Contribution of metabolic parameters from 18FDG PET/CT to lymph node staging in non- small cell lung cancer

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Published Jun 21, 2026
https://doi.org/10.62438/tunismed.v104i06.6470
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Vol. 104 No. 06 (2026): Tunis Med Jun 2026

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Chedly Mhiri
Department of Nuclear Medicine, Salah Azaiez Institute, Faculty of Medicine, Tunis, Tunis El Manar University, Tunis, Tunisia
Marwa Somai
Department of Nuclear Medicine, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Ons Ben Hamida
Department of Nuclear Medicine, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Imène Yeddes
Department of Nuclear Medicine, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Ihsen Slim
Department of Nuclear Medicine, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Imen Meddeb
Department of Nuclear Medicine, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Aida Mhiri
Service de médecine nucléaire,Institut Salah Azaiez, Faculté de médecine de Tunis, Université Tunis El Manar, Tunis, Tunisie

Abstract

Background: Although histology remains the gold standard, several studies have investigated the role of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) in the nodal characterization of non-small cell lung cancer (NSCLC).
Aim: to assess the performance of metabolic PET parameters in lymph node characterization.
Methods: We conducted a retrospective observational study including patients referred to our department for staging of NSCLC with 18F-FDG PET/CT. We measured the maximum standardized uptake value of lymph nodes (SUVmaxN) and calculated SUV ratios normalized to the liver (SUVN/L), the mediastinum (SUVN/M), and the primary tumor (SUVN/T). These metabolic parameters were then compared with histology or follow-up.
Results: Our study included 43 patients and a total of 173 lymph nodes. SUVmaxN and SUVN/L were the most discriminative parameters. Their sensitivity and specificity exceeded 90% and 85%. The mean cut-off values obtained were: SUVmaxN = 3.35: Sensitivity 91.4%, specificity 85.9%; SUVN/L = 1.28: Sensitivity 90.1%, specificity 87.2%;
SUVN/M = 1.85: Sensitivity 85.2%, specificity 87.2%
Conclusion: 18F-FDG PET/CT appears to be a valuable tool for lymph node characterization, which may help optimize therapeutic strategy.

Keywords:

Positron emission tomography, Fluorodeoxyglucose F18, Non-small cell lung cancer, Lymph nodes, Diagnostic Imaging

