Chinese Journal of Cancerindexed by SCI
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Significant value of 18F-FDG-PET/CT in diagnosing small cervical lymph node metastases in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy
Hao Peng, Lei Chen, Ling-Long Tang, Wen-Fei Li, Yan-Ping Mao, Rui Guo, Yuan Zhang, Li-Zhi Liu, Li Tian, Xu Zhang, Xiao-Ping Lin, Ying Guo, Ying Sun and Jun Ma
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China

Little is known about the nature of metastasis to small cervical lymph nodes (SCLNs) in the patients with nasopharyngeal carcinoma (NPC) examined by using 18-fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). The present study aimed to evaluate the diagnostic values of PET/CT in identifying metastasis in SCLNs in NPC patients.
Magnetic resonance images (MRI) and PET/CT scans for 470 patients with newly diagnosed, non-distant metastatic NPC were analyzed. Metastatic rates of SCLNs were defined by the positive number of SCLNs on PET/CT scans and total number of SCLNs on MRI scans. Receiver operating characteristic curve was applied to compare PET/CT-determined stage with MRI-determined stage.
In total, 2082 SCLNs were identified, with 808 (38.8%) ≥ 5 and < 6 mm in diameter (group A), 526 (25.3%) ≥ 6 and < 7 mm in diameter (group B), 374 (18.0%) ≥ 7 and < 8 mm in diameter (group C), 237 (11.4%) ≥ 8 and < 9 mm in diameter (group D), and 137 (6.5%) ≥ 9 and < 10 mm in diameter (group E). The overall metastatic rates examined by using PET/CT for groups A, B, C, D, and E were 3.5%, 8.0%, 31.3%, 60.0%, and 83.9%, respectively (P < 0.001). In level IV/Vb, the metastatic rate for nodes ≥ 8 mm was 84.6%. PET/CT examination resulted in modification of N category and overall stage for 135 (28.7%) and 46 (9.8%) patients, respectively. The areas under curve of MRI-determined and PET/CT-determined overall stage were 0.659 and 0.704 for predicting overall survival, 0.661 and 0.711 for predicting distant metastasis-free survival, and 0.636 and 0.663 for predicting disease-free survival.
PET/CT was more effective than MRI in identifying metastatic SCLNs, and the radiologic diagnostic criteria for metastatic lymph nodes in level IV/Vb should be re-defined.
Chinese Journal of Cancer   Epub date: 2017-12-19   doi:10.1186/s40880-017-0265-9   [ PDF Full-text ]   


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