Surgical Management of Breast Cancer Developing Along the Pathway of a Ventriculoperitoneal Shunt: A Case Report.

BACKGROUND Ventriculoperitoneal shunts are commonly used in neurosurgery for the treatment of hydrocephalus. This case report details an unusual instance where breast cancer developed along the pathway of an existing ventriculoperitoneal shunt. CASE REPORT An 86-year-old woman, who previously underwent ventriculoperitoneal shunt placement for normal-pressure hydrocephalus, visited our hospital upon detecting a mass in her left breast. The physical examination discovered an irregular mass located at the 9 o'clock position of the left breast. Subsequent breast ultrasonography identified a 36 mm mass with indistinct borders, rough margins, and signs of skin infiltration. Invasive ductal carcinoma of a triple-negative subtype was diagnosed through a core-needle biopsy. Contrast-enhanced computed tomography indicated the ventriculoperitoneal shunt's pathway, running from the left ventricle, passing through the center of the breast mass, and leading into the abdominal cavity. Fears of shunt occlusion and potential infection due to the untreated breast cancer prompted surgical intervention after consultation with the neurosurgeon. The surgery involved rerouting the ventriculoperitoneal shunt from the left thoracoabdomen to the right, performing a left mastectomy, and removing the fistula in the abdominal wall to minimize the risk of cancer recurrence along the shunt pathway. Postoperative histopathological examination confirmed the initial diagnosis of invasive ductal carcinoma of a triple-negative subtype, with no malignancy detected in the removed abdominal wall fistula. CONCLUSIONS Taking into account prior cases of cancer metastasizing distantly due to ventriculoperitoneal shunts, our case emphasizes the necessity to consider additional preventative measures against cancer seeding. This approach is particularly significant when treating breast cancer that arises along the pathway of a ventriculoperitoneal shunt, apart from performing conventional breast cancer surgery.

[Pulmonary Nodule Localization by Pleural Marking Using Virtual Thoracoscopic Imaging].

Percutaneous or transbronchial markings are performed to localize pulmonary nodules preoperatively. We present a novel intraoperative procedure that utilizes virtual thoracoscopic imaging-assisted pleural marking. In this procedure, a virtual thoracoscopic image is created preoperatively, and the coordinates of the pleural point above the tumor are determined. The pleural marker is intraoperatively placed on the coordinates, and dye is transferred to the visceral pleura with two lung ventilations. We present the specific procedures and countermeasures for cases when nodules are not palpable. Additionally, we present a comparison between the various methods of preoperative marking and this method.

[Surgical Treatment for Pneumothorax with Granulomatosis with Polyangiitis].

A 42-year-old man had been treated for granulomatosis with polyangiitis for eight years. He was referred to our department with the diagnosis of right pneumothorax on chest radiograph. After chest drainage, the surgical treatment was performed because of continuing air leak from chest tube. Under thoracoscopic approach, the pleural adhesions were carefully dissected and the air leak site was sutured and enforced by a polyglycolic acid sheet with fibrin glue. No recurrence of pneumothorax was observed six months after surgery.

Advanced esophagogastric junction cancer with brain, bone and gastric intramural metastases responding to combined modality therapy.

A 63-year-old man was admitted to our hospital in March 2017 with dysphagia and right homonymous hemianopsia. We diagnosed him with esophagogastric junction cancer (adenocarcinoma) with metastases to the cerebral occipital lobe, bone, and lymph nodes. After one cycle of 5FU + cisplatin (FP), the brain metastasis was resected because of the hemiplegic symptoms he developed. Histology of the resected tissue showed no viable tumor cells. After three cycles of FP, the primary lesion and metastases were resolved. Upper gastrointestinal endoscopy revealed a scar at the primary site. This was considered a complete response (CR). In April 2018, CT revealed a mass at the cardia, which was considered as lymph node metastases with gastric wall invasion. Although two additional cycles of FP were administered for recurrent tumors, the efficacy was progressive. In August 2018, proximal gastrectomy and D1 + lymph node dissection were performed. The pathological diagnosis was gastric intramural metastases and lymph node metastases (ypN1 [2/22]). Weekly paclitaxel therapy was administered for three months after surgery. Two years have passed since the last surgery without recurrence. We report a rare case of esophagogastric junction cancer with brain, bone, and gastric intramural metastases that responded to combined modality therapy.

Unusual local and distant metastases after complete resection of roentgenographically occult squamous cell carcinoma.

