Abdominal Radiology

, Volume 44, Issue 3, pp 828–835 | Cite as

Comparative accuracy of qualitative and quantitative 18F-FDG PET/CT analysis in detection of lymph node metastasis from anal cancer

  • Thitinan ChulroekEmail author
  • Hamed Kordbacheh
  • Dearada Wangcharoenrung
  • Kamonwon Cattapan
  • Pedram Heidari
  • Mukesh G. Harisinghani
Hollow Organ GI



To compare the diagnostic performance of qualitative and quantitative 18F-FDG PET/CT in detection of regional and distant lymph node metastasis in patients with anal cancer.


Between 2004 and 2017, 28 patients with anal cancer who had staging PET/CT and pathological assessment of suspicious lymph nodes were included. For qualitative analysis, positive lymph nodes were defined as uptake visually higher than the liver reference uptake. For quantitative study, lymph nodes were contoured to determine maximum standard uptake value (SUVmax) and metabolic tumor volume (MTV). Receiver operating characteristic (ROC) curves were plotted to extract the optimal cut-offs and area under the curve (AUC) of SUVmax, lesion to background (L/B) ratio, short axis diameter (SAD), and MTV of lymph nodes. Histopathologic analysis was a reference standard.


A total of 28 lymph nodes (24 inguinal, 2 external iliac, 1 internal iliac, and 1 paraaortic nodes) in 28 patients on PET/CT were included. With the qualitative visual analysis, 19 patients were categorized as positive for nodal metastasis with sensitivity, specificity, and accuracy of 85%, 75%, and 82%. The optimal SUVmax and L/B ratio cut-offs were 2.6 and 1.0 with both sensitivity and specificity of 95% and 75% (AUC of SUVmax = 0.893, AUC of L/B ratio = 0.912). Using the best cut-off of 1.6 cm for SAD and 3.65 cm3 for MTV, both sensitivity and specificity were 80% and 100% (AUC of SAD = 0.950, AUC of MTV = 0.931).


SUVmax optimization may be helpful in enhancing the diagnostic accuracy of 18F-FDG PET/CT in nodal staging patients with anal cancer.


Anal cancer Squamous cell carcinoma PET/CT Lymph node metastasis SUVmax 



This study was not funded.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors. IRB statement: Institutional Review Board (IRB) and Health Insurance Portability and Accountability Act (HIPPA) approval were obtained and requirement for informed consent was waived by our hospital IRB.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyMassachusetts General HospitalBostonUSA
  2. 2.Department of Diagnostic Radiology, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkokThailand
  3. 3.Department of Diagnostic Radiology, Faculty of Medicine, Vajira HospitalNawamindradhiraj UniversityBangkokThailand
  4. 4.Department of RadiologyPrince of Songkla UniversitySongkhlaThailand

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