Abstract
Objective
The purpose of our study was to develop a simple noninvasive technique for nodal staging
using routine preoperative computed tomography (CT).
Materials and methods
The institutional review board approved this retrospective study, and written informed
consent to perform the initial and follow-up CT studies was obtained from all patients.
Preoperative CT findings (n=218 patients with resectable non-small cell lung cancer) and pathological diagnoses
after surgical resection were evaluated. Using CT images, lymph node section area,
circumference, and lesion attenuation values (LAVs) were drawn freehand, and the short
axis (SA) and long axis (LA) were measured using caliper software. Receiver operating
characteristic (ROC) curves were then used to analyze the section area, circumference,
and LAVs.
Results
Based on ROC curves, two cut-off values, lymph node section area >30 mm2 and circumference >25 mm, showed greater sensitivity for nodal staging than the conventional criterion
of lymph node SA ≥10 mm or the LA, SA/LA ratio or LAVs. Using lymph node section area >30 mm2 for diagnosis, the sensitivity, specificity, and accuracy of nodal staging were 90.5%,
56.3%, and 58.3%, respectively. Using lymph node circumference >25 mm, the values were 76.2%, 70.4%, and 70.8%, respectively.
Conclusion
Lymph node section area >30 mm2 and circumference >25 mm can serve as supportive criteria used by radiologists and surgeons to determine
nodal staging. If these CT criteria are met, use of a more sensitive procedure such
as positron emission tomography or mediastinoscopy is recommended.
Concise abstract
CT is used routinely during preoperative management of lung cancer. Based on ROC analyses,
the cut-off values for surface area, circumference, the SA/LA ratio, and LAVs for
diagnosis of lymph node metastasis were 30 mm2, 25 mm, 0.65, and 50 Hounsfield units, respectively. Our findings indicate that lymph
node surface area >30 mm2 and circumference >25 mm are supportive criteria that can be used by radiologists and thoracic surgeons
to determine nodal staging and surgical indications.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global cancer statistics, 2002.CA Cancer J Clin. 2005; 55: 74-108
- Global cancer statistics.CA Cancer J Clin. 2011; 61: 69-90
- Revisions in the international system for staging lung cancer.Chest. 1997; 111 ([17]): 1710-1717
- Small peripheral lung adenocarcinoma: clinicopathological features and surgical treatment.Surg Today. 2010; 40: 191-198
- Follow-up of patients with completely resected lung cancer.Chest. 1999; 115: 1487-1498
- Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small cell lung cancer. A study of 569 patients.Eur J Cardiothorac Surg. 1994; 8: 37-42
- The restaging issue.Lung Cancer. 2003; 42: S39-S45
- Importance of preoperative imaging with 64-row three-dimensional multidetector computed tomography for safer video-assisted thoracic surgery in lung cancer.Surg Today. 2009; 39: 844-847
- Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition).Chest. 2007; 132: 178S-201S
- Invasive mediastinal staging of lung cancer. ACCP evidence-based clinical practice guidelines (2nd edition).Chest. 2007; 132: 202S-220S
- Mediastinal nodes in bronchogenic carcinoma: comparison between CT and mediastinoscopy.Radiology. 1988; 167: 367-372
- Can computed tomography of the chest stage lung cancer? Yes and no.Ann Thorac Surg. 1990; 49: 591-595
- Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping.Am J Roentgenol. 1985; 144: 261-265
- Computed tomography to stage lung cancer. Approaching a controversy using meta-analysis.Am Rev Respir Dis. 1990; 141: 1096-1101
- Current concepts in the mediastinal lymph node staging of nonsmall cell lung cancer.Ann Surg. 2003; 238: 180-188
- Metastases from non-small cell lung cancer: mediastinal staging in the 1990s—meta-analytic comparison of PET and CT.Radiology. 1999; 213: 530-536
- Accuracy of helical computed tomography for the identification of lymph node metastasis in resectable non-small cell lung cancer.Surg Today. 2008; 38: 1083-1090
- Sobin LH Gospodarowicz MK Ch Wittekind TNM Classification of Malignant Tumours. 7th edit. Wiley-Blackwell, New York2009
- A method of comparing the area under receiver operating characteristic curves derived from the same cases.Radiology. 1983; 148: 839-843
- Improved radiologic staging of lung cancer with 2-[18F]-fluoro-2-deoxy-d-glucose-positron emission tomography and computed tomography registration.J Comput Assist Tomogr. 2003; 27: 479-484
- Accuracy and cost-effectiveness of [18F]-2-fluoro-deoxy-d-glucose-positron emission tomography scan in potentially resectable non-small cell lung cancer.Chest. 2004; 125: 1413-1423
- Accuracy of helical computed tomography and [18F] fluorodeoxyglucose positron emission tomography for identifying lymph node mediastinal metastases in potentially resectable non-small-cell lung cancer.J Clin Oncol. 2005; 23: 8348-8356
- Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging.Radiology. 2005; 236: 1011-1019
- PET/CT in the staging of the non-small-cell lung cancer.J Biomed Biotechnol. 2012; 2012: 783739
- Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (1 cm), intermediate (1 to 3 cm), and large (3 cm) lymph node lesions.Chest. 2000; 117: 773-778
- Accuracy and clinical impact of mediastinal lymph node staging with FDG-PET imaging in potentially resectable lung cancer.Am J Clin Oncol. 2000; 23: 47-52
- Whole body 18F-2-deoxyglucose positron emission tomography to restage non-small cell lung cancer.Oncol Rep. 2001; 8: 337-339
- Modern diagnostic and therapeutic interventional radiology in lung cancer.J Thorac Dis. 2013; 5: S511-S523
- Semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma stage III/IV—a feasibility study.Eur Radiol. 2008; 18: 1114-1122
- Volumetric measurement of pulmonary nodules at low-dose chest CT: effect of reconstruction setting on measurement variability.Eur Radiol. 2010; 20: 1180-1187
- Diagnosis of regional node metastases in lung cancer with computer-aided 3D measurement of the volume and CT-attenuation values of lymph nodes.Acad Radiol. 2013; 20: 740-745
Article info
Publication history
Published online: February 18, 2014
Accepted:
February 10,
2014
Received in revised form:
January 25,
2014
Received:
December 5,
2013
Footnotes
☆Disclosures: The authors have no financial conflict of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
