Characteristics of Advantages of Positron Emission Tomography over Computed Tomography for N-staging in Lung Cancer Patients

Abstract

For N-staging, PET was superior to CT for the following: (1) more accurate for N0, N2 and N3 diseases but not for N1; (2) lower frequency of false-positive in the upper mediastinal nodes; and (3) lower frequencies of false-negative in adenocarcinoma and false-positive in squamous cell carcinoma. Recognizing these advantages of PET could make the N-staging of lung cancer more accurate.

Limitations of 18F-2-Deoxy-d-Glucose Positron Emission Tomography in N1 Detection in Patients With Pathologic Stage II-N1 and Implications for Management

“…Among the articles, 11 matched the inclusion criteria of our study. The pooled sensitivity of our study and the cases in the literature was 41% (range, 17% to 93%) for detecting N1 disease (Table 4) [4][5][6][7][8][9][10][11][12][13][14][15].…”

“…In patients with pathologic N1 (pN1) disease, the preoperative FDG-PET detected pN1 disease in 24%, and the location and size of the tumor did not affect the ability of FDG-PET or FDG-PET/CT to detect pN1 disease. The reported sensitivity of FDG-PET in detecting pN1 disease has a wide range (17% to 93%) [4,5,[7][8][9][10][11][12][13][14][15][16], and this can partially be attributed to differences in methodology and the threshold SUVmax used to diagnose pN1 disease. For instance, when a SUV of 1.5 and higher is used to diagnose pN1 disease, the sensitivity is 96.9% with a specificity of 16.3%, whereas when 2.5 is used, the sensitivity of detecting pN1 disease is 48.5% with a specificity of 80.2% [8].…”

“…In fact, when the presence of pN1 disease will redirect patient therapy, endobronchial ultrasound or endoesophageal ultrasound and biopsy should be considered in the clinical staging algorithm. [7] 2012 PET/CT 1 6 17 Lin [9] 2012 PET/CT 10 18 56 Carrillo [8] 2012 PET/CT 16 33 48 Ceylan [10] 2012 PET/CT 3 5 60 Nakagawa [12] 2009 PET/CT 4 19 21 Bille [6] 2009 PET/CT 12 17 71 Turkmen [11] 2007 PET 3 14 21 Ebihara [13] 2006 PET 19 31 61 Cerfolio [14] 2004 PET/CT 14 15 93 Halter [15] 2004 …”

“…FDG-PET results were negative for lymph node involvement (N1) in these patients at diagnosis. The reported sensitivity of FDG-PET in detecting hilar lymph node metastasis (N1) has not been thoroughly investigated but has been reported to be 17% to 93% [4][5][6][7][8][9][10][11][12][13][14][15] and to predict worse survival when detected by FDG-PET before resection [4].The purpose of this study was to evaluate FDG-PET in the detection of N1 disease and to determine, as reported in the literature, if positive N1 on FDG-PET predicts poorer survival in patients with pathologic stage II-N1 NSCLC.…”

Positron emission tomography in lung cancer

“…32 We previously examined the characteristics of advantages of PET over CT for lymph node staging, especially among various lymph node locations and histological types. 33,34 Table 3 shows the number with coincidence of N staging by PET and CT with the pathological N staging. PET was able to diagnose N0, N2, and N3 diseases more accurately than CT with signifi cant differences (P = 0.03, 0.01, and 0.02, respectively).…”