Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Mar 17;21(1):49.
doi: 10.1186/s12880-021-00580-w.

Impact of 18F-FDG PET/CT, CT and EBUS/TBNA on preoperative mediastinal nodal staging of NSCLC

Akram Al-Ibraheem  1 , Nader Hirmas  2 , Stefano Fanti  3 , Diana Paez  4 , Fawzi Abuhijla  5 , Dalia Al-Rimawi  6 , Ula Al-Rasheed  7 , Riad Abdeljalil  8 , Feras Hawari  9 , Kamal Alrabi  10 , Asem Mansour  11
Affiliations
Comparative Study

Impact of 18F-FDG PET/CT, CT and EBUS/TBNA on preoperative mediastinal nodal staging of NSCLC

Akram Al-Ibraheem et al. BMC Med Imaging. .

Abstract

Background: Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC.

Methods: We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories.

Results: 18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3% vs. 54.6%), and better specificity (60.5% vs. 43.6%, p = 0.01) overall and in patients with histopathological confirmation in MLN staging (60.6% vs. 38.2%). Negative predictive value of mediastinoscopy, EBUS/TBNA, and 18F-FDG PET/CT were (87.1%), (90.91%), and (83.33%) respectively. The overall accuracy was highest for mediastinoscopy (88.6%) and EBUS/TBNA (88.2%), followed by 18F-FDG PET/CT (70.2%). Dividing patients into N1 disease vs. those with N2/N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA in patients with histopathological confirmation shows 28 correlated true positive and true negative findings with final N-staging. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise remained undiscovered by EBUS/TBNA alone. Lymph nodes with a maximal standardized uptake value (SUVmax) more than 3 were significantly more likely to be true-positive.

Conclusion: Multimodality staging of the MLNs in NSCLC is essential to provide accurate staging and the appropriate treatment. 18F-FDG PET/CT has better overall diagnostic utility when compared to the CT scan. The NPV of 18F-FDG PET/CT in MLNs is reliable and comparable to the NPV of EBUS/TBNA. SUVmax of MLNs can help in predicting metastases, but nevertheless, a positive 18F-FDG PET/CT MLNs particularly if such a result would change the treatment plan, should be verified histopathologically.

Keywords: 18F-FDG PET/CT; EBUS/TBNA; Mediastinal lymph node staging; NPV; NSCLC.

PubMed Disclaimer

Conflict of interest statement

Akram Al-Ibraheem, Nader Hirmas, Stefano Fanti, Diana Paez, Fawzi Abuhijla, Dalia Al-Rimawi, Ula Al-Rasheed, Riad Abdeijalil, Feras Hawari, Kamal Alrabi and Asem Mansour declare they have no conflict of interest relevant to this research.

Figures

Fig. 1
Fig. 1
True positive FDG-PET/CT and true positive EBUS/TBNA. A case of moderately differentiated lung adenocarcinoma in the right lung. Axial CT showed prominent pretracheal lymph node. Axial FDG-PET and FDG-PET/CT showed hypermetabolic (SUVmax: 3.8) pretracheal lymph node (arrow) and suggested a metastases. EBUS/TBNA from this lymph node turned positive for metastases that was confirmed later by lymph node dissection
Fig. 2
Fig. 2
True negative FDG-PET/CT and true negative EBUS/TBNA. A case of poorly differetiated lung adenocarcinoma. Axial CT scan showed prominent right upper paratracheal lymphnode (arrow). Axial FDG-PET and PFDG-PET/CT didn’t show concerning hypermetabolic features (SUVmax: 1.2) in this lymph node. EBUS/TBNA turned negative for metastases in this lymph node that was confirmed during lymph node dissection
Fig. 3
Fig. 3
True positive FDG-PET/CT and false negative EBUS/TBNA. A case of SCC involving the right lung. Axial FDG-PET, CT and FDG-PET/CT images showed a suspected prominent hypermetabolic (SUVmax: 3.1) right paratracheal lymph node (arrows) and recommended tissue confirmation. EBUS/TBNA turned out negative; Mediastinoscopy proved a metastatic lymph node
Fig. 4
Fig. 4
False positive FDG-PET/CT and true negative EBUS/TBNA. A case of right lung moderately differentiated lung adenocarcinoma. Axial CT scan showed prominent right lower paratracheal lymph node. Axial FDG-PET and FDG-PET/CT showed suspicious hypermetabolic (SUVmax: 3) right lower paratracheal lymph node. EBUS/TBNA turned negative for lymph node metastases. Lymph node dissection confirmed the EBUS/TBNA result
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zhang Y, Elam Y, Hall P, Williams H, Pucar D, Patel V. The role of fluorodeoxy-D-glucose positron emission tomography/computed tomography in nodal staging of nonsmall cell lung cancer in sequential surgical algorithm. World J Nucl Med. 2017;16(4):281–285. doi: 10.4103/1450-1147.215486. - DOI - PMC - PubMed
    1. Funatsu T, Matsubara Y, Hatakenaka R, Kosaba S, Yasuda Y, Ikeda S. The role of mediastinoscopic biopsy in preoperative assessment of lung cancer. J Thorac Cardiovasc Surg. 1992;104(6):1688–1695. doi: 10.1016/S0022-5223(19)33901-7. - DOI - PubMed
    1. Lemaire A, Nikolic I, Petersen T, Haney JC, Toloza EM, Harpole DH, Jr, et al. Nine-Year Single Center Experience With Cervical Mediastinoscopy: Complications and False Negative Rate. Ann Thorac Surg. 2006;82(4):1185–1189. doi: 10.1016/j.athoracsur.2006.05.023. - DOI - PubMed
    1. Vansteenkiste J, Dooms C, De Leyn P. Early stage non-small-cell lung cancer: Challenges in staging and adjuvant treatment: Evidence-based staging. Ann Oncol. 2010;21(7):189–195. doi: 10.1093/annonc/mdq424. - DOI - PubMed
    1. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328–354. doi: 10.1007/s00259-014-2961-x. - DOI - PMC - PubMed

Publication types

MeSH terms

Substances