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Date Published: 09/02/2026
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DOI: https://doi.org/10.55046/vjrnm.61.1432.2025
Issue
No. 61 (2025)
Section
Scientific research
How to Cite
Nguyễn, V. T., Dang, D. C., & Nguyen, V. K. (2025). Prognostic Value of Tumor-to-Mediastinal Lymph Node SUVmax Ratio on PET/CT in Predicting Nodal Metastasis in Patients with Non-Small Cell Lung Cancer. Vietnamese Journal of Radiology and Nuclear Medicine, 61, 21-28. https://doi.org/10.55046/vjrnm.61.1432.2025

Prognostic Value of Tumor-to-Mediastinal Lymph Node SUVmax Ratio on PET/CT in Predicting Nodal Metastasis in Patients with Non-Small Cell Lung Cancer

Văn Thắng Nguyễn1, , Dang Duy Cuong2, Nguyen Van Khai3
1 Khoa YHHN - BV Ung bướu Hà Nội
2 *Department of Nuclear Medicine - Hanoi Oncology Hospital
3 Department of Nuclear Medicine - Hanoi Oncology Hospital.

Main Article Content

Abstract

Objective: This study aimed to evaluate the prognostic value of the tumor-to-mediastinal lymph node SUVmax ratio (T/LN SUVmax) compared to the standalone lymph node SUVmax in predicting mediastinal lymph node metastasis in patients with non-small cell lung cancer (NSCLC).


Materials and Methods: A retrospective descriptive study was conducted on 74 NSCLC patients who underwent whole-body 18F-FDG PET/CT prior to surgery, followed by tumor resection and mediastinal lymph node dissection. A total of 311 mediastinal lymph nodes were identified on PET/CT, of which 178 showed increased FDG uptake. For each suspicious lymph node, both the node’s SUVmax and that of the primary tumor were recorded to calculate the T/LN SUVmax ratio. Receiver operating characteristic (ROC) analysis was used to compare the diagnostic performance of T/LN SUVmax versus lymph node SUVmax alone and to determine the optimal cut-off values.


Results: Among the 178 FDG-avid lymph nodes, 32 (17.98%) were confirmed as metastatic by histopathology. The median SUVmax of metastatic nodes was 6.14, significantly higher than that of non-metastatic nodes (3.14; p < 0.01). A strong correlation was observed between lymph node and tumor SUVmax in metastatic nodes (rs = 0.69; p < 0.001), compared to a weaker correlation in non-metastatic nodes (rs = 0.27; p = 0.001). The T/LN SUVmax ratio showed superior discriminatory performance, with an optimal cut-off value of 2.45, achieving a sensitivity of 86.3%, specificity of 93.7%, and area under the ROC curve (AUC) of 0.931 (p < 0.001). In contrast, lymph node SUVmax alone, with a cut-off of 4.77, provided a higher sensitivity (93.8%) but lower specificity (76.7%), with an AUC of 0.877 (p < 0.001).


Conclusion: The T/LN SUVmax ratio demonstrated significantly higher accuracy than lymph node SUVmax alone in predicting mediastinal lymph node metastasis in NSCLC. A cut-off value of 2.45 offers high specificity while maintaining acceptable sensitivity. T/LN SUVmax is a reliable and promising parameter that should be considered in lymph node staging using PET/CT.


Keywords: Tumor-to-lymph node SUVmax ratio, PET/CT, non-small cell lung cancer.

Keywords

Tumor-to-lymph node SUVmax ratio, PET/CT, non-small cell lung cancer.

Article Details

References

1. Tahayneh K, Idkedek M, Abu Akar F. NSCLC: Current Evidence on Its Pathogenesis, Integrated Treatment, and Future Perspectives. J Clin Med. 2025;14(3):1025.
2. Sebro R, Aparici CM, Hernandez-Pampaloni M. FDG PET/CT evaluation of pathologically proven pulmonary lesions in an area of high endemic granulomatous disease. Ann Nucl Med. 2013;27(4):400-405.
3. Wang Y, Ma S, Dong M, Yao Y, Liu K, Zhou J. Evaluation of the factors affecting the maximum standardized uptake value of metastatic lymph nodes in different histological types of non-small cell lung cancer on PET-CT. BMC Pulm Med. 2015;15(1):20.
4. Koksal D, Demirag F, Bayiz H, et al. The correlation of SUVmax with pathological characteristics of primary tumor and the value of Tumor/ Lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients. J Cardiothorac Surg. 2013;8(1):63.
5. Suga K, Kawakami Y, Hiyama A, et al. Differential diagnosis between 18F-FDG-avid metastatic lymph nodes in non-small cell lung cancer and benign nodes on dual-time point PET/CT scan. Ann Nucl Med. 2009;23(6):523- 531.
6. Ugurlu E, Metin M, Cetin N, et al. Evaluation of hypermetabolic mediastinal-hilar lymph nodes determined by PET/CT with EBUS-TBNA and calculation of SUVmax cutoff values in differentiation of malignancy. Medicine (Baltimore). 2023;102(35):e34928.
7. The role of tumor SUVmax/lymph node SUVmax ratio viewed on PET-CT in the detection of mediastinal metastasis in patients with lung cancer. Accessed July 31, 2025. https://tgkdc.dergisi.org/abstract.php?lang=en&id=1607
8. Koksal D, Demirag F, Bayiz H, et al. The correlation of SUVmax with pathological haracteristics of primary tumor and the value of Tumor/ Lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients. J Cardiothorac Surg. 2013;8(1):63.
9. Chiu KL, Chow TK, Ma KM, Ma WH. Lymph node to primary tumor SUV ratio as a valuable parameter on [18F] fluorodeoxyglucose PET/computedtomography in nonsmall cell lung cancer nodal staging. Nucl Med Commun. Published online June 20, 2025.
10. Açikgoz Y, Gurler F, Inci BK, et al. The prognostic value of tumor/lymph node standardized uptake value max ratio and correlation with hematologic parameters in stage III nonsmall cell lung cancer. Medicine (Baltimore). 2020;99(48):e23168.