A Phase 1b Clinical Trial of Neoadjuvant Radio-immunotherapy for Esophageal Squamous Cell Cancer.

PURPOSE: Neoadjuvant chemoradiotherapy is the recommended treatment for patients with resectable esophageal cancer but is associated with a higher incidence of adverse effects. Given the efficacy of immunotherapy, we propose a chemotherapy-free regimen of neoadjuvant radio-immunotherapy (NRIT) to balance therapeutic efficacy and potential side effects or overtreatment. METHODS AND MATERIALS: In this phase 1b clinical trial, we assessed the safety and efficacy of NRIT in esophageal squamous cell cancer. The enrolled patients received 41.4 Gy of radiation and 4 cycles of 240 mg of toripalimab injection before surgery. The primary endpoint was treatment-related adverse events and the secondary endpoints were pathologic complete response and major pathologic response. Immunohistochemistry and multiplex immunofluorescence staining were used to evaluate the tumor microenvironment before and after neoadjuvant treatment. RESULTS: Of the 22 patients enrolled, 19 underwent R0 surgery. One patient discontinued neoadjuvant immune therapy due to experiencing a grade 3 treatment-related adverse event. Three patients did not undergo surgery due to tumor progression or side effects. Among the patients who underwent surgery, 3 patients experienced serious complications shortly after surgery. Upon pathologic evaluation, the pathologic complete response and major pathologic response rates were 47.4% and 68.4%, respectively. CONCLUSIONS: The NRIT regimen is safe and feasible for patients with esophageal squamous cell cancer.

Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review.

Anastomotic leak is still a severe complication in esophageal surgery due to high mortality. This article reviews the updates on the treatment of anastomotic leak after esophagectomy in order to provide reference for clinical treatment and research. The relevant studies published in the Chinese Zhiwang, Wanfang, and MEDLINE databases to December 21, 2021 were retrieved, and esophageal carcinoma, esophagectomy, anastomotic leakage, and fistula selected as the keywords. A total of 78 studies were finally included. The treatments include traditional surgical drainage, new reverse drainage trans-fistula, stent plugging, endoscopic clamping, biological protein glue injection plugging, endoluminal vacuum therapy (EVT), and reoperation, etc. Early diagnosis, accurate classification and optimal treatment can promote the rapid healing of anastomotic leaks. EVT may be the most valuable approach, simultaneously with good commercial prospects. Reoperation should be considered in patients with complex fistula in which conservative treatment is insufficient or has failed.

Surgery combined with photodynamic therapy versus surgery alone for the treatment of non-melanoma skin cancer and actinic keratosis: A retrospective cohort study.

Photodynamic therapy (PDT) is an effective treatment for some non-melanoma skin cancers (NMSC) and actinic keratosis. To compare recurrence-free survival (RFS) rates between surgery alone and surgery with postoperative PDT in patients with NMSC in China. This retrospective cohort study included patients with pathologically confirmed NMSC or actinic keratosis treated by surgical excision with/without PDT. A total of 125 patients were included, including 72 patients (43 females) aged 57-75 years in the surgery alone group and 53 patients (32 females) aged 61-76 years in the surgery+PDT group. The most common NMSC types were squamous cell carcinoma and basal cell carcinoma, the most common lesion site was the head and neck, and the vast majority of patients had a primary disease and solitary lesions. There were no significant differences between groups in baseline characteristics. RFS rates in the surgery alone and surgery+PDT groups were, respectively, 100.0% and 98.1% at 1 week, 98.6% and 98.1% at 4 weeks, 97.2% and 98.1% at 8 weeks, 97.2% and 98.1% at 12 weeks, and 90.3% and 90.4% at 24 weeks, with no significant differences between groups. Adjuvant PDT after surgical excision of NMSC or actinic keratosis does not provide short-term improvement in RFS, but the results need to be confirmed by a formal randomized controlled trial.