Roentgenographically occult squamous cell carcinoma (ROSCC) was reported to have been cured after complete resection. We experienced unusual local and distant metastases after complete resection of a ROSCC of left B6 bronchus. During the operation due to the proximal bronchial stump being positive for squamous cell carcinoma (SCC), a left lower sleeve lobectomy was performed. Six years after the operation, a chest CT showed no abnormal shadows. 6 months later a PET-CT showed metastases on bilateral supraclavicular lymph nodes, mediastinal lymph nodes, and the right adrenal glands. A biopsy of the right supraclavicular lymph node revealed that it was a metastatic SCC. The possibility of recurrence from a second pulmonary SCC might still remain. A prolonged follow-up over many years is desirable for a heavy smoker with a ROSCC.

Virtual thoracoscopic imaging-assisted pleural marking of pulmonary nodules.

BACKGROUND: Computed tomography (CT) is now able to detect small pulmonary nodules. Surgical resection for diagnosis of these nodules is widely performed with video-assisted thoracoscopic surgery (VATS). However, it is very difficult to localize a small tumor by palpation via a small access port. In this study, we aimed to describe a novel intraoperative method for marking the location of the pulmonary nodule. METHODS: In 46 cases, a virtual thoracoscopic image was reconstructed using the CT images of the chest using volume rendering software before surgery. During thoracoscopic surgery, a pleural marker was affixed to the parietal pleura, just above the tumor, by referring to the virtual thoracoscopic image. The pleural marker dye was then transferred to the point on the visceral pleura just above the nodule. The distance between the center of the marking and the visceral pleura closest to the tumor was measured to evaluate the accuracy of the marking. RESULTS: The mean distance between the center of the marking and the visceral pleura closest to the tumor was 10.2 mm. In 42 cases (92%), the tumor was within 30 mm of the marked point. All tumors were fully resected. No morbidity occurred intra- or postoperatively. CONCLUSIONS: Our pleural marking, using a virtual thoracoscopic image, identified the tumor location with high accuracy, may help surgeon to confirm whether the palpated nodule is the target one. This new procedure can assist in the localization of the pulmonary nodule with ease of application, safety, and accuracy.

Emergence of lung cancer with a low PD-L1 expression level after the administration of immune check point inhibitor for lung adenocarcinoma with a high PD-L1 expression level: A case report.

BACKGROUND: Checkpoint therapy against PD-1 has proven effective and positive results have been observed in several types of cancer, including lung cancer, renal cancer, lymphoma and melanoma. However, the effects of long-term ICI treatment remain insufficient and the development of resistance is an issue that remains to be solved. CASE PRESENTATION: A 70-year-old man was diagnosed with lung adenocarcinoma (stage IVB, T4N3M1c) with a high programmed death ligand-1 (PDL1) expression level (tumor proportion score [TPS]: 80% score at the time of the diagnosis, before treatment). At 16.5 months after the start of pembrolizumab, following the administration of 22 cycles of pembrolizumab, a new lesion appeared. Biopsy by video-assisted thoracic surgery (VATS) was performed for this lesion and a pathological diagnosis of lung adenocarcinoma with a low PD-L1 expression level. After the operation, pembrolizumab treatment was continued. The patient currently remains alive without disease progression at 20 months after the initial therapy. CONCLUSIONS: Our case highlights the importance of biopsy by VATS during immune checkpoint inhibitor (ICI) treatment when deciding the treatment strategy for newly confirmed tumors.

Higher Tumor Mutation Burden and Higher PD-L1 Activity Predicts the Efficacy of Immune Checkpoint Inhibitor Treatment in a Patient With Four Lung Cancers. A Case Report.