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References

  1. Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer [En ligne]. Lyon: IARC. Feb 2024 - [consulté en
  2. mai 2024]. Disponible: https://gco.iarc.who.int/today/en/dataviz/ pie?mode=cancer&group_populations=1.
  3. Sharma R. Mapping of global, regional and national incidence, mortality and mortality-to-incidence ratio of lung cancer in 2020
  4. and 2050. Int J Clin Oncol. 2022;27(4):665–675.
  5. Nicholson AG, Tsao MS, Beasley MB, Borczuk AC, Brambilla E, Cooper WA, et al. The 2021 WHO classification of lung tumors:
  6. Impact of advances since 2015. J Thorac Oncol. 2022;17(3):362–387.
  7. Iskender I, Kadioglu SZ, Kosar A, Atasalihi A, Kir A. Is there any maximum standardized uptake value variation among positron
  8. emission tomography scanners for mediastinal staging in non-small cell lung cancer?. Interact Cardiovasc Thorac Surg. 2011;12(6):965–
  9. Cerfolio RJ, Bryant AS. Ratio of the maximum standardized uptake value on FDG-PET of the mediastinal (N2) lymph nodes to the
  10. primary tumor may be a universal predictor of nodal malignancy in patients with nonsmall-cell lung cancer. Ann Thorac Surg.
  11. ;83(5):1826–1829.
  12. Lv YL, Yuan DM, Wang K, Miao XH, Qian Q, Wei SZ, et al. Diagnostic performance of integrated positron emission tomography/
  13. computed tomography for mediastinal lymph node staging in non- small cell lung cancer: a bivariate systematic review and meta-
  14. analysis. J Thorac Oncol. 2011;6(8):1350-1358.
  15. Schmidt-Hansen M, Baldwin DR, Hasler E, Zamora J, Abraira V, Roqué i Figuls M. PET-CT for assessing mediastinal lymph node
  16. involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Database Syst Rev. 2014;2014(11):CD009519.
  17. Lin WY, Hsu WH, Lin KH, Wang SJ. Role of preoperative PET-CT in assessing mediastinal and hilar lymph node status in early stage
  18. lung cancer. J Chin Med Assoc. 2012;75(5):203–238.
  19. Hollings N, Shaw P. Diagnostic imaging of lung cancer. Eur Respir J. 2002;19(4):722–742.
  20. Alongi F, Ragusa P,Montemaggi P, BonaCM. Combining independent studies of diagnostic fluorodeoxyglucose positron-emission
  21. tomography and computed tomography in mediastinal lymph node staging for non-small cell lung cancer. Tumori. 2006;92(4):327–333.
  22. Kudo S, Imai K, Ishiyama K, Hashimoto M, Saito H, Motoyama S, et al. New CT criteria for nodal staging in non-small cell lung cancer.
  23. Clin Imaging. 2014;38(4):448–453.
  24. Kinahan PE, Fletcher JW. PET/CT Standardized uptake values (SUVs) in clinical practice and assessing response to therapy. Semin
  25. Ultrasound CT MR. 2010;31(6):496–505.
  26. Wang R, Fan Q, Tian R, Su M. Intrapatient repeatability of background 18F-FDG uptake on PET/CT. Quant Imaging Med Surg.
  27. ;11(9):4172180–4174180.
  28. Genseke P, Wielenberg CF, Schreiber J, Luecke E, Frese S, Walles T, et al. Prospective evaluation of quantitative F-18-FDG-PET/CT
  29. for pre-operative thoracic lymph node staging in patients with lung cancer as a target for computer-aided diagnosis. Diagnostics.
  30. ;13(7):1263.
  31. Cho J, Choe JG, Pahk K, Choi S, Kwon HR, Eo JS, et al. Ratio of mediastinal lymph node SUV to primary tumor SUV in 18F-FDG
  32. PET/CT for nodal staging in non-small-cell lung cancer. Nucl Med Mol Imaging. 2017;51(2):140–146.
  33. AlRasheedi M, Han S, Thygesen H, Neilson M, Hendry F, Alkarn A, et al. A comparative evaluation of mediastinal nodal SUVmax
  34. and derived ratios from 18F-FDG PET/CT imaging to predict nodal metastases in non-small cell lung cancer. Diagnostics
  35. ;13(7):1209.
  36. Lee AY, Choi SJ, Jung KP, Park JS, Lee SM, Bae SK. Characteristics of metastatic mediastinal lymph nodes of non-small cell lung
  37. cancer on preoperative F-18 FDG PET/CT. Nucl Med Mol Imaging 2014;48(1):41–46.
  38. Yang DD, Mirvis E, Goldring J, Patel ARC, Wagner T. Improving diagnostic performance of 18F-FDG-PET/CT for assessment of
  39. regional nodal involvement in non-small cell lung cancer. Clin Radiol. 2019;74(10):818.e17-818.e23.
  40. Lv X, Wu Z, Cao J, Hu Y, Liu K, Dai X, et al. A nomogram for predicting the risk of lymph node metastasis in T1–2 non-small-cell lung
  41. cancer based on PET/CT and clinical characteristics. Transl Lung Cancer Res. 2021;10(1):430-438.
  42. Werutsky G, Hochhegger B, Pinto JALF, Martinez-Mesa J, Zanini ML, Berdichevski EH. PET-CT has low specificity for mediastinal staging of non-small-cell lung cancer in an endemic area for tuberculosis:a diagnostic test study (LACOG 0114). BMC Cancer. 2019;19(1):5.
  43. Falay FO, Mericoz ÇA, Demirtas E, Bulutay P, Seymen H, Firat P, et al. 18F-FDG PET/CT texture analysis of anthracotic lymph nodes
  44. detected with EBUS and comparison with cytological findings. Hell J Nucl Med. 2022;25(2):148–154.
  45. Sun J, Wu S, Jin Z, Ren S, Cho WC, Zhu C, et al. Lymph node micrometastasis in non–small cell lung cancer. Biomed &
  46. Pharmacotherapy 2022;149:112817.
  47. Samejima J, Ito H, Nagashima T, Nemoto D, Eriguchi D, Nakayama H, et al. Anatomical location and number of metastatic lymph
  48. nodes for prognosis of non-small cell lung cancer. J Thorac Dis. 2021;13(7):4083–4093.
  49. Luo T, Chen Q, Zeng J. Analysis of lymph node metastasis in 200 patients with non-small cell lung cancer. Transl Cancer Res.
  50. ;9(3):1577-1583.
  51. Ketchedjian A, Daly BDT, Fernando HC, Florin L, Hunter CJ, Morelli DM, et al. Location as an important predictor of lymph node
  52. involvement for pulmonary adenocarcinoma. J Thorac Cardiovasc Surg. 2006;132(3):544–548.
  53. Liang RB, Yang J, Zeng TS, Long H, Fu JH, Zhang LJ, et al. Incidence and distribution of lobe-specific mediastinal lymph node metastasis in non-small cell lung cancer: Data from 4511 resected cases. Ann Surg Oncol. 2018;25(11):3300–3307.
  54. Wang Z, Li M, Teng F, Kong L, Yu J. Primary tumor location is an important predictor of survival in pulmonary adenocarcinoma.
  55. Cancer Manag Res. 2019;2019(11):2269–2280.
  56. Ding N, Mao Y, Gao S, Xue Q, Wang D, Zhao J, et al. Predictors of lymph node metastasis and possible selective lymph node
  57. dissection in clinical stage IA non-small cell lung cancer. J Thorac Dis. 2018;10(7):4061-4068.
  58. Zhang S, Li S, Pei Y, Huang M, Lu F, Zheng Q, et al. Impact of maximum standardized uptake value of non-small cell lung cancer
  59. on detecting lymph node involvement in potential stereotactic body radiotherapy candidates. J Thorac Dis. 2017;9(4):1023–1031.
  60. Yu X, Wang J, Huang L, Xie L, Su Y. Predictive value of 18F-FDG PET/ CT metabolic parameters for lymph node metastasis of non-small
  61. cell lung cancer. Biomark Med. 2025;19(2):35–41.