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Accuracy of F-18 FDG PET/CT with optimal cut-offs of maximum standardized uptake value according to size for diagnosis of regional lymph node metastasis in patients with rectal cancer

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Author(s)
배성욱원경숙송봉일정운경백성규김해원
Alternative Author(s)
Bae, Sunk UkWon, Kyoung SookSong, Bong IlJeong, Woon KyungBaek, Seong KyuKim, Hae Won
Publication Year
2018
Keyword
Rectal cancerLymph node metastasisMaximum standardized uptake valuePartial volume effectF-18 FDGPET/CT
Abstract
Background:
The low sensitivity of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the evaluation of metastatic lymph nodes (LNs) is mainly due to the partial volume effect in patients with rectal cancer. This retrospective study evaluated the diagnostic accuracy of F-18 FDG PET/CT with optimal cut-off values of the maximum standardized uptake value (SUVmax), according to LN size, for the evaluation of regional LN in rectal cancer patients.

Methods:
This study included 176 patients with rectal cancer who underwent F-18 FDG PET/CT for initial staging. Patients were classified based on the long-axis diameter of the regional LN on CT images as small (≤ 7 mm; n = 118) and large (> 7 mm; n = 58) LN groups. The optimal cut-off value of SUVmax was determined for each group, using receiver operating characteristic curve analysis. Areas under the curve (AUC) were compared by C-statistics using two methods: the cut-off value of SUVmax optimized according to LN size, and a fixed SUVmax cut-off value of 2.5.

Results:
The optimal cut-off values of SUVmax for the small and large LN groups were 1.1, and 2.1, respectively. The sensitivity, specificity, and accuracy of F-18 FDG PET/CT using the optimal cut-off values were 90.6, 70.9, and 76.3% in the small LN group, and 68.6, 78.3, and 72.4% in the large LN group. The sensitivity, specificity, and accuracy of F-18 FDG PET/CT using the fixed cut-off value were 18.8, 100, and 78.0% in the small LN group, and 51.4, 87.0, and 65.5% in the large LN group. The AUC was significantly higher using the optimal cut-off values than the fixed cut-off value (0.808 vs. 0.594, p = 0.005) in the small LN group, but not in the large LN group (0.734 vs. 0.692, p = 0.429).

Conclusions:
Application of the lower cut-off value of SUVmax improves the diagnostic performance of F-18 FDG PET/CT for the evaluation of small regional LNs in patients with rectal cancer.
Department
Dept. of Surgery (외과학)
Dept. of Nuclear Medicine (핵의학)
Publisher
School of Medicine (의과대학)
Citation
Cancer Imaging, Vol.18(1) : null-null, 2018
Type
Article
ISSN
1470-7330
DOI
10.1186/s40644-018-0165-5
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/41777
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