We experienced a patient who had four lung cancers with different pathological features, with the most advanced being diagnosed as pStage IIA. A month after the resection, the original lung cancer had metastasized to the lung and to the liver. Of the original lung cancers that were resected, the biggest adenocarcinoma of S3 showed 50 × 31 × 17 mm (invasion 50 mm) and pT2bN0M0 (pStage IIA) with epidermal growth factor receptor (EGFR) mutation (-) and anaplastic lymphoma kinase (ALK) translocation (-), but expression of programmed death ligand 1 (PD-L1) (+) tumor proportion score (TPS) 80%. The pleomorphic carcinoma showed 23 × 20 × 17 mm (invasion 23 mm) and pT1cN0M0 (pStage Ic) with EGFR (-), ALK (-), PD-L1 (+), TPS 95%. Tumor mutation burden (TMB), microsatellite instability (MSI), and structural chromosome aberration analysis by DNA microarray were performed. One hundred somatic mutations in the adenocarcinoma and 75 somatic mutations in the pleomorphic carcinoma were identified, which showed an extremely high mutation rate, although only 16 somatic mutations were common between the two cancers. Chromosomal structural aberrations differed greatly between the two cancers, but common aberrations were found in chromosomes 8 and 10 and partially common aberration in chromosomes 4, 14, 17, and X. These results indicated that each lung cancer originated from a common ancestor clone and developed on an individual molecular evolution. The patient received a single injection of pembrolizumab and 13 injections of atezolizumab. Immune checkpoint inhibitor treatment made metastatic pulmonary and liver lesions reduce in size and show as Partial response (PR). Multiple lung cancers with high PD-L1 activity tend to be TMB-high, reflecting rapid molecular evolution and relevance to the patient's response to immune checkpoint inhibitors. Genomic examination could help determine what had happened in multiple cancers on progression and provide useful data to patient treatment. Each lung cancer originated from a common ancestor clone and developed on an individual molecular evolution.

Relationships and Qualitative Evaluation Between Diffusion-Weighted Imaging and Pathologic Findings of Resected Lung Cancers.

For detecting malignant tumors, diffusion-weighted magnetic resonance imaging (DWI) as well as fluoro-2-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) are available. It is not definitive how DWI correlates the pathological findings of lung cancer. The aim of this study is to evaluate the relationships between DWI findings and pathologic findings. In this study, 226 patients with resected lung cancers were enrolled. DWI was performed on each patient before surgery. There were 167 patients with adenocarcinoma, 44 patients with squamous cell carcinoma, and 15 patients with other cell types. Relationships between the apparent diffusion coefficient (ADC) of DWI and the pathology were analyzed. When the optimal cutoff value (OCV) of ADC for diagnosing malignancy was 1.70 × 10-3 mm2/s, the sensitivity of DWI was 92.0% (208/226). The sensitivity was 33.3% (3/9) in mucinous adenocarcinoma. The ADC value (1.31 ± 0.32 × 10-3 mm2/s) of adenocarcinoma was significantly higher than that (1.17 ± 0.29 × 10-3 mm2/s) of squamous cell carcinoma (p = 0.012), or (0.93 ± 0.14 × 10-3 mm2/s) of small cell carcinoma (p = 0.0095). The ADC value (1.91 ± 0.36 × 10-3 mm2/s) of mucinous adenocarcinoma was significantly higher than that (1.25 ± 0.25 × 10-3 mm2/s) of adenocarcinoma with mucin and that (1.24 ± 0.30 × 10-3 mm2/s) of other cell types. The ADC (1.11 ± 0.26 × 10-3 mm2/s) of lung cancer with necrosis was significantly lower than that (1.32 ± 0.33 × 10-3 mm2/s) of lung cancer without necrosis. The ADC of mucinous adenocarcinoma was significantly higher than those of adenocarcinoma of other cell types. The ADC of lung cancer was likely to decrease according to cell differentiation decreasing. The sensitivity of DWI for lung cancer was 92% and this result shows that DWI is valuable for the evaluation of lung cancer. Lung cancer could be evaluated qualitatively using DWI.

Thoracoscopic small pulmonary nodule detection using computed tomography-guided cutaneous marking and pleural marking.

BACKGROUND: In recent years, small lung nodules have been detected by computed tomography (CT). Wedge resection of small pulmonary nodules is widely performed with video-assisted thoracoscopic surgery (VATS). However, it is extremely difficult to identify the position of a small tumor by palpation using a small access port. Therefore, this study aimed to describe a newly devised method of marking the location of the tumor. METHODS: In 51 cases, we marked the skin directly above the tumor under CT guidance before surgery and then placed a pleural marker with dye on the parietal pleura directly below the region marked on the skin using a catheter needle. To evaluate the accuracy of the marking, the distance between the center of the marking and the visceral pleura closest to the tumor was measured. RESULTS: The mean distance between the center of marking and the visceral pleura closest to the tumor was 12.4 mm. In 47 cases (92%), the tumor was within 30 mm from the marking site. The surgical approach was VATS in 44 cases. In one case, conversion to open surgery was required for palpation of the tumor. All tumors were resected completely. No morbidity was observed during or after surgery. CONCLUSIONS: Our CT-guided cutaneous marking and pleural marking method was able to identify the location of the tumor with high accuracy, making palpation easier during VATS. This new procedure should be implemented in the clinical setting given its ease of application, safety, and accuracy.