A Modified Flexor Tendon Suture Technique Combining Kessler and Loop Lock Flexor Tendon Sutures

OBJECTIVES: In the present study, a novel single knot tenorrhaphy was developed by combining the modified Kessler flexor tendon suture (MK) with the loop lock technique. METHODS: A total of 48 porcine flexor digitorum profundus tendons were collected and randomly divided into six groups. The tendons were transversely cut and then repaired using six different techniques, the MK method, double knot Kessler-loop lock flexor tendon suture (DK), and single knot Kessler-loop lock flexor tendon suture (SK), each in combination with the epitendinous suture (P), and the same three techniques without P. Furthermore, by performing the load-to-failure tests, the biomechanical properties and the time taken to complete a repair, for each tenorrhaphy, were assessed. RESULTS: Compared to the MK+P method, DK+P was more improved, thereby enhancing the ultimate tensile strength. The SK+P method, which required fewer knots than DK+P, was easier to perform. Moreover, the SK+P repair increased the force at a 2-mm gap formation, while requiring lesser knots than DK+P. CONCLUSION: As opposed to the traditional MK+P method, the SK+P method was improved and exhibited better biomechanical properties, which may facilitate early mobilization after the repair.

Erratum: miR-23b suppresses lung carcinoma cell proliferation through CCNG1.

[This corrects the article DOI: 10.3892/ol.2018.9181.].

CircABCB10 promotes nonsmall cell lung cancer cell proliferation and migration by regulating the miR-1252/FOXR2 axis.

Circular RNA (circRNA) is a key regulator in the development and progression of human cancers. Previous studies confirmed circRNA-0008717 (circABCB10) as an oncogene in osteosarcoma, but the regulatory effect of circABCB10 in nonsmall cell lung cancer (NSCLC) is still unclear. In the current study, we examined the expression of circABCB10 in different NSCLC cell lines. Bioinformatics analysis, Cell Counting Kit-8 assays, Transwell migration, fluorescein reporting experiments, and xenografts in mice were used to detect the effect of circABCB10 on NSCLC cell proliferation and migration in vitro and tumor growth in vivo. The results showed that the expression of circABCB10 in NSCLC cell lines was increased. Downregulation of circABCB10 suppressed NSCLC cell proliferation and migration by promoting microRNA miR-1252 expression and suppressing Forkhead box 2 (FOXR2). Fluorescein reporting experiments confirmed that circABCB10 expression increased FOXR2 levels by sponging miR-1252, and in vivo experiments found that knockdown of circABCB10 decreased tumor growth. These data suggested that circABCB10 acted as a tumor promoter through a novel miR-1252/FOXR2 axis, providing potential biomarkers and therapeutic targets for the management of NSCLC.

miR-23b suppresses lung carcinoma cell proliferation through CCNG1.

Lung carcinoma with high incidence rate could be divided into four subtypes, including small cell carcinoma, squamous cell carcinoma, adenocarcinoma and large cell carcinoma. miR-23b has been reported to have a low expression and play major roles in abundant tumors, however there is little research in lung carcinoma and hence the purpose of this study was to explore the impact of miR-23b in lung carcinoma. The RNA level of miR-23b and cyclin G1 (CCNG1) was measured by reverse transcription quantitative PCR. Luciferase activity reporter assay was used to verify that CCNG1 is a target of miR-23b. MTT and Transwell assays were utilized to test the functional studies of miR-23b in lung cancer cells. In lung carcinoma and lung cancer cells miR-23b expression is low compared with that in paracancerous tissues and normal lung cells. Low miR-23b expression inhibited lung cancer cell proliferation measured by MTT assay. We applied luciferase reporter to determine whether CCNG1 is a target of miR-23b and there was a negative correlation between them. Moreover, interference with CCNG1 reduced the cell proliferation ability, which partially reversed function of miR-23b. miR-23b inhibited cell proliferation of lung cancer by directly targeting CCNG1. It is suggested that miR-23b/CCNG1 axis may present a new target for the treatment of lung cancer.

