N-staging in large cell neuroendocrine carcinoma of the lung: diagnostic value of [18F]FDG PET/CT compared to the histopathology reference standard

Abstract Background Large cell neuroendocrine carcinoma of the lung (LCNEC) is a rare entity occurring in less than 4% all cancers. Due to its low differentiation and high glucose transporter 1 (GLUT1) expression, LCNEC demonstrates an increased turnover. Thus, PET/CT with 2-[ 18 F]-fluoro-deoxyglucose ([ F]FDG) suitable for staging. Surgery curative intent treatment choice early stage LCNEC. Prerequisite this correct lymph node This study aimed at evaluating diagnostic performance [ F]FDG validated by histopathology following surgical resection or mediastinoscopy. N-staging interrater-reliability was assessed test robustness findings. Methods Between 03/2014 12/2020, 46 patients were included single center retrospective analysis. All underwent pre-operative staging subsequently either surgery ( n = 38) mediastinoscopy 8). Regarding involvement, sensitivity, specificity, accuracy, positive predictive value (PPV) negative (NPV) calculated using final histopathological (pN0 pN3) as reference. Results Per patient 14 ± 7 (range 4–32) nodes resected histologically processed. 31/46 had no spread into nodes. In 8/46 patients, pN1, 5/46 pN2 2/46 pN3. diagnosed metastasis sensitivity 93%, specificity 87%, accuracy 89%, PPV 78% NPV 96%. four false cases, uptake 33 67% comparison that respective primary. Interrater-reliability strong level agreement (κ 0.82). Conclusions both excellent but slightly reduced PPV. Accordingly, preoperative invasive mediastinal may be omitted cases cN0 disease PET/CT. cN1-cN3 stages histological confirmation warranted, particularly case only moderate compared