In patients with lung cancer (LC), malignant melanoma (MM), gastroenteropancreatic neuroendocrine tumours (GEP-NETs) and prostate cancer (PCA), N-staging is often performed by integrated (18)F-FDG-Positron Emission Tomography/Computed Tomography (PET/CT) (LC, MM), (68)Ga-DOTATOC-PET/CT (GEP-NET) and (68)Ga-PSMA-PET/CT (PCA): N-staging is not always accurate due to indeterminate PET-findings. To better evaluate malignant lymph node (LN) infiltration, additional surrogate parameters, especially in cases with indeterminate PET-findings, would be helpful. The purpose of this study was to evaluate if maximal standardized uptake values (SUVmax) in the PET-examination might correlate with semi-automated density measurements of LN in the CT-component of the integrated PET/CT examination.
After approval by the institutional review board, 1022 LNs in PET/CT-examinations of 148 patients were retrospectively analysed (LC: 327 LN out of 40 patients, MM: 224 LN out of 33 patients; GEP-NET: 217 LN out of 35 patients, PCA: 254 LN out of 40 patients). PET/CT was performed before surgery/biopsy, chemotherapy, or internal or external radiation therapy, according to the clinical schedule, patients with prior chemotherapy or radiation therapy were ruled out. LN analyses were performed on the basis of SUV-uptake 60 minutes after tracer injection and volumetric CT histogram analysis in non-contrast enhanced CT.
LNs were considered positive or negative on the basis of tracer uptake, histological confirmation was not available. Of the 1022 lymph nodes, 331 had positive SUVmax-findings (3-times SUVmax of bloodpool), 86 were indeterminate (1-3 SUVmax bloodpool), 605 were negative (< SUVmax bloodpool). LNs with positive SUV-uptake had significantly higher CT-density values compared to PET-negative LN, irrespective of the cancer entity.
Density measurements of LNs in patients with LC, MM, GEP-NET and PCA correlate with FDG uptake in PET, and might therefore serve as an additional surrogate parameter for the differentiation between malignant and benign LNs. A possible density threshold in clinical routine might be a 7.5 Hounsfield Units (HU) cut-off value to differentiate between malignant and benign LN infiltration, and a 20 HU cut off to exlude benign lymph node processes, especially helpful in PET-indeterminate LNs.
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 September 2016.
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