Relationship between maximum standardized uptake value (SUVmax) of lung cancer and lymph node metastasis on FDG-PET

Purpose  To evaluate the relationship between SUVmax of primary lung cancers on FDG-PET and lymph node metastasis. Method and materials  The subjects were a total of consecutive 66 patients with lung cancer who were examined by FDG-PET and subsequently underwent surgery between October 2004 and January 2008. There were 41 males and 25 females, ranging in age from 45 to 83 years with an average of 68 years. The pathological subtypes of the lung cancers consisted of 49 adenocarcinomas, 11 squamous cell carcinomas, 2 adenosquamous carcinoma, 1 large cell carcinoma, 1 small cell carcinoma, 1 pleomorphic carcinoma and 1 mucoepidermoid carcinoma. We statistically compared (1) the mean SUVmax of lung cancer between the groups with and without lymph node metastasis (2) the frequency of lymph node metastasis between higher and lower SUVmax of lung cancer groups that were classified by using the median SUVmax of lung cancer, and (3) evaluated the relationship between the SUVmax of lung cancer and frequency of lymph node metastases, and (4) correlations between the SUVmax of lung cancer and number of the metastatic lymph nodes and pathological n stages. Results  The difference in the average of the SUVmax of lung cancer between the cases with and without lymph node metastases was statistically significant (p = 0.00513). Lymph node metastasis was more frequently seen in the higher SUVmax of lung cancer group (17/33, 52%) than in the lower SUVmax of lung cancer group (7/33, 21%) with a statistically significant difference. There was no lymph node metastasis in lung cancers with an SUVmax of lung cancer less than 2.5, and lung cancers with an SUVmax of lung cancer more than 12 had a 70% frequency of lymph node metastasis. There were moderate correlations between SUVmax of lung cancer, and the number of the metastatic lymph nodes (γ = 0.404, p = 0.001) and pathological n stage (γ = 0.411, p = 0.001). Conclusions  The likelihood of lymph node metastasis increases with an increase of the SUV of a primary lung cancer.