Identification of false-negative and false-positive diagnoses of lymph node metastases in non-small cell lung cancer patients staged by integrated ^18F-fluorodeoxyglucose-positron emission tomography/computed tomography: A retrospective cohort study

Background: The aim of this study was to evaluate the diagnostic accuracy of integrated ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in hilar and mediastinal lymph node (HMLN) staging of non-small cell lung cancer (NSCLC), and to investigate potential risk factors for false-negative and false-positive HMLN metastases. Methods: We examined the data of 388 surgically resected NSCLC patients preoperatively staged by integrated FDG-PET/CT. Risk factors for false-negative and false-positive HMLN metastases were analyzed using univariate and multivariate analyses of clinicopathological factors. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of integrated FDG-PET/CT in detecting HMLN metastases were 47.4%, 91.0%, 56.3%, 87.7%, and 82.5%, respectively. On multivariate analysis, the maximum standardized uptake value (SUVmax) of the tumor (P = 0.042), adenocarcinoma (P = 0.003), and tumor size (P = 0.017) were risk factors for false-negative HMLN metastases, and history of lung disease (P = 0.006) and tumor location (central; P = 0.025) were risk factors for false-positive HMLN metastases. Conclusions: The present study identified risk factors for false-negative and false-positive HMLN metastases in NSCLC patients staged by preoperative integrated FDG-PET/CT. These findings would be helpful in selecting appropriate candidates for mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.