title: The evaluation of hypermetabolic mediastinal-hilar lymph nodes determined by PET/CT in pulmonary and extrapulmonary malignancies: correlation with EBUS-TBNA.
abstract: OBJECTIVE
  We aimed to define the optimal SUV(max) cut-off value in determination of mediastinal-hilar lymph node metastasis, by comparing positive PET/CT results with the results of endobronchial ultrasound guided transbronchial needle aspiration biopsy (EBUS-TBNA).
  
  
  METHODS
  Thirty-one patients with malignancy whose PET/CT imaging revealed a hypermetabolic mediastinal and/or hilar lymph node and who had undergone EBUS-TBNA were evaluated retrospectively. Histopathology was regarded as the gold standard. The diagnostic role of PET/CT in mediastinal/hilar lymph node metastasis was investigated and compared with the results of contrast-enhanced CT.
  
  
  RESULTS
  When a SUV(max) value of 2.5 was used, the sensitivity, positive predictive value (PPV), and diagnostic accuracy of the PET/CT were 100%, 65.4%, and 65.4% respectively. In the ROC analysis, the SUV(max) cut-off value with the highest diagnostic accuracy (75%) was calculated as 6.3, and when this value was considered, the sensitivity, specificity, PPV, negative predictive value, and diagnostic accuracy of the PET/CT were determined as 70.6%, 83.3%, 88.9%, 60%, and 75% respectively (AUC: 0.779). The sensitivity, PPV, and diagnostic accuracy of the thorax CT were calculated as 91.1%, 72%, and 71.1%, respectively.
  
  
  CONCLUSIONS
  When determining mediastinal-hilar lymph node metastasis via PET/CT, although a SUV(max) cut-off value of 6.3 increases specificity and diagnostic accuracy, we think that a SUV(max) cut-off value of 2.5 and above give more optimal results in routine practice.
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Kandemir
authors.forename: Aysegül
authors.initials: A
authors.lastname: Sentürk
authors.forename: Elif
authors.initials: E
authors.lastname: Ozdemir
authors.forename: Nilüfer
authors.initials: N
authors.lastname: Yildirim
authors.forename: Hatice Canan
authors.initials: HC
authors.lastname: Hasanoğlu
authors.forename: Mutlay
authors.initials: M
authors.lastname: Keskin
authors.forename: Seyda
authors.initials: S
authors.lastname: Türkölmez
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D001999:Bronchoscopy / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013899:Thoracic Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D014057:Tomography, X-Ray Computed; D055815:Young Adult