# Clinical utility of [F]FDG PET/CT in the assessment of mediastinal lymph node disease after neoadjuvant chemoimmunotherapy for non-small cell lung cancer.

**Tumor:** CPNM (cáncer de pulmón)
**Autores:** Zhang L, E H, Huang J et al
**Revista:** Eur Radiol (2023)
**PMID:** 37464112 | **PMCID:** —
**DOI:** [10.1007/s00330-023-09910-8](https://doi.org/10.1007/s00330-023-09910-8)
**Fuente:** PubMed (abstract only)

## Relevancia
CPNM resecable tras quimio-inmunoterapia neoadyuvante (CheckMate-816, NADIM, KEYNOTE-671): downstaging mediastínico (ypN0/N1), tasas de pCR ganglionar y supervivencia. Paralelo importante con mama: la conversión nodal patológica predice EFS/OS y orienta la extensión de la disección ganglionar.

## Abstract
The performance of positron emission tomography/computed tomography (PET/CT) for the prediction of ypN2 disease in non-small cell lung cancer (NSCLC) after neoadjuvant chemoimmunotherapy has not been reported. This multicenter study investigated the utility of PET/CT to assess ypN2 disease in these patients.

A total of 181 consecutive patients (chemoimmunotherapy&#x2009;=&#x2009;86, chemotherapy&#x2009;=&#x2009;95) at four institutions were enrolled in this study. Every patient received a PET/CT scan prior to surgery and complete resection with systematic nodal dissection. The diagnostic performance was evaluated through area under the curve (AUC). Kaplan-Meier method and Cox analysis were performed to identify the risk factors affecting recurrences.

The sensitivity, specificity, and accuracy of PET/CT for ypN2 diseases were 0.667, 0.835, and 0.779, respectively. Therefore, the AUC was 0.751. Compared with the false positive cases, the mean value of max standardized uptake value (SUV) (6.024 vs. 2.672, p&#x2009;<&#x2009;0.001) of N2 nodes was significantly higher in true positive patients. Moreover, the SUVof true positive (7.671 vs. 5.976, p&#x2009;=&#x2009;0.365) and false (2.433 vs. 2.339, p&#x2009;=&#x2009;0.990) positive cases were similar between chemoimmunotherapy and chemotherapy, respectively. Survival analysis proved that pathologic N (ypN) 2 patients could be stratified by PET/CT-N2(+&#x2009;vs. -) for both chemoimmunotherapy (p&#x2009;=&#x2009;0.023) and chemotherapy (p&#x2009;=&#x2009;0.010).

PET/CT is an accurate and non-invasive test for mediastinal restaging of NSCLC patients who receive neoadjuvant chemoimmunotherapy. The ypN2 patients with PET/CT-N2(&#x2009;+) are identified as an independent prognostic factor compared with PET/CT-N2(-).

Imaging with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) plays an integral role during disease diagnosis, staging, and therapeutic response assessments in patients with NSCLC. PET/CT could be an effective non-invasive tool for predicting ypN2 diseases after neoadjuvant chemoimmunotherapy.

&#x2022; PET/CT could serve as an effective non-invasive tool for predicting ypN2 diseases. &#x2022; The ypN2 patients with PET/CT-N2(&#x2009;+) were a strong and independent prognostic factor. &#x2022; The application of PET/CT for restaging should be encouraged in clinical practice.

## Acceso
Vía [DOI](https://doi.org/10.1007/s00330-023-09910-8) o suscripción institucional.

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*Datos de PubMed. Citar: doi 10.1007/s00330-023-09910-8*
