The aim of this study was to assess the diagnostic utility of metabolic parameters on fluorine-18-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) for predicting lymph node (LN) metastasis in patients with cN2 non-small cell lung cancer (NSCLC). We retrospectively reviewed patients who underwent surgery for cN2 NSCLC between 2007 and 2020. Those who had clinically diagnosed positive hilar and mediastinal LNs by routine CT and PET/CT imaging were investigated. To measure the metabolic parameters of LNs, the data according to maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and LN-to-primary tumor ratio of SUVmax (LPR) were examined. The diagnosis of each retrieved LN was confirmed based on histopathological examination of surgical tissue specimens. Receiver operating characteristics (ROC) curves with area under the curve (AUC) calculations and multivariate analysis by logistic regression were performed. Forty-five patients with 84 clinically diagnosed positive hilar or mediastinal LNs were enrolled in the present study. Of the 84 LNs, 63 LNs were pathologically proven as positive (75%). The SUVmax, MTV, TLG, and LPR of LN metastasis were significantly higher than those of benign nodes. In the ROC analysis, the AUC value of LPR [AUC, 0.776; 95% confidence interval (CI), 0.640–0.913] was higher than that of LN SUVmax (AUC, 0.753; 95% CI, 0.626–0.880) or LN TLG3.5 (AUC, 0.746; 95% CI, 0.607–0.885). Using the optimal LPR cutoff value of 0.47, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.1, 66.7, 88.3, 58.3, and 79.8%, respectively. Multivariate analysis by logistic regression showed that LPR was an independent predictor for LN metastasis (odds ratio, 6.45; 95% CI, 1.785–23.301; P = 0.004). In the subgroup analysis of adenocarcinoma patients (n = 18; 32 LNs), TLG3.5 was a better predictor (AUC, 0.816; 95% CI, 0.639–0.985) than LPR (AUC, 0.792; 95% CI, 0.599–0.986) or LN SUVmax (AUC, 0.792; 95% CI, 0.625–0.959). Our findings suggest that LPR on FDG-PET is a useful predictor for LN metastasis in patients with cN2 NSCLC. TLG can be a good predictor for LN metastasis in patients with adenocarcinoma.

中文翻译：

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FDG PET/CT 代谢参数对 cN2 非小细胞肺癌患者淋巴结转移的诊断效用

本研究的目的是评估代谢参数对氟-18-氟-2-脱氧-D-葡萄糖-正电子发射断层扫描（FDG-PET）/计算机断层扫描（CT）预测淋巴结（LN）的诊断效用cN2 非小细胞肺癌 (NSCLC) 患者的转移。我们回顾性地回顾了 2007 年至 2020 年间接受 cN2 NSCLC 手术的患者。对那些通过常规 CT 和 PET/CT 成像临床诊断出阳性肺门和纵隔 LN 的患者进行了调查。为了测量 LN 的代谢参数，根据最大标准化摄取值 (SUVmax)、代谢肿瘤体积 (MTV)、总病变糖酵解 (TLG) 和 LN 与原发肿瘤的 SUVmax 比率 (LPR) 检查数据。根据手术组织标本的组织病理学检查确认了每个检索到的 LN 的诊断。使用曲线下面积 (AUC) 计算和多变量分析进行了接受者操作特征 (ROC) 曲线和逻辑回归分析。本研究招募了 84 名临床诊断阳性肺门或纵隔淋巴结的 45 名患者。在 84 个 LN 中，63 个 LN 经病理证实为阳性 (75%)。LN 转移的 SUVmax、MTV、TLG 和 LPR 显着高于良性淋巴结。在ROC分析中，LPR的AUC值[AUC，0.776；95% 置信区间 (CI), 0.640–0.913] 高于 LN SUVmax (AUC, 0.753; 95% CI, 0.626–0.880) 或 LN TLG3.5 (AUC, 0.746; 95% CI, 0.6857-0)。 . 使用 0.47 的最佳 LPR 截止值，敏感性、特异性、阳性预测值、阴性预测值和准确度分别为 84.1、66.7、88.3、58.3 和 79.8%。通过逻辑回归进行的多变量分析显示 LPR 是 LN 转移的独立预测因子（比值比，6.45；95% CI，1.785–23.301；P = 0.004）。在腺癌患者（n = 18；32 LN）的亚组分析中，TLG3.5 是比 LPR（AUC，0.792；95% CI，0.5969–0.99）更好的预测因子（AUC，0.816；95% CI，0.639–0.985）。 ) 或 LN SUVmax (AUC, 0.792; 95% CI, 0.625–0.959)。我们的研究结果表明，FDG-PET 上的 LPR 是 cN2 NSCLC 患者 LN 转移的有用预测因子。TLG 可以很好地预测腺癌患者的 LN 转移。985) 而不是 LPR (AUC, 0.792; 95% CI, 0.599–0.986) 或 LN SUVmax (AUC, 0.792; 95% CI, 0.625–0.959)。我们的研究结果表明，FDG-PET 上的 LPR 是 cN2 NSCLC 患者 LN 转移的有用预测因子。TLG 可以很好地预测腺癌患者的 LN 转移。985) 而不是 LPR (AUC, 0.792; 95% CI, 0.599–0.986) 或 LN SUVmax (AUC, 0.792; 95% CI, 0.625–0.959)。我们的研究结果表明，FDG-PET 上的 LPR 是 cN2 NSCLC 患者 LN 转移的有用预测因子。TLG 可以很好地预测腺癌患者的 LN 转移。