PLoS ONE (Jan 2013)

Implications of false negative and false positive diagnosis in lymph node staging of NSCLC by means of ¹⁸F-FDG PET/CT.

  • Shaolei Li,
  • Qingfeng Zheng,
  • Yuanyuan Ma,
  • Yuzhao Wang,
  • Yuan Feng,
  • Bingtian Zhao,
  • Yue Yang

DOI
https://doi.org/10.1371/journal.pone.0078552
Journal volume & issue
Vol. 8, no. 10
p. e78552

Abstract

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BACKGROUND:Integrated ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) is widely performed in hilar and mediastinal lymph node (HMLN) staging of non-small cell lung cancer (NSCLC). However, the diagnostic efficiency of PET/CT remains controversial. This retrospective study is to evaluate the accuracy of PET/CT and the characteristics of false negatives and false positives to improve specificity and sensitivity. METHODS:219 NSCLC patients with systematic lymph node dissection or sampling underwent preoperative PET/CT scan. Nodal uptake with a maximum standardized uptake value (SUV(max)) >2.5 was interpreted as PET/CT positive. The results of PET/CT were compared with the histopathological findings. The receiver operating characteristic (ROC) curve was generated to determine the diagnostic efficiency of PET/CT. Univariate and multivariate analysis were conducted to detect risk factors of false negatives and false positives. RESULTS:The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT in detecting HMLN metastases were 74.2% (49/66), 73.2% (112/153), 54.4% (49/90), 86.8% (112/129), and 73.5% (161/219). The ROC curve had an area under curve (AUC) of 0.791 (95% CI 0.723-0.860). The incidence of false negative HMLN metastases was 13.2% (17 of 129 patients). Factors that are significantly associated with false negatives are: concurrent lung disease or diabetes (p4.0 (p=0.009). Postoperatively, 45.5% (41/90) patients were confirmed as false positive cases. The univariate analysis indicated age > 65 years old (p=0.009), well differentiation (p=0.002), and SUV(max) of primary tumor ≦4.0 (p=0.007) as risk factors for false positive uptake. CONCLUSION:The SUV(max) of HMLN is a predictor of malignancy. Lymph node staging using PET/CT is far from equal to pathological staging account of some risk factors. This study may provide some aids to pre-therapy evaluation and decision-making.