Mediastinal lymphnode positivity clinical scoring system for lung adenocarsinoma-mediastinal lymph node evaluation and staging

Year 2022, Volume: 5 Issue: 3, 831 - 838, 30.05.2022

İsmail Ağababaoğlu , Ozgur Omer Yildiz , Dilek Yapar , Hasan Ersöz , Seray Hazer , Özant Helvacı , Selim Şakir Erkmen Gülhan , Nurettin Karaoglanoglu

https://doi.org/10.32322/jhsm.1061755

Abstract

Aim: The study-cohort aims to assess PET-CT's correlation with adenocarcinomas' subtypes and propose a scoring system for mediastinal lymph nodes staging.
Material and Method: The patient cohort is a multicenter, retrospective analysis of 268 patient that underwent surgery for NSCLC adenocarcinoma. Preoperative PET-CT results for mediastinal lymph node staging was pathologically confirmed on tissue specimens obtained at anatomical resection. Statistical evaluation of PET CT, radiological and pathological outcomes were performed on all subgroups.
Results: The low FDG affinity in the lepidic pattern was statistically significant in the study (p <0.001). Among all cases, 65 had an increase in the disease stage to 3B. According to the multivariate logistic regression analysis, Stage 3 disease (OR=2.7), SUV max ≥6.85 (OR=2.1), lepidic type disease (OR=2.6), and tumor size ≥31 mm (OR=2.2) were found to be independently associated with post-op stage 3B disease. Based on their respective odds ratios, points were assigned to each item ranging from 2 to 3. AUC of the scoring system to diagnose post-op stage 3B disease was 0.753 (0.686-0.819), p<0.001. The optimal threshold was ≥4 points; this yielded a sensitivity of 80%, a specificity of 64%, a positive likelihood ratio of 2.2, and a diagnostic odds ratio of 7 (95% CI=3.5-13.6).
Conclusion: The lepidic subtype of adenocarcinomas could have a lower FDG affinity. The MLP scoring system based on SUVmax, tumor size, pathological subtype and cancer stage could help the clinicians to evaluate the mediastinal staging in NSCLC Adenocarcinomas accurately.

Keywords

Lung Cancer, Adenocarcinomas, Mediastinal Staging, Pozitron Emission Tomography

References

• Hochhegger B, Alves GR, Irion KL, et al. PET/CT imaging in lung cancer: indications and findings. J Bras Pneumol 2015 May-Jun; 41: 264-74.
• Zhao L, He ZY, Zhong XN, Cui ML. (18)FDG-PET/CT for detection of mediastinal nodal metastasis in non-small cell lung cancer: a meta-analysis. Surg Oncol 2012; 21: 230-6.
• Schmidt-Hansen M, Baldwin DR, Hasler E, Zamora J, Abraira V, Roqué I Figuls M. PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Database Syst Rev 2014; 2014(11): CD009519.
• Sara V, Jason MA, Angela T, Adam P, Giuseppe A, Aman SC. The role of positron emission tomography in the diagnosis, staging and response assessment of non-small cell lung cancer. Ann Transl Med 2018; 6: 95.
• Erasmus JJ, Macapinlac HA. Low-sensitivity FDG-PET studies: less common lung neoplasms. Semin Nucl Med 2012; 42: 255-60.
• Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6: 244-85.
• Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11: 39-51.
• Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997; 111: 1718-23.
• Hamacher K, Coenen HH, Stöcklin G. Efficient stereospecific synthesisof no-carrier-added 2-(18F)-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 1986; 27: 235-8.
• Öztaş S, Öztürk AV,Acartürk E, et al. The role of tumor SUVmax/lymph node SUVmax ratio viewed on PET-CT in the detection of mediastinal metastasis in patients with lung cancer. Turk Gogus Kalp Dama 2012; 20: 544-51.
• Obuchowski NA. Receiver operating characteristic curves and their use in radiology. Radiology 2003; 229: 3–8.
• Metz CE. Basic principles of ROC analysis. Semin Nucl Med. 1978; 8: 283–98.
• Böhning D, Holling H, Patilea V. A limitation of the diagnostic-odds ratio in determining an optimal cut-off value for a continuous diagnostic test. Stat Methods Med Res 2011; 20: 541-50.
• Zogheib E, Cosse C, Sabbagh C, et al. Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score. Ann Intensive Care 2018; 8: 46.
• Groheux D, Quere G, Blanc E, et al. FDG PET-CT for solitary pulmonary nodule and lung cancer: A literature review. Diagn Interv Imaging 2016; 97: 1003-17.
• Feng M, Yang X, Ma Q, He Y. Retrospective analysis for the false-positive diagnosis of PET-CT scan in lung cancer patients. Medicine (Baltimore) 2017; 96: e7415.
• Song SH, Ahn JH, Lee HY, et al. Prognostic impact of a nomogram based on whole tumor size, tumour disappearance ratio on CT and SUVmax on PET in lung adenocarcinoma. Eur Radiol 2016; 26: 1538–46.
• Xiaoliang S, Rong N, Zhenxing J, Xiaonan S, Yuetao W. Role of PET/CT in management of early lung adenocarcinoma. American J Roentgenol 2020; 214: 437-45.
• Şanlı BA, Ulugün Fİ, Karaçam V, et al. Positron emission tomography/computed tomography findings of lung invasive adenocarcinoma subgroups and comparison of their short-term survivals. Turk J Thoracic Cardiovasc Surg 2021; 29: 370-6.
• Cruickshank A, Stieler G, Ameer F. Evaluation of the solitary pulmonary nodule. Intern Med J 2019; 49: 306-15.
• Tang K, Wang L, Lin J, Zheng X, Wu Y. The value of 18F-FDG PET/CT in the diagnosis of different size of solitary pulmonary nodules. Medicine (Baltimore).2019; 98: e14813.
• De Leyn P, Dooms C, Kuzdzal J, et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg. May 2014; 45: 787-98.
• De Leyn P, Lardinois D, Van Schil PE, et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg. Jul 2007; 32: 1-8.
• Ambrosini V, Nicolini S, Caroli P, et al. PET/CT imaging in different types of lung cancer: an overview. Eur J Radiol 2012; 81: 988-1001.
• Sivrikoz CM, Ak I, Simsek FS, Döner E, Dündar E. Is mediastinoscopy still the gold standard to evaluate mediastinal lymph nodes in patients with non-small cell lung carcinoma?. Thorac Cardiovasc Surg 2012; 60: 116-21.
• Thornblade LW, Wood DE, Mulligan MS, et al. Variability in invasive mediastinal staging for lung cancer: a multicenter regional study. J Thorac Cardiovasc Surg 2018; 155: 2658-71.
• Eberhardt WE, De Ruysscher D, Weder W, et al. Panel Members. 2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer. Ann Oncol 2015; 26: 1573-88.
• Smith DE, Fernandez AJ, Da Lozzo A, Montagne JA, Beveraggi E, Dietrich A. Accuracy of positron emission tomography and computed tomography (PET/CT) in detecting nodal metastasis according to histology of non-small cell lung cancer. Updates Surg 2019; 71: 741-6.
• Yalcınkaya E, Anar C, Yavuz YM, et al. Prognostic importance of SUVmax value in PET/CT and correlation SUVmax Value between lymph node, distant metastasis in non-small cell lung cancer. Izmir Gogus Hastanesi Derg 2015; 24: 127-37.