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. 2025 Feb 18:90:e97-e102.
doi: 10.5114/pjr/200009. eCollection 2025.

Diagnostic value of the standardised uptake value (SUV) ratio of mediastinal lymph node to primary tumour in lung cancer

Błażej Kużdżał  1 , Adam Kużdżał  1 , Karolina Gambuś  2 , Adam Ćmiel  3 , Konrad Moszczyński  4 , Sofiia Popovchenko  5 , Monika Bryndza  5 , Lucyna Rudnicka  6 , Katarzyna Żanowska  7 , Łukasz Trybalski  7 , Janusz Warmus  7 , Piotr Kocoń  7   8
Affiliations

Diagnostic value of the standardised uptake value (SUV) ratio of mediastinal lymph node to primary tumour in lung cancer

Błażej Kużdżał et al. Pol J Radiol. .

Abstract

Purpose: This study aimed to determine whether the mediastinal lymph node/tumour ratio (NTR) of the standardised uptake value (SUV) predicts N2 involvement more accurately than node SUV in patients with non-small cell lung cancer (NSCLC).

Material and methods: We retrospectively analysed consecutive patients with lung cancer at clinical stages I-IVA. All patients underwent positron emission tomography-computed tomography (PET-CT), followed by mediastinal staging using endobronchial ultrasound and endoscopic ultrasound imaging, and curative-intent lung resection with systematic lymph node dissection. Pathological examination of the surgical specimen was performed for confirmation.

Results: The data from 774 patients were analysed. There was a significant correlation between the risk of false-negative PET results for N2 disease and both the SUV of the mediastinal nodes (p = 0.012) and NTR (p = 0.030). The NTR outperformed node SUV in predictive ability; the Akaike information criterion was 307.268 for NTR compared to 308.498 for node SUV. Three factors were significantly associated with the positive predictive value of PET: patient age (p = 0.021), female sex (p = 0.012), and adenocarcinoma histology (p = 0.036). There were no significant correlations between PET sensitivity, specificity, and negative predictive value (NPV), and age, sex, body mass index (BMI), tumour grade, lobar location, or histological type.

Conclusions: The NTR may be a useful tool for excluding N2 disease in NSCLC. PET sensitivity and NPV for detecting N2 disease are not influenced by age, sex, BMI, tumour grade, lobar location, or histological type.

Keywords: PET scan; lung cancer; lymph nodes; mediastinum.

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Figures

Figure 1
Figure 1
Relationship between node-tumour ratio (NTR) and false-negative (FN) results of positron-emission tomography
Figure 2
Figure 2
Relationship between sensitivity of positron-emission tomography and: A) standardised uptake value (SUV) value of mediastinal lymph nodes, and B) node-tumour ratio (NTR)
See this image and copyright information in PMC

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