A Biomechanical Analysis of the Interlock Suture and a Modified Kessler-Loop Lock Flexor Tendon Suture

OBJECTIVE: In this work, we attempted to develop a modified single-knot Kessler-loop lock suture technique and compare the biomechanical properties associated with this single-knot suture technique with those associated with the conventional modified Kessler and interlock suture techniques. METHODS: In this experiment, a total of 18 porcine flexor digitorum profundus tendons were harvested and randomly divided into three groups. The tendons were transected and then repaired using three different techniques, including modified Kessler suture with peritendinous suture, interlock suture with peritendinous suture, and modified Kessler-loop lock suture with peritendinous suture. Times required for suturing were recorded and compared among groups. The groups were also compared with respect to 2-mm gap load, ultimate failure load, and gap at failure. RESULTS: For tendon repair, compared with the conventional modified Kessler suture technique, the interlock and modified Kessler-loop lock suture techniques resulted in significantly improved biomechanical properties. However, there were no significant differences between the interlock and modified Kessler-loop lock techniques with respect to biomechanical properties, gap at failure, and time required. CONCLUSIONS: The interlock and modified Kessler-loop lock techniques for flexor tendon sutures produce similar mechanical characteristics in vitro.

Classification of chronic radiation-induced ulcers in the chest wall after surgery in breast cancers.

BACKGROUND AND PURPOSE: To explore the methods of clinical classification in chronic radiation-induced ulcers in the chest wall (CRUCWs). MATERIALS AND METHODS: A total of 64 patients with CRUCWs were treated. We divided the cases into 3 types (mild, moderate, or severe) according to their clinical manifestations. Conservative treatments, axial-pattern myocutaneous or local flaps, or filleted flaps were applied correspondingly. RESULTS: The cases were divided as follows: mild (n = 11), moderate (n = 45), and severe (n = 8). Eight cases were cured by conservative surgical therapy. One case had a recurrence 6 months after conservative therapy and was cured by a latissimus dorsi myocutaneous flap. The transferred flaps all survived, including 26 transverse rectus abdominis myocutaneous flaps, 8 longitudinal rectus abdominis myocutaneous flaps, 6 latissimus dorsi myocutaneous flaps, 3 contralateral breast flaps, 5 lateral thoracic rotation flaps, and 7 filleted flaps. In 2 transverse rectus abdominis myocutaneous flaps and 2 latissimus dorsi myocutaneous flaps, distal necrosis appeared in small areas. The resulting wounds were salvaged with skin graft and full healing was achieved. CONCLUSION: CRUCWs can be divided into three types. Surgical methods should vary with distinguished classifications. The effective classification of CRUCWs has definite instructive significance on the selection of surgical approaches.

Transcriptome sequencing and comparative analysis reveal long-term flowing mechanisms in Hevea brasiliensis latex.

BACKGROUND: The rubber tree, Hevea brasiliensis, is a major commercial source of natural rubber. Increasing the rubber yield of rubber trees is a very serious problem since the demands for high quality rubber materials are great. Establishment of a tapping system is based on an estimate of tapping intensity from the rubber tree. Latex flowing time is one of the most critical factors that determine the rubber yield. Long-term flow is a type of phenomenon of the rubber tree latex with longer flowing time than normal latex flow, and is always caused by intensive tapping. Thus, transcriptome and expression profiling data for long-term flowing latex (LFL) are needed as an important resource to identify genes and to better understand the biological mechanisms of latex flow in rubber trees. RESULTS: The transcripts were sequenced using the Illumina sequencing platform. After cleaning, quality checks and sequencing, 98,697 transcripts and 38,584 unigenes were assembled with the mean size of 1437.31bp and 923.86bp, respectively. In BLAST searches of our database against public databases, 65.17% (25,147) of the unigenes were annotated with gene descriptions, conserved protein domains, or gene ontology terms. Functional categorization further revealed 853 individual unigenes related to long-term flow. According to KEGG classification, the clusters for "cysteine and methionine metabolism", "energy", "oxidative phosphorylation", "terpenoid backbone biosynthesis", "plant hormone signal transduction" and "copper, potassium transporter" were significantly enriched metabolic pathways. CONCLUSIONS: We conducted high-resolution transcriptome profiling related to LFL in H. brasiliensis. The research facilitates further studies on gene discovery and on the molecular mechanisms related to the estimation of tapping intensity and prolonging latex flowing time. We concluded that it was necessary to improve energy supplies for intensive tapping and the copper ion content of rubber tree latex could be considered as a standard to estimate tapping intensity.