Indocyanine green fluorescence-guided thoracoscopic pulmonary resection for intralobar pulmonary sequestration: a case report.

BACKGROUND: The potential complications of pulmonary sequestration are serious and may include recurrent pulmonary infection, hemoptysis, and tumorigenesis. Therefore, the gold standard of treatment has been surgery. Although an adequate boundary between the nonfunctional lung and normal lung is required for the resection of pulmonary sequestration, the boundaries have been conventionally identified intraoperatively with inflation/deflation of the target segment by clamping and unclamping the relevant bronchus. The technique of visualizing the demarcation line based on near-infrared fluorescence imaging with indocyanine green was recently developed. CASE PRESENTATION: A 42-year-old Japanese woman with right Pryce III intralobar sequestration was admitted to our hospital. We planned video-assisted thoracoscopic wedge resection of the right sequestration using near-infrared fluorescence imaging with indocyanine green because of the small volume of the nonfunctional region. The aberrant artery was recognized in the pulmonary ligament; the artery was cut off after ligation. Indocyanine green at 5 mg/body was rapidly injected into the peripheral vein, and the boundary of the sequestration was clearly identified under near-infrared fluorescence imaging. CONCLUSION: Near-infrared fluorescence imaging with indocyanine green is safe and useful for the identification of the boundary of a pulmonary sequestration.

Lung cancer combined with methotrexate-associated lymphoproliferative disorder: A case report.

INTRODUCTION: Methotrexate (MTX)-associated lymphoproliferative disorder occurs in rheumatoid arthritis patients treated with MTX; however, patients with concomitant pulmonary lesions are rare. We present a case of lung cancer combined with MTX-associated lymphoproliferative disorder for which, for which it was necessary to differentiate these from possible pulmonary metastasis. PRESENTATION OF A CASE: A 72-year-old man was referred to our hospital for treatment of squamous cell carcinoma in the left upper bronchus. He was receiving oral MTX and prednisolone for rheumatoid arthritis for 15 years. However, chest computed tomography performed 1 week before surgery revealed a 1-cm-sized pulmonary nodule in the right lung. Surgical pulmonary resection of the right lung tumor revealed substantial B-cell lymphoma-type lymphoproliferative disorder. Left upper lobectomy for the squamous cell carcinoma in the left upper bronchus was performed 5 weeks after the first surgery. Chest CT performed 2 weeks after the first surgery revealed a new 1-cm-sized nodule in the lower left lung lobe. However, after discontinuing oral MTX therapy, the new lesion in the left lower lobe disappeared. DISCUSSION AND CONCLUSION: In lung cancer patients treated with MTX for rheumatoid arthritis, MTX-associated lymphoproliferative disorder should be considered as a differential diagnosis.

What is the allowed volume threshold for chest tube removal after lobectomy: A randomized controlled trial.

INTRODUCTION: The management of chest tubes and the volume threshold for chest tube removal after pulmonary resection remain controversial. Several studies have reported the volume threshold for chest tube removal following pulmonary resection to range from 200 to 450 mL/24 h. METHODS: A prospective randomized single-blind clinical study was performed with data collected from patients who had undergone lobectomy and lymph node dissection at our hospital between June 2014 and April 2018. The patients were randomly assigned to the High group (removal of chest tube when drainage was <450 mL/24 h) or Low group (removal of chest tube when drainage was <200 mL/24 h) at postoperative day (POD) 2. The primary end point was drainage time. The secondary end point were complications and rate of thoracentesis. RESULTS: Seventy patients met the inclusion criteria and were randomized, with 35 patients assigned to the High group and 35 patients to the Low group. The average duration of chest tube placement was 2.05 days in the High group and 2.31 days in the Low group. The duration of chest tube placement in the High group was significantly shorter than that in the Low group (p = 0.02). There were no major postoperative complications in either group. Thoracentesis was not necessary in either group. CONCLUSION: Pleural effusion of 450 mL/day is tolerable as the volume threshold for the removal of a chest tube after pulmonary resection.

Diffusion-Weighted Imaging Can Differentiate between Malignant and Benign Pleural Diseases.

