Prediction of occult lymph node metastasis using SUV, volumetric parameters and intratumoral heterogeneity of the primary tumor in T1-2N0M0 lung cancer patients staged by PET/CT

  • Ming-li Ouyang
  • Hu-wei Xia
  • Man-man Xu
  • Jie Lin
  • Li-li Wang
  • Xiang-wu Zheng
  • Kun TangEmail author
Original Article



The aim of this study was to identify whether PET/CT-related metabolic parameters of the primary tumor could predict occult lymph node metastasis (OLM) in patients with T1-2N0M0 NSCLC staged by 18F-FDG PET/CT.


215 patients with clinical T1-2N0M0 (cT1-2N0M0) NSCLC who underwent both preoperative FDG PET/CT and surgical resection with the systematic lymph node dissection were included in the retrospective study. Heterogeneity factor (HF) was obtained by finding the derivative of the volume-threshold function from 40 to 80% of the maximum standardized uptake value (SUVmax). Univariate and multivariate stepwise logistic regression analyses were used to identify these PET parameters and clinicopathological variables associated with OLM.


Statistically significant differences were detected in sex, tumor site, SUVmax, mean SUV (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis and HF between patients with adenocarcinoma (ADC) and squamous cell carcinoma (SQCC). OLM was detected in 36 (16.7%) of 215 patients (ADC, 27/152 = 17.8% vs. SQCC, 9/63 = 14.3%). In multivariate analysis, MTV (OR = 1.671, P = 0.044) in ADC and HF (OR = 8.799, P = 0.023) in SQCC were potent associated factors for the prediction of OLM. The optimal cutoff values of 5.12 cm3 for MTV in ADC, and 0.198 for HF in SQCC were determined using receiver operating characteristic curve analysis.


In conclusion, MTV was an independent predictor of OLM in cT1-2N0M0 ADC patients, while HF might be the most powerful predictor for OLM in SQCC. These findings would be helpful in selecting patients who might be considered as candidates for sublobar resection or new stereotactic ablative radiotherapy.


Non-small cell lung cancer Heterogeneity factor Metabolic tumor volume 18F-FDG PET/CT Occult nodal metastasis 



Kun Tang kindly provided statistical advice for this manuscript. The authors would like to thank Xiangwu Zheng, MD for the study design and editing the draft of the manuscript.


This research did not receive any funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethics approval

The local Institutional Review Board approved this study. Since this was a retrospective study with secondary data, the Local Ethics Committee did not request individual informed consent.


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Copyright information

© The Japanese Society of Nuclear Medicine 2019

Authors and Affiliations

  • Ming-li Ouyang
    • 1
  • Hu-wei Xia
    • 1
  • Man-man Xu
    • 1
  • Jie Lin
    • 1
  • Li-li Wang
    • 1
  • Xiang-wu Zheng
    • 1
  • Kun Tang
    • 1
    Email author
  1. 1.Department of PET/CT, Radiology Imaging CenterThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople’s Republic of China

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