Hypoxia imaging with 18F-fluoroerythronitroimidazole integrated PET/CT and immunohistochemical studies in non-small cell lung cancer.

PURPOSE: (18)F-fluoroerythronitroimidazole ((18)F-FETNIM) PET/CT allows a noninvasive assessment of tumor hypoxia. The purpose of this study was to evaluate a noninvasive and simplicity parameter for quantization of (18)F-FETNIM uptake with expectations to predict survival in non-small cell lung cancer surgical patients and investigate the relationship between (18)F-FETNIM uptake and molecular markers related to hypoxia, glucose metabolism, and angiogenesis. PATIENTS AND METHODS: Thirty-two patients with biopsy-proven non-small cell lung cancer for surgical treatment were enrolled from March 2007 to February 2011. All patients had PET/CT studies with (18)F-FETNIM and subsequently underwent surgery. Twenty-five patients had stage II disease of surgical staging only for statistical analysis. The tumor-to-mediastinum (T/Me) ratio was calculated and correlated with survival and immunohistochemical staining of hypoxia inducible factor 1α (HIF-1α), glucose transporter 1 (GLUT-1), and vascular endothelial growth factor (VEGF). RESULTS: The actuarial survival was worse for patients showing a high T/Me ratio, the best discriminative cutoff value being 1.9. A statistically significant worse survival was noted in patients having a tumor with a T/Me ratio of 1.9 or greater, compared with patients showing a tumor with a T/Me ratio of less than 1.9, a 3-year survival of 43.8% and 88.9%, respectively (P = 0.034). There was a positive correlation between T/Me ratio and HIF-1α (P = 0.023), GLUT-1 (P = 0.035), and VEGF (P = 0.042). CONCLUSIONS: T/Me ratio provides a noninvasive parameter for quantization of (18)F-FETNIM uptake on PET/CT. T/Me ratio is correlated with a worse outcome and with the expression of HIF-1α, GLUT-1, and VEGF, all up-regulated under hypoxic conditions.

Effective modulation of CD4(+)CD25 (+high) regulatory T and NK cells in malignant patients by combination of interferon-α and interleukin-2.

Overinduced CD4(+)CD25(+high) regulatory T cells (Treg) and downregulated NK cells contribute to tumor-relevant immune tolerance and interfere with tumor immunity. In this study, we aimed to design a novel strategy with cytokine combination to correct the dysregulated Treg and NK cells in malignant patients. Initially, a total of 58 healthy individuals and 561 malignant patients were analyzed for their cellular immunity by flow cytometry. The average percentages of CD4(+)CD25(+high)/lymphocyte were 1.30 ± 1.19 % ([Formula: see text] ± SD) in normal adults and 3.274 ± 4.835 % in malignant patients (p < 0.001). The ratio of CD4(+)CD25(+high) to CD4(+) was 3.58 ± 3.19 % in normal adults and 6.01 ± 5.89 % to 13.50 ± 23.60 % in different kinds of malignancies (p < 0.001). Of normal adults, 15.52 % had >3 % Treg and 12.07 % had <10 % NK cells. In contrast, the Treg (>3 %) and NK (<10 %) percentages were 40.82 and 34.94 % in malignant patients, respectively. One hundred and ten patients received the immunomodulation therapy with IFN-α and/or IL-2. The overinduced Treg in 86.3 % and the reduced NK cells in 71.17 % of the patients were successfully modulated. In comparison, other lymphocyte subpopulations in most patients were much less affected by this treatment. No other treatment-relevant complications except slight pyrexia, fatigue, headache, and myalgia were observed. In conclusion, dysregulated Treg and/or NK cells were common in malignant patients. Different from any regimens ever reported, this strategy was simple and effective without severe complications and will become a basic regimen for other cancer therapies.

