The Potential of NTR Value in Primary Lung Cancer to Predict Lymphovascular Invasion: A Retrospective Study

Aim This retrospective study aims to improve preoperative conventional imaging and assessment criteria for non-small cell lung cancer cases eligible for surgery and to enhance the surgical and clinical approach to patients through reliable preoperative staging. Materials and Methods A group of 574 patients who attended the Thoracic Surgery outpatient clinic at Cukurova University Balcalı Training and Research Hospital between 2012 and 2022 and were investigated for suspected lung cancer or diagnosed with lung cancer were retrospectively examined. T SUVmax (primary tumour SUVmax), N SUVmax (mediastinal lymph node SUVmax) and NTR (node to tumor SUVmax ratio), correlated with clinical Tumor (T)-Node (N)-Metastasis (M) staging, were recorded and compared with histopathological findings of lymphovascular invasion of the tumour. Results In the 574 NSCLC patients included in the study, the ratio of the SUVmax value of the lymph node with the highest metabolic activity detected in the mediastinum to the SUVmax value of the primary lesion (node-to-tumour SUVmax, NTR) was examined, and this ratio was found to have significant potential for predicting lymphovascular invasion (AUC: 73.1 and 71% sensitivity, 74% specificity for a cut-off value of 0.79). Conclusion The NTR value from metabolic parameters in F-18 FDG PET/CT can be used to evaluate the primary lesion for lymphovascular invasion in the preoperative period in NSCLC.