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Open Access Research article

The correlation of SUVmax with pathological characteristics of primary tumor and the value of Tumor/ Lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients

Deniz Koksal1*, Funda Demirag2, Hulya Bayiz1, Ozlem Ozmen3, Ebru Tatci3, Bahadir Berktas1, Koray Aydoğdu4 and Erdal Yekeler4

Author Affiliations

1 Chest Diseases Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey

2 Pathology Department, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey

3 Nuclear Medicine Department, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey

4 Chest Surgery Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey

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Journal of Cardiothoracic Surgery 2013, 8:63  doi:10.1186/1749-8090-8-63

Published: 4 April 2013

Abstract

Background

We aimed to investigate the correlation of maximum standardized uptake value (SUVmax) with pathological characteristics of primary tumor and to determine a Tumor/ Lymph node (T/LN) SUVmax ratio predicting metastasis to lymph nodes in NSCLC patients.

Methods

Eighty-one NSCLC patients who had PET/CT examination at initial staging and subsequently underwent surgical resection were retrospectively evaluated. There were 100 PET/CT positive mediastinal or hilar lymph node stations. Pathological characteristics of the tumor such as largest tumor diameter, tumor histology, differentiation, number of mitosis, degree of stromal inflammation, necrosis; etiology of PET/CT positive lymph node stations; SUVmax of primary tumor and positive lymph node stations were recorded. A T/LN SUVmax ratio was calculated for each lymph node station.

Results

SUVmax of the primary tumor was positively correlated with the largest tumor diameter (p = 0.001, r = 0.374), number of mitosis (p < 0.001, r = 0.405), and postoperative pathological stage (p = 0.007, r = 0.298). Patients with squamous cell carcinoma had a statistically significant higher mean SUVmax, number of mitosis and advanced N stages compared to adenocarcinoma. The etiology of 100 PET/CT positive lymph node stations were metastasis in 14, anthracosis in 40, reactive in 39, granulomatous in 4, and silicosis in 3 patients. A T/LN SUVmax ratio of 5 or lower was suggestive for a malignant lymph node with a sensitivity of 92.8% and specificity of 47%.

Conclusions

SUVmax of a primary tumor is related to certain pathological characteristics, such as largest diameter, histology, and number of mitosis. A T/LN SUVmax ratio lower than 5 predicts the metastasis to lymph nodes with a high sensitivity.