Imaging proliferation of ¹8F-FLT PET/CT correlated with the expression of microvessel density of tumour tissue in non-small-cell lung cancer.

PURPOSE: The aim of this study was to analyse the correlation between (18)F-labelled 3'-deoxy-3'-fluorothymidine ((18)F-FLT) PET/CT proliferation images and tumour angiogenesis as reflected by intratumoral microvessel density (MVD) in non-small-cell lung cancer (NSCLC) to provide a noninvasive method to predict the response to antiangiogenic therapy. METHODS: A total of 68 patients with proven or suspected NSCLC underwent FLT PET/CT scans followed by surgery. PET/CT images were compared with pathology. Tumour proliferation was evaluated in terms of a Ki-67 labelling index (Ki-67 LI). MVD was determined using an anti-CD31 mAb (CD31-MVD), anti-CD34 mAb (CD34-MVD) and an anti-CD105 mAb (CD105-MVD) for each resected tumour. RESULTS: Tumour FLT maximum standardized uptake values (SUVmax) were significantly correlated with the Ki-67 LI and CD105-MVD (r = 0.550 and 0.633, P = 0.000 and 0.000, respectively), but were only marginally correlated with the CD31-MVD and CD34-MVD (r = 0.228 and 0.235, P = 0.062 and 0.054, respectively). The FLT PET false-negative patients had a longer median survival time than the FLT PET true-positive patients (log rank test, P = 0.012). The patients with a lower CD105-MVD had a longer median survival time than those with a higher CD105-MVD (P = 0.046), while patients with a lower CD31-MVD and CD34-MVD did not have a longer median survival time than those with a higher value (P = 0.438 and 0.187, respectively). CONCLUSION: FLT PET/CT imaging correlated with tumour angiogenesis as reflected by CD105-MVD and prognosis, and may be helpful in assessing antiangiogenic therapy of NSCLC.

Value of dual-time-point FDG PET/CT for mediastinal nodal staging in non-small-cell lung cancer patients with lung comorbidity.

PURPOSE: To evaluate the efficacy of dual-time-point F-18 fluorodeoxyglucose positron emission tomography (FDG PET)/ computed tomography (CT) for mediastinal nodal staging in non-small-cell lung cancer patients with lung comorbidity. MATERIALS AND METHODS: Fifty-three pathologically proven non-small-cell lung cancer patients with pulmonary comorbidity and 49 patients as controlled group without comorbidity were enrolled. PET/CT was performed at 1-hour (whole body) post-FDG injection and repeated 2 hours (thoracic) after injection. All patients received radical surgery with system mediastinal lymph node (LN) dissection. The results of LN detection by single-time-point and dual-time-point scan were compared with the histopathologic findings. RESULTS: On a per-patient basis, in patients with pulmonary comorbidity, the sensitivity, specificity, accuracy, and positive predictive values (PPV), and negative predictive values of single-time-point scan were 87.5%, 59.5%, 67.9%, 48.3%, and 91.7%, respectively. Those values of dual-time-point scan were 93.8%, 67.6%, 75.5%, 55.6%, and 96.2%, respectively. In patients without comorbidity, dual-time-point scan was similar in those values to single-time-point. On a per-nodal station basis, the specificity, accuracy, and PPV of dual-time-point scan were better than those of single-time-point with statistically significant differences (P = 0.017, 0.002, and 0.027, respectively) in patients with pulmonary comorbidity, but the difference was not statistically significant in patients with no pulmonary comorbidity. CONCLUSIONS: Dual-time-point FDG PET/CT is more effective for mediastinal nodal staging than single-time-point in patients with pulmonary comorbidity. Dual-time-point scan was useful for diagnosis of mediastinal LN metastases in reducing the false-positive results in all patients, but improved specificity, accuracy, and PPV only in patients with pulmonary comorbidity.

iASPP is important for bladder cancer cell proliferation.

