.9%). Lymph nodes after surgical resection: N0=21 (41.2%), N1=12 (23.5%), N2=18 (35.3%). Mean ratio of the SUVmax of N1 lymph node to the SUVmax of the primary lung tumor (SUVmax N1/T ratio) was 0.60 (range 0.08-2.80). ROC curve analysis to obtain the optimal cut-off value of SUVmax N1/T ratio to predict N2 disease was performed. At multivariate analysis, we found that a ratio of 0.46 or greater was an independent predictor factor of N2 mediastinal lymph node metastases with a sensitivity and specificity of 77.8% and 69.7%, respectively.
  
  
  CONCLUSIONS
  SUVmax N1/T ratio in NSCLC patients correlates with mediastinal lymph node metastasis (N2 disease) after surgical resection. When SUVmax N1/T ratio on integrated PET-CT scan is equal or superior to 0.46, special attention should be paid on higher probability of N2 disease.
authors.affiliation: Thoracic Surgery Department, University General Hospital of Albacete, Spain. Electronic address: tonyhonguero@yahoo.es.
authors.forename: A F
authors.initials: AF
authors.lastname: Honguero Martínez
authors.affiliation: Thoracic Surgery Department, University General Hospital of Albacete, Spain.
authors.forename: M D
authors.initials: MD
authors.lastname: García Jiménez
authors.affiliation: Nuclear Medicine Department, University General Hospital of Ciudad Real, Spain.
authors.forename: A
authors.initials: A
authors.lastname: García Vicente
authors.affiliation: Zone IV Health Center, Albacete, Spain.
authors.forename: J
authors.initials: J
authors.lastname: López-Torres Hidalgo
authors.affiliation: Cardiothoracic Surgery Department, Mount Sinai Hospital, New York USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Colon
authors.affiliation: Nuclear Medicine Department, University General Hospital of Ciudad Real, Spain.
authors.forename: O
authors.initials: O
authors.lastname: van Gómez López
authors.affiliation: Nuclear Medicine Department, University General Hospital of Ciudad Real, Spain.
authors.forename: Á M
authors.initials: ÁM
authors.lastname: Soriano Castrejón
authors.affiliation: Thoracic Surgery Department, University General Hospital of Albacete, Spain.
authors.forename: P
authors.initials: P
authors.lastname: León Atance
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D000072078:Positron Emission Tomography Computed Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Cirugía; Cáncer de pulmón no célula pequeña; Enfermedad N1; N1 disease; Non-small cell lung cancer; PET-CT scan; PET-TC; SUVmax; Surgery