It is not clear whether magnetic resonance imaging (MRI) is useful for the assessment of pleural diseases. The aim of this study is to determine whether diffusion-weighted magnetic resonance imaging (DWI) can differentiate malignant pleural mesothelioma (MPM) from pleural dissemination of lung cancer, empyema or pleural effusion. The DWI was calibrated with the b value of 0 and 800 s/mm2. There were 11 MPMs (8 epithelioid and 3 biphasic), 10 pleural disseminations of lung cancer, 10 empyemas, and 12 pleural effusions. The apparent diffusion coefficient (ADC) of the pleural diseases was 1.22 ± 0.25 × 10-3 mm2/s in the MPMs, 1.31 ± 0.49 × 10-3 mm2/s in the pleural disseminations, 2.01 ± 0.45 × 10-3 mm2/s in the empyemas and 3.76 ± 0.62 × 10-3 mm2/s in the pleural effusions. The ADC of the MPMs and the pleural disseminations were significantly lower than the ADC of the empyemas and the pleural effusions. Concerning the diffusion pattern of DWI, all 11 MPMs showed strong continuous diffusion, 9 of 10 pleural disseminations showed strong scattered diffusion and 1 pleural dissemination showed strong continuous diffusion, all 10 empyemas showed weak continuous diffusion, and all 12 pleural effusions showed no decreased diffusion. DWI can evaluate pleural diseases morphologically and qualitatively, and thus differentiate between malignant and benign pleural diseases.

Low-dose indocyanine green fluorescence-navigated segmentectomy: prospective analysis of 20 cases and review of previous reports.

BACKGROUND: A technique of visualizing the demarcation line based with indocyanine green (ICG) was recently developed, and its utility was reported. We demonstrated the safety and utility of low-dose (5 mg/body) ICG fluorescence-navigated video-assisted thoracic surgery (VATS) segmentectomy. METHODS: Patients who had undergone lung segmentectomy for early-stage non-small cell lung cancer (NSCLC) or small pulmonary metastasis were included in this study. ICG at 5 mg/body was rapidly injected into the peripheral vein, and the lung was observed using near-infrared (NIR) fluorescence thoracoscopy. We evaluated the identification rate of the demarcation line based on NIR fluorescence imaging with ICG and the perioperative outcomes. RESULTS: Lung segmentectomy NIR fluorescence imaging with ICG was performed in 20 patients. The identification of the target segmental line was possible in 18 (90%) of the 20 patients. The median duration of chest tube placement was one day, and the median length of postoperative stay was 8 days. Complications occurred in 5 (25%) of the 20 patients. All cases were prolonged air leak that required pleurodesis. There were no complications resulting from NIR fluorescence imaging with ICG. CONCLUSIONS: NIR fluorescence imaging with ICG is safe and useful for the identification of the demarcation line for lung segmentectomy. Low-dose ICG might achieve a sufficient rate of identification of the segmental line.

Diffusion-weighted magnetic resonance imaging is useful for the response evaluation of chemotherapy and/or radiotherapy to recurrent lesions of lung cancer.

Diffusion-weighted magnetic resonance imaging (DWI) has been reported to be useful for the assessment of lung cancer staging. It is uncertain whether DWI is more accurate for the response evaluation of chemotherapy and/or radiotherapy compared to computed tomography (CT). The purpose of this study is to compare the response evaluation of DWI for chemotherapy and/or radiotherapy to recurrent tumors of lung cancer with that of CT which is a standard tool in RECIST (Response Evaluation Criteria in Solid Tumours). Forty-one patients who agreed to this project and had CT scan and DWI examinations within a month of each other every six months for at least 2 years after pulmonary resection of primary lung cancer were enrolled in this study. Of the patients, 24 patients had metastases or recurrences, and CT and DWI were performed for assessment of the response evaluation of chemotherapy and/or radiotherapy to recurrent lesions. They were followed up for at least two years after the relapse. The response evaluation by CT using RECIST were PR in five patients, SD in two, and PD in the remaining 17 patients. On the other hand, the response evaluation by DWI were CR in four patients, PR in two patients, SD in one, and PD in the remaining 17 patients. Follow-up studies revealed the response evaluation by DWI were correct. Functional evaluation of DWI is better than that of CT for the response evaluation of chemotherapy and/or radiotherapy to recurrent tumors of lung cancer.