Inhibitor of apoptosis stimulatory protein phosphatase (iASPP) is a key inhibitor of p53 conserved from worm to human and is associated with cell proliferation and carcinogenesis in a variety of human cancers. Because iASPP is important for tumor cell apoptosis, it is a potential target for cancer gene therapy. However, it is still not clear whether iASPP is relevant to p53-deficient human bladder cancer. In the present study, iASPP was knocked down in bladder carcinoma 5637 and T24 cells (p53 defective) by lentiviral-mediated interfering short hairpin RNAs (siRNAs). MTT assay, BrdU incorporation assay, and colony formation assay were performed to investigate the role of iASPP on cell proliferation. It was suggested that iASPP knockdown led to cell growth deceleration and slow colony formation. A positive relationship between expression of iASPP and bladder cancer proliferation was found. The expression of iASPP may be critical for proliferation of bladder cancer cells. Our study indicates iASPP could be an important target for therapy in bladder cancer.

[Value of 18F-FETNIM PET-CT for detection of tumor hypoxia in non-small-cell lung cancer].

OBJECTIVE: To assess the feasibility of [(18)F]fluoroerythronitroimidazole ((18)F-FETNIM) with integrated positron emission tomography and computed tomography (PET-CT) imaging in detection of hypoxia in non-small-cell lung cancer (NSCLC) patients. METHODS: Forty-two patients with newly diagnosed NSCLC underwent (18)F-FETNIM PET-CT before treatment. Nineteen patients rested for approximately 120 minutes before undergoing PET-CT, 23 patients underwent 2 sequential PET-CT scans at 60 minutes and 120 minutes after intravenous injection (18)F-FETNIM. (18)F-FETNIM uptake was quantified by calculating the maximum standardized uptake value in the tumor (SUVmax-T) and contralateral normal lung tissue (SUVmax-N). Regions of interest (ROIs) were drawn in the tumor and contralateral position and the radioactivity ratio of tumor to normal (T/N) was calculated. RESULTS: SUVmax-T (2.43 +/- 1.34) was significantly higher than SUVmax-N (0.87 +/- 0.46, P < 0.001) at 120 min. SUVmax-T (2.80 +/- 1.09) and SUVmax-N (1.16 +/- 0.56) at 60 min were significantly higher than SUVmax-T (2.61 +/- 1.10) and SUVmax-N (P < 0.01) at 120 min. T/N (2.56 +/- 0.71) at 60 min was higher than that at 120 min (2.48 +/- 0.60), but the difference between them was not significant (P = 0.324). CONCLUSION: Our results indicate that (18)F-FETNIM PET-CT may be a useful tool for evaluating hypoxia and may be a means to target specifically tumor cells resistant to conventional treatment before and during ongoing therapy in NSCLC.

Imaging of proliferation with 18F-FLT PET/CT versus 18F-FDG PET/CT in non-small-cell lung cancer.

PURPOSE: To compare the diagnostic efficacies of (18)F-FLT and (18)F-FDG PET/CT in non-small-cell lung cancer (NSCLC), focusing on the correlation between FLT and FDG tumour uptake and tumour cell proliferation as indicated by the cyclin D1 labelling index. METHODS: A total of 31 patients with NSCLC underwent FLT and FDG PET/CT scanning followed by surgery. PET/CT images were compared with the pathology. Tumour cell proliferation was assessed by cyclin D1 immunohistochemistry. RESULTS: The sensitivities of FLT and FDG PET/CT for the primary lesion were 74% and 94%, respectively (p=0.031). For N staging, 77% patients were correctly staged, 6% overstaged, 16% understaged by FLT, while the values for FDG were 77%, 16% and 6%, respectively. The sensitivity, specificity, accuracy, and positive predictive value with FLT for lymph nodes were 65%, 98%, 93% and 89%, respectively, and 85%, 84%, 84% and 52% with FDG (p<0.01).Tumour SUV of FLT was significantly correlated with the cyclin D1 labelling index (r=0.644; p<0.01), but the SUV of FDG was not significantly correlated (r=0.293; p>0.05). CONCLUSION: In terms of N staging, FLT PET/CT resulted in understaging of more patients but overstaging of fewer patients, and for regional lymph nodes showed better specificity, accuracy and positive predictive value than FDG PET/CT in NSCLC. Tumour FLT uptake was correlated with tumour cell proliferation as indicated by the cyclin D1 labelling index, suggesting that further studies are needed to evaluate the use of FLT PET/CT for the assessment of therapy response to anticancer drugs.

