When to Consider Invasive Lymph Node Staging in Non–Small-Cell Lung Cancer? A Novel Scoring System Utilising Metabolic Parameters in 18F-FDG PET/CT

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia Pub Date : 2024-10-01 DOI:10.1016/j.arbres.2024.05.020

{"title":"When to Consider Invasive Lymph Node Staging in Non–Small-Cell Lung Cancer? A Novel Scoring System Utilising Metabolic Parameters in 18F-FDG PET/CT","authors":"","doi":"10.1016/j.arbres.2024.05.020","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div><span>The maximum standardised uptake value (SUVmax) is a widely utilised metric in positron emission tomography/computed tomography for clinically staging non–small-cell lung cancer (NSCLC), yet the reliability of SUVmax remains controversial. We herein aimed to assess the effectiveness of semi-quantitative parameters, encompassing size, SUVmax, metabolic tumour volume (MTV), total lesion glycolysis (TLG) and heterogeneity factor (HF), in evaluating both </span>primary tumours and lymph nodes (LNs) on positron emission tomography/computed tomography. A novel scoring system was devised to appraise the role of semi-quantitative parameters and visually evaluate LNs for nodal staging.</div></div><div><h3>Materials and Methods</h3><div>Patients with pathological NSCLC, diagnosed between 2014 and 2019 and clinically staged I-III, were enrolled in the study. Patient demographics, including age, sex, tumour location, diameter, tumour-node-metastasis stage, as well as SUVmax, MTV, TLG and HF parameters of primary tumours and LNs, were documented.</div></div><div><h3>Results</h3><div><span><span>The analysis comprised 319 patients and 963 LNs. Patients had a mean age of 61.62 years, with 91.5% being male. Adenocarcinoma exhibited a histological association with LN </span>metastasis (P</span>  <span>0.043). The study findings revealed that tumour size, SUVmax, MTV, TLG and HF did not significantly affect the detection of LN metastasis. Conversely, non-squamous cell carcinoma, LNs exhibiting higher FDG levels than the liver, LN size, SUVmax, MTV and TLG were identified as risk factors (P</span>    <!-->cm<sup>3</sup> for MTV and 5.485 for TLG. The scoring system incorporated these parameters, and visual assessment indicated that a score of ≥3 increased the risk of metastasis by 14.33 times.</div></div><div><h3>Conclusion</h3><div>We devised a novel scoring system and demonstrated that LNs with a score of ≥3 in patients with NSCLC have a high likelihood of metastasis. This innovative scoring system can serve as a valuable tool to mitigate excessive and extreme measures in the assessment of invasive pathological staging.</div></div>","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":null,"pages":null},"PeriodicalIF":8.7000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archivos De Bronconeumologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0300289624001844","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

The maximum standardised uptake value (SUVmax) is a widely utilised metric in positron emission tomography/computed tomography for clinically staging non–small-cell lung cancer (NSCLC), yet the reliability of SUVmax remains controversial. We herein aimed to assess the effectiveness of semi-quantitative parameters, encompassing size, SUVmax, metabolic tumour volume (MTV), total lesion glycolysis (TLG) and heterogeneity factor (HF), in evaluating both primary tumours and lymph nodes (LNs) on positron emission tomography/computed tomography. A novel scoring system was devised to appraise the role of semi-quantitative parameters and visually evaluate LNs for nodal staging.

Materials and Methods

Patients with pathological NSCLC, diagnosed between 2014 and 2019 and clinically staged I-III, were enrolled in the study. Patient demographics, including age, sex, tumour location, diameter, tumour-node-metastasis stage, as well as SUVmax, MTV, TLG and HF parameters of primary tumours and LNs, were documented.

Results

The analysis comprised 319 patients and 963 LNs. Patients had a mean age of 61.62 years, with 91.5% being male. Adenocarcinoma exhibited a histological association with LN metastasis (P = 0.043). The study findings revealed that tumour size, SUVmax, MTV, TLG and HF did not significantly affect the detection of LN metastasis. Conversely, non-squamous cell carcinoma, LNs exhibiting higher FDG levels than the liver, LN size, SUVmax, MTV and TLG were identified as risk factors (P < 0.0001). The identified cut-off values were 1.05 cm for LN size, 4.055 for SUVmax, 1.805 cm³ for MTV and 5.485 for TLG. The scoring system incorporated these parameters, and visual assessment indicated that a score of ≥3 increased the risk of metastasis by 14.33 times.

Conclusion

We devised a novel scoring system and demonstrated that LNs with a score of ≥3 in patients with NSCLC have a high likelihood of metastasis. This innovative scoring system can serve as a valuable tool to mitigate excessive and extreme measures in the assessment of invasive pathological staging.

查看原文本刊更多论文

何时考虑对非小细胞肺癌进行淋巴结浸润性分期？利用 18F-FDG PET/CT 代谢参数的新型评分系统。

目的：最大标准化摄取值（SUVmax最大标准化摄取值（SUVmax）是正电子发射计算机断层扫描（Positron emission tomography/Computed tomography）中广泛使用的指标，用于非小细胞肺癌（NSCLC）的临床分期，但SUVmax的可靠性仍存在争议。我们在此旨在评估半定量参数（包括肿瘤大小、SUVmax、代谢肿瘤体积（MTV）、总病灶糖酵解（TLG）和异质性因子（HF））在正电子发射断层扫描/计算机断层扫描中评估原发肿瘤和淋巴结（LN）的有效性。研究人员设计了一套新的评分系统来评估半定量参数的作用，并对淋巴结进行直观评估，以进行结节分期：研究对象为2014年至2019年期间确诊的病理NSCLC患者，临床分期为I-III期。研究记录了患者的人口统计学特征，包括年龄、性别、肿瘤位置、直径、肿瘤-结节-转移分期，以及原发肿瘤和LN的SUVmax、MTV、TLG和HF参数：分析包括 319 名患者和 963 个 LN。患者平均年龄为61.62岁，91.5%为男性。腺癌在组织学上与淋巴结转移有关（P=0.043）。研究结果显示，肿瘤大小、SUVmax、MTV、TLG和HF对LN转移的检测无明显影响。相反，非鳞癌、表现出比肝脏更高的 FDG 水平的 LN、LN 大小、SUVmax、MTV 和 TLG 被确定为风险因素（MTV 的 P3 和 TLG 的 5.485）。评分系统纳入了这些参数，目测评估结果显示，得分≥3分的转移风险增加了14.33倍：我们设计了一套新颖的评分系统，并证明NSCLC患者LN评分≥3分的转移可能性很高。这种创新的评分系统可作为一种有价值的工具，在有创病理分期评估中减少过度和极端的措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Archivos De Bronconeumologia Medicine-Pulmonary and Respiratory Medicine

CiteScore

3.50

自引率

17.50%

发文量

330

审稿时长

14 days

期刊介绍： Archivos de Bronconeumologia is a scientific journal that specializes in publishing prospective original research articles focusing on various aspects of respiratory diseases, including epidemiology, pathophysiology, clinical practice, surgery, and basic investigation. Additionally, the journal features other types of articles such as reviews, editorials, special articles of interest to the society and editorial board, scientific letters, letters to the editor, and clinical images. Published monthly, the journal comprises 12 regular issues along with occasional supplements containing articles from different sections. All manuscripts submitted to the journal undergo rigorous evaluation by the editors and are subjected to expert peer review. The editorial team, led by the Editor and/or an Associate Editor, manages the peer-review process. Archivos de Bronconeumologia is published monthly in English, facilitating broad dissemination of the latest research findings in the field.