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Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of (18)F-FDG PET/CT

BACKGROUND: Integrated (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) is widely performed in hilar and mediastinal lymph node (HMLN) staging of non-small cell lung cancer (NSCLC). However, the diagnostic efficiency of PET/CT remains controversial. This r...

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Autores principales: Li, Shaolei, Zheng, Qingfeng, Ma, Yuanyuan, Wang, Yuzhao, Feng, Yuan, Zhao, Bingtian, Yang, Yue
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808350/
https://www.ncbi.nlm.nih.gov/pubmed/24205256
http://dx.doi.org/10.1371/journal.pone.0078552
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author Li, Shaolei
Zheng, Qingfeng
Ma, Yuanyuan
Wang, Yuzhao
Feng, Yuan
Zhao, Bingtian
Yang, Yue
author_facet Li, Shaolei
Zheng, Qingfeng
Ma, Yuanyuan
Wang, Yuzhao
Feng, Yuan
Zhao, Bingtian
Yang, Yue
author_sort Li, Shaolei
collection PubMed
description BACKGROUND: Integrated (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) is widely performed in hilar and mediastinal lymph node (HMLN) staging of non-small cell lung cancer (NSCLC). However, the diagnostic efficiency of PET/CT remains controversial. This retrospective study is to evaluate the accuracy of PET/CT and the characteristics of false negatives and false positives to improve specificity and sensitivity. METHODS: 219 NSCLC patients with systematic lymph node dissection or sampling underwent preoperative PET/CT scan. Nodal uptake with a maximum standardized uptake value (SUVmax) >2.5 was interpreted as PET/CT positive. The results of PET/CT were compared with the histopathological findings. The receiver operating characteristic (ROC) curve was generated to determine the diagnostic efficiency of PET/CT. Univariate and multivariate analysis were conducted to detect risk factors of false negatives and false positives. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/ CT in detecting HMLN metastases were 74.2% (49/66), 73.2% (112/153), 54.4% (49/90), 86.8% (112/129), and 73.5% (161/219). The ROC curve had an area under curve (AUC) of 0.791 (95% CI 0.723-0.860). The incidence of false negative HMLN metastases was 13.2% (17 of 129 patients). Factors that are significantly associated with false negatives are: concurrent lung disease or diabetes (p<0.001), non-adenocarcinoma (p<0.001), and SUVmax of primary tumor >4.0 (p=0.009). Postoperatively, 45.5% (41/90) patients were confirmed as false positive cases. The univariate analysis indicated age > 65 years old (p=0.009), well differentiation (p=0.002), and SUVmax of primary tumor ≦4.0 (p=0.007) as risk factors for false positive uptake. CONCLUSION: The SUVmax of HMLN is a predictor of malignancy. Lymph node staging using PET/CT is far from equal to pathological staging account of some risk factors. This study may provide some aids to pre-therapy evaluation and decision-making.
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spelling pubmed-38083502013-11-07 Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of (18)F-FDG PET/CT Li, Shaolei Zheng, Qingfeng Ma, Yuanyuan Wang, Yuzhao Feng, Yuan Zhao, Bingtian Yang, Yue PLoS One Research Article BACKGROUND: Integrated (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) is widely performed in hilar and mediastinal lymph node (HMLN) staging of non-small cell lung cancer (NSCLC). However, the diagnostic efficiency of PET/CT remains controversial. This retrospective study is to evaluate the accuracy of PET/CT and the characteristics of false negatives and false positives to improve specificity and sensitivity. METHODS: 219 NSCLC patients with systematic lymph node dissection or sampling underwent preoperative PET/CT scan. Nodal uptake with a maximum standardized uptake value (SUVmax) >2.5 was interpreted as PET/CT positive. The results of PET/CT were compared with the histopathological findings. The receiver operating characteristic (ROC) curve was generated to determine the diagnostic efficiency of PET/CT. Univariate and multivariate analysis were conducted to detect risk factors of false negatives and false positives. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/ CT in detecting HMLN metastases were 74.2% (49/66), 73.2% (112/153), 54.4% (49/90), 86.8% (112/129), and 73.5% (161/219). The ROC curve had an area under curve (AUC) of 0.791 (95% CI 0.723-0.860). The incidence of false negative HMLN metastases was 13.2% (17 of 129 patients). Factors that are significantly associated with false negatives are: concurrent lung disease or diabetes (p<0.001), non-adenocarcinoma (p<0.001), and SUVmax of primary tumor >4.0 (p=0.009). Postoperatively, 45.5% (41/90) patients were confirmed as false positive cases. The univariate analysis indicated age > 65 years old (p=0.009), well differentiation (p=0.002), and SUVmax of primary tumor ≦4.0 (p=0.007) as risk factors for false positive uptake. CONCLUSION: The SUVmax of HMLN is a predictor of malignancy. Lymph node staging using PET/CT is far from equal to pathological staging account of some risk factors. This study may provide some aids to pre-therapy evaluation and decision-making. Public Library of Science 2013-10-25 /pmc/articles/PMC3808350/ /pubmed/24205256 http://dx.doi.org/10.1371/journal.pone.0078552 Text en © 2013 Li et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Li, Shaolei
Zheng, Qingfeng
Ma, Yuanyuan
Wang, Yuzhao
Feng, Yuan
Zhao, Bingtian
Yang, Yue
Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of (18)F-FDG PET/CT
title Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of (18)F-FDG PET/CT
title_full Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of (18)F-FDG PET/CT
title_fullStr Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of (18)F-FDG PET/CT
title_full_unstemmed Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of (18)F-FDG PET/CT
title_short Implications of False Negative and False Positive Diagnosis in Lymph Node Staging of NSCLC by Means of (18)F-FDG PET/CT
title_sort implications of false negative and false positive diagnosis in lymph node staging of nsclc by means of (18)f-fdg pet/ct
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808350/
https://www.ncbi.nlm.nih.gov/pubmed/24205256
http://dx.doi.org/10.1371/journal.pone.0078552
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