[Evaluation of the diagnostic value of (18)F-FDG PET-CT and enhanced CT for staging of lymph node metastasis in non-small cell lung cancer].

OBJECTIVE: To evaluate the clinical value of (18)F-FDG PET-CT and enhanced CT imaging for staging of regional lymph node metastasis in non-small cell lung cancer (NSCLC) patients. METHODS: 122 patients with proven or suspected NSCLC underwent integrated PET-CT and enhanced CT scan before surgery. The results of lymph node metastasis diagnosed by PET-CT and CT were compared and analyzed according to the results of histopathological examination. RESULTS: PET-CT showed correctly lymph node staging in 80.3% of cases, overstaged in 13.1%, and understaged in 6.6%, while 55.8%, 26.2% and 18.0% by CT, respectively. The sensitivity, specificity, and accuracy of PET-CT for lymph node staging was 86.3%, 85.0% and 85.3%, respectively, while the corresponding data were 68.6%, 71.0% and 70.4% by CT, respectively (P < 0.01). 81.3% of false-negative and 71.6% false-positive lymph nodes by CT were interpreted correctly by PET-CT, while 57.1% of false-negative and 45.2% of false-positive lymph nodes by PET-CT were correctly diagnosed by CT. 5.9% of PET-CT-diagnosed negative lymph nodes were pathologically proven to be positive with small cancer foci and below 10 mm in diameter, while 8.2% of pathologically proven negative lymph nodes with inflammation, high FDG uptake and exceeding 10 mm (15 mm in subcarnial nodes) in diameter were false-positive on both PET-CT and CT imaging, therefore, these lymph nodes were still in the common blind area of diagnosis by both of PET-CT and CT. CONCLUSION: Compared with enhanced CT, integrated PET-CT improves the accuracy and is helpful to correct some CT-diagnosed false-positive and false-negative lymph nodes. But CT is also beneficial supplementation to PET-CT for assessment of regional lymph node metastasis. The combination of PET-CT and CT can make up the shortage of both of them in staging of regional lymph nodes in NSCLC patients.

Value of PET/CT versus enhanced CT for locoregional lymph nodes in non-small cell lung cancer.

PURPOSE: To compare the diagnostic efficacies of integrated (18)F FDG PET/CT images and contrast-enhanced helical CT images in locoregional lymph node metastasis in the patients with non-small cell lung cancer (NSCLC). METHODS: From June 2005 to June 2007, 122 potentially operable patients with proven or suspected non-small cell lung cancer underwent integrated PET/CT and contrast-enhanced CT scans followed by surgical nodal staging. The results of reviewing PET/CT and enhanced CT images for the locoregional lymph node metastasis were compared in relation to pathologic findings. RESULTS: Preoperative nodal staging was compared with postoperative histopathological staging, 80% (98 of 122) of patients correctly staged, 13% (16 of 122) of patients were overstaged, and 7% (8 of 122) were understaged by PET/CT, while those values for CT were 56% (68 of 122), 26% (32 of 122), and 18% (22 of 122), respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for lymph nodes were 86%, 85%, 85%, 64%, 95%, respectively; compared with 69%, 71%, 70%, 43%, 88% for CT (P=0.000, 0.000, 0.000, 0.001, 0.001, respectively). 81% false-negative interpretations and 72% false-positive interpretations on CT were corrected by PET/CT. 57% false-negative interpretations and 45% false-positive interpretations on PET/CT were corrected by CT. 6 % (9 of 153) positive lymph nodes and 8% (40 of 486) negative nodes at pathology were incorrectly diagnosed both by PET/CT and CT. CONCLUSION: Integrated PET/CT improves the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value than enhanced CT in the assessment of locoregional lymph nodes, and provides more efficient and accurate data of nodal staging, with a better effect on diagnosis and therapy in non-small cell lung cancer.