title: New PET/CT criterion for nodal staging in non-small cell lung cancer: measurement of the ratio of section area of standard uptake values ≥2.5/lymph node section area.
abstract: BACKGROUND
  The aim of the present study was to use surgical and histological results to develop a simple noninvasive technique for improving nodal staging using preoperative PET/CT in patients with resectable non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Preoperative PET/CT findings (163 patients) and pathological diagnoses after surgical resection were evaluated. Using PET/CT images, lymph node section area (SA), the maximum standardized uptake value (SUVmax), SA of SUV ≥2.5 and ≥3.0 were drawn freehand and measured using caliper software. Receiver operating characteristic (ROC) curves were then used to analyze those data.
  
  
  RESULTS
  Based on ROC analyses, the cut-off values for SA of SUV ≥2.5, SA of SUV ≥3.0, SUV ≥2.5 SA/node SA and SUV ≥3.0 SA/node SA for diagnosis of lymph node metastasis were 200 mm2, 30 mm2, 1.0 and 0.4. SUV ≥2.5 SA/node SA ≥1.0 had the highest negative predictive value, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of nodal staging were 61.1, 73.4, 36.7, 88.2 and 70.9%.
  
  
  CONCLUSIONS
  When diagnosing nodal staging based a lymph node SUV ≥2.5 SA/node SA ratio of ≥1.0, it can be an effective criterion for use to determine surgical indications.
authors.affiliation: Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Yoshitaro
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. i-karo@mui.biglobe.ne.jp.
authors.forename: Kazuhiro
authors.identifier: http://orcid.org/0000-0003-4490-7862
authors.initials: K
authors.lastname: Imai
authors.affiliation: Division of Radiology and Radiation Medicine, Department of Integrated Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Ishiyama
authors.affiliation: Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Saito
authors.affiliation: Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Motoyama
authors.affiliation: Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Konno
authors.affiliation: Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujishima
authors.affiliation: Division of Radiology and Radiation Medicine, Department of Integrated Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Minamiya
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D011013:Pneumonectomy; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011184:Postoperative Period; D012372:ROC Curve
keywords: Computed tomography; Lung cancer; Lymph node; Metastasis; Positron-emission tomography