Occult mediastinal lymph node metastasis in FDG‐PET/CT node‐negative lung adenocarcinoma patients: Risk factors and histopathological study

作者：Miao Huang, Shaolei Li, Nan Li, Lai Yumei, Zhang Shanyuan, Fangliang Lu, Yang Yue · 发表于：Thoracic Cancer · 年份：2019 · DOI：10.1111/1759-7714.13093 · 被引用次数：43 · 研究领域：Lung Cancer Diagnosis and Treatment、Hepatocellular Carcinoma Treatment and Prognosis、Lung Cancer Treatments and Mutations

BACKGROUND: F-fluorodeoxy-glucose PET/CT node-negative lung adenocarcinoma patients. METHODS: We reviewed the clinical data and PET/CT parameters of 360 consecutive pulmonary adenocarcinoma patients who were scheduled to undergo anatomical pulmonary resection and systemic mediastinal node dissection. The nodal metastasis was pathologically defined and all resected tumors were classified according to the 2011 IASLC/ATS/ERS classification. Univariate and multivariate analysis were conducted to evaluate the associations between clinicopathological variables and MLNM. RESULTS: Of all 360 patients, 54 (15.0%) had pathological N2 diseases. The serum CEA level, nodule type, hilar nodal SUVmax, tumor SUVmax, size, location and histologic subtype were associated with MLNM significantly on univariate analysis. On multivariate analysis, CEA ≥ 5.0 ng/mL (P < 0.001), solid nodule (P = 0.012), tumor SUVmax ≥ 3.7 (P < 0.027), hilar nodal SUVmax ≥ 2.0 (P < 0.001) and centrally located tumor (P = 0.035) were independent risk factors for MLNM. The area under the ROC curve (AUC) for tumor SUVmax and hilar nodal SUVmax in predicting MLNM was 0.764 and 0.730, respectively, and the combined use of five factors yielded a higher AUC of 0.885. CONCLUSION: Increased primary tumor and hilar lymph node SUVmax, solid nodule, centrally located tumor and increased CEA level predicted the increased risk of mediastinal lymph node metastasis. Combined use of these factors improved the diagnostic capacity for ...