[Lung Adenosquamous Cell Carcinoma in which the Administration of Nivolumab Became Untenable due to Bleeding from Small Intestine Metastasis].

A 59-year-old man who had postoperative recurrence of lung adenosquamous cell carcinoma was administered nivolumab as 3rd-line chemotherapy. Although nivolumab was considered effective, bleeding from a metastatic lesion at the jejunum was recognized by double-balloon enteroscopy, and partial resection was performed. Although the re-administration of nivolumab was planned, the patient died of acute respiratory failure 6 days postoperatively.

Expression and Prognostic Impact of VEGF, CD31 and αSMA in Resected Primary Lung Cancers.

BACKGROUND/AIM: One of the most important factors concerning cancer growth is angiogenesis. The purpose of this study was to clarify the relationship of maturation of tumor vessels and prognosis of lung cancer. MATERIALS AND METHODS: Immunohistochemical stainings of 125 lung cancers for VEGF, CD31 and α-smooth muscle actin (αSMA) were scored by multiplying the intensity and the frequency from 0 to 12. RESULTS: Adenocarcinomas showed significantly higher staining scores of both VEGF and αSMA than squamous cell carcinomas did. In 42 cases of high CD31 score, five-year survival rate (87%) of patients with lung cancer showing mature tumor vessels was significantly better than that (69%) of patients with immature tumor vessels. CONCLUSION: Not the number of tumor vessels but their maturation may be a prognostic factor of patients with lung cancer. VEGF may not only stimulate proliferation of endothelial cells but also their maturation in differentiated lung cancers.

Müllerian cyst in posterior mediastinum: A report of a case.

INTRODUCTION: A Müllerian cyst is a recently defined rare benign tumor of the posterior mediastinum. It is necessary to distinguish it from neurogenic tumor or bronchogenic cyst arising in the posterior mediastinum. Herein, we have reported and reviewed a case of Müllerian cyst in the light of the existing literature. PRESENTATION OF A CASE: A 40-year-old woman was referred to our department for abnormal mediastinal tumor on computed tomography (CT). Chest CT revealed a 2-cm nodule in the left posterior mediastinum, while magnetic resonance imaging (MRI) T2-weighted scan revealed an elliptical, homogenous, and high-intensity neoplasm, and bronchogenic cyst or neurogenic tumor was suspected. She did not present with any symptoms. A thoracoscopic surgery was performed for the cyst removal. Histopathological examination revealed that the cyst wall was covered with a layer of columnar epithelium.　Immunohistochemical staining revealed the presence of estrogen receptor (ER) and progesterone receptor (PgR). Therefore a diagnosis of mediastinal Müllerian cyst was made. DISCUSSION AND CONCLUSION: It is important to differentiate Müllerian cyst in the posterior mediastinal from other mediastinal cystic tumor for optimal decision-making in treatment.

FDG-PET/CT and diffusion-weighted imaging for resected lung cancer: correlation of maximum standardized uptake value and apparent diffusion coefficient value with prognostic factors.

Diffusion-weighted magnetic resonance imaging (DWI) is useful for detecting malignant tumors and the assessment of lymph nodes, as FDG-PET/CT is. But it is not clear how DWI influences the prognosis of lung cancer patients. The focus of this study is to evaluate the correlations between maximum standardized uptake value (SUVmax) of FDG-PET/CT and apparent diffusion coefficient (ADC) value of DWI with known prognostic factors in resected lung cancer. A total of 227 patients with resected lung cancers were enrolled in this study. FEG-PET/CT and DWI were performed in each patient before surgery. There were 168 patients with adenocarcinoma, 44 patients with squamous cell carcinoma, and 15 patients with other cell types. SUVmax was a factor that was correlated to T factor, N factor, or cell differentiation. ADC of lung cancer was a factor that was not correlated to T factor, or N factor. There was a significantly weak inverse relationship between SUVmax and ADC (Correlation coefficient r = - 0.227). In analysis of survival, there were significant differences between the categories of sex, age, pT factor, pN factor, cell differentiation, cell type, and SUVmax. Univariate analysis revealed that SUVmax, pN factor, age, cell differentiation, cell type, sex, and pT factor were significant factors. Multivariate analysis revealed that SUVmax and pN factor were independent significant prognostic factors. SUVmax was a significant prognostic factor that is correlated to T factor, N factor, or cell differentiation, but ADC was not. SUVmax may be more useful for predicting the prognosis of lung cancer than ADC values.