FDG PET/CT for the preoperative nodal staging of non‐small cell lung cancer in a tuberculosis‐endemic country: Are maximum standardized uptake values useful?

Background The aim of this study was to determine an optimum standardized uptake value threshold for identifying nodal metastasis in non‐small cell lung cancer ( NSCLC) patients using Fluorine‐18 2‐fluoro‐2‐deoxy‐D‐glucose ( FDG) positron emission tomography/computed tomography ( PET / CT) in T aiwan, a tuberculosis‐endemic country. The variation in standardized uptake values of nodal metastasis among different NSCLC histological subtypes was also evaluated. Methods We retrospectively reviewed 75 NSCLC patients who had received FDG PET / CT before surgery. The diagnostic accuracy of FDG PET / CT for the preoperative nodal staging was evaluated by histopathologic findings. Results A total of 316 nodal stations were evaluated. The sensitivity and specificity of FDG PET / CT for nodal staging were 58.6% and 81.8%, respectively, using an SUV cut‐off of 2.6. With regard to the levels of mean SUVmax in true‐positive and false‐positive groups, there was no significant difference among different histological subtypes. Conclusion The present study demonstrated that FDG PET / CT for pre‐operative nodal staging using SUVmax > 2.6 is a useful tool (with a higher specificity and a higher negative predictive value) to rule out the possibility of metastatic lymphadenopathy in operable patients with NSCLC .