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. 2018 Oct 28:2018:3417190.
doi: 10.1155/2018/3417190. eCollection 2018.

Is SUVmax Helpful in the Differential Diagnosis of Enlarged Mediastinal Lymph Nodes? A Pilot Study

Congcong Yu  1   2 , Xiaotian Xia  1   2 , Chunxia Qin  1   2 , Xun Sun  1   2 , Yongxue Zhang  1   2 , Xiaoli Lan  1   2
Affiliations

Is SUVmax Helpful in the Differential Diagnosis of Enlarged Mediastinal Lymph Nodes? A Pilot Study

Congcong Yu et al. Contrast Media Mol Imaging. .

Abstract

Objective: To explore the diagnostic value of maximum standard uptake value (SUVmax) from 18F-FDG PET/CT images in enlarged mediastinal lymph nodes of unknown etiology.

Methods: We performed a retrospective study of patients with enlarged mediastinal lymph nodes on 18F-FDG PET/CT scans. SUVmax and the short axis and long axis of lymph nodes were recorded. These parameters were compared among the five commonest causes of mediastinal lymphadenopathy: lymphoma, metastatic disease, sarcoidosis, tuberculosis, and lymphadenitis. Histopathologic diagnosis was recorded as the final golden standard.

Results: A total of 94 patients (62 men and 32 women; age range 7-85 y) were included with final diagnoses of 42 patients with benign pathology and 52 patients with malignancies. The sensitivity, specificity, and the accuracy of PET/CT in diagnosis of the benign and malignant mediastinal lymph nodes were 94.2%, 73.8%, and 85.1%, respectively. The SUVmax of benign and malignant groups were 13.10 ± 5.21 and 12.59 ± 5.50, respectively, which had no statistical difference (P > 0.05). However, the long axis and the short axis of lymph nodes in the benign and malignant groups were 2.86 ± 1.02 cm, 1.77 ± 0.60 cm and 6.04 ± 3.83 cm, 3.95 ± 2.08 cm, respectively (P < 0.05). The diagnostic values of PET/CT were higher than those of the long or short axis. However, the specificity of PET/CT was lower (73.8%) than that from the long or short axis (90.5% and 92.9%, respectively), although no statistical difference existed. Among the five common causes of mediastinal lymphadenopathy, significant differences could be seen in SUVmax and in the long axis and the short axis of lymph nodes (P < 0.05).

Conclusions: SUVmax, a commonly used semiquantitative measurement, was not helpful for differentiation between benign and malignant lesions in patients with enlarged mediastinal lymph nodes in this study. Many benign lesions, such as sarcoidosis and tuberculosis, had high FDG uptake, possibly a trend that the size of the lymph nodes seems to have some diagnostic value.

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Figures

Figure 1
Figure 1
A 42-year-old female patient developed dry cough without fever. (a) Chest CT axial imaging showed enlarged lymph nodes in the mediastinum and right hilar areas. (b) PET/CT scan showed extensive hypermetabolic activity in the mediastinal and hilar lymph nodes (SUVmax 24.5). PET/CT indicated malignant lesions (lymphoma). The final pathological diagnosis was tuberculosis (c).
Figure 2
Figure 2
ROC curves of the long axis (a) and short axis (b) of lymph nodes in the differentiation between the benign and malignant diseases.
Figure 3
Figure 3
The comparison of SUVmax (a), long axis (b), and short axis (c) in five common mediastinal lymphadenopathy diseases (∗∗P < 0.01,∗P < 0.05).
See this image and copyright information in PMC

References

    1. Detterbeck F. C., Jantz M. A., Wallace M., Vansteenkiste J., Silvestri G. A., American College of Chest Physicians Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) Chest. 2007;132(3):202S–220S. - PubMed
    1. Toloza E. M., Harpole L., Detterbeck F., McCrory D. C. Invasive staging of non-small cell lung cancer: a review of the current evidence. Chest. 2003;123(1):157S–166S. - PubMed
    1. Herth F. J., Eberhardt R., Krasnik M., Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887–191. - PubMed
    1. Annema J. T., Versteegh M. I., Veseliç M., Voigt P., Rabe K. F. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging. Journal of Clinical Oncology. 2005;23(33):8357–8361. doi: 10.1200/jco.2005.01.1965. - DOI - PubMed
    1. Czarnecka-Kujawa K., Yasufuku K. The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer. Journal of Thoracic Disease. 2017;9(2):S83–S97. doi: 10.21037/jtd.2017.03.102. - DOI - PMC - PubMed

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