La PET-TC en la estadificación ganglionar prequirúrgica del carcinoma de pulmón de células no pequeñas: implicación de los falsos negativos y falsos positivos

Castro, A. Bustos García de; Domínguez, J. Ferreirós; Delgado-Bolton, Roberto; Fernández-Pérez, Cristina; Martínez, B. Cabeza; García-Esquinas, M. García; Delgado, José Luis Carreras

doi:10.1016/j.rx.2016.12.001

Cited by 22 publications

(5 citation statements)

References 38 publications

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“…The T_SUVmax threshold of 6.05 is not directly comparable to the one reported in other studies: we did not seek an optimal threshold but a threshold minimizing the number of occult lymph nodes. However, it is interesting to note that this threshold remains in the same range as those previously reported between 4 ( 13 ) and 7.5 ( 12 ). The study by Vansteenkiste et al ( 17 ), although not directly concerning occult LNI, reported a better 2-year survival when the primary tumor had SUV lesser than 7 and tumor size lower than 3 cm.…”

Section: Discussionsupporting

confidence: 84%

“…For unresectable tumors, it would allow better planning of radiotherapy and possible adjuvant treatments. Overall, some 18F-FDG PET/CT predictors of occult LNI have already been described: primary tumor localization as central and right superior lobe tumors are associated with a greater risk of occult N2 node (6); primary tumor size: the negative predictive value of 18F-FDG PET/CT was higher for tumors of less than 3 cm in diameter (9)(10)(11); primary tumor 18F-FDG uptake (11)(12)(13). The objective of this study is to build and validate a model to identify patients without LNI more accurately than the simple visual interpretation of 18F-FDG PET/CT.…”

Section: Introductionmentioning

confidence: 99%

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18F-FDG primary tumor uptake to improve N status prediction in cT1 non-metastatic non-small cell lung cancer: development and validation of a positron emission tomography model

et al. 2023

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Purpose:Occult lymph node involvement is a major issue in the management of non-small cell lung carcinoma (NSCLC), with an estimated prevalence of approximately 2.9–21.6% in 18F-FDG PET/CT series. The aim of the study is to construct a PET model to improve lymph node assessment.Methods:Patients with a non-metastatic cT1 NSCLC were retrospectively included from two centers, one used to constitute the training set, the other for the validation set. The best multivariate model based on Akaike’s information criterion was selected, considering age, sex, visual assessment of lymph node (cN0 status), lymph node SUVmax, primary tumor location, tumor size, and tumoral SUVmax (T_SUVmax). A threshold minimizing false pN0 prediction was chosen. This model was then applied to the validation set.Results:In total, 162 patients were included (training set: 44, validation set: 118). A model combining cN0 status and T_SUVmax was selected (AUC 0.907, specificity at threshold: 88.2%). In the validation cohort, this model resulted in an AUC of 0.832 and a specificity of 92.3% versus 65.4% for visual interpretation alone (p = 0.02). A total of two false N0 predictions were noted (1 pN1 and 1 pN2).Conclusion:Primary tumor SUVmax improves N status prediction and could allow a better selection of patients who are candidates for minimally invasive approaches.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

18F-FDG primary tumor uptake to improve N status prediction in cT1 non-metastatic non-small cell lung cancer: development and validation of a positron emission tomography model

et al. 2023

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“…Hypothetically, IFRT may meaningfully improve the therapeutic index by positively enhancing the clinical outcomes and reducing the acute and late complication rates. Nevertheless, conversely, the 25% false-negative rates in PET-CT staged <1 cm LNs and postoperative 10–35% rates of occult LN metastases in clinical stage I NSCLC patients collectively suggest increased risks for nodal failures with IFRT, as the clinically uninvolved LN stations are not irradiated [ 12 – 16 ]. But, starkly contradicting with such evidence, the scarce IFRT studies and a meta-analysis successfully showed that the isolated elective nodal failures (IENFs) after IFRT were consistently less than 10%, essentially when PET-CT was utilized as the initial staging tool [ 6 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Involved Field Radiotherapy versus Elective Nodal Irradiation in Stage IIIB/C Non-Small-Cell Lung Carcinoma Patients Treated with Concurrent Chemoradiotherapy: A Propensity Score Matching Study

Topkan

Özdemir

Güler

et al. 2020

Journal of Oncology

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Background. We retrospectively compared the incidence of isolated elective nodal failure (IENF) and toxicity rates and survival outcomes after elective nodal irradiation (ENI) versus involved-field RT (IFRT) by employing the propensity score matching (PSM) methodology in stage IIIB/C inoperable non-small-cell lung cancer (NSCLC) patients treated with definitive concurrent chemoradiotherapy (C-CRT). Methods. Our PSM examination included 1048 stage IIIB/C NSCLC patients treated with C-CRT from January 2007 to December 2016: a total dose of 66 Gy (2 Gy/fraction) radiotherapy and 1–3 cycles of platinum-based doublet chemotherapy concurrently. The primary and secondary endpoints were the IENF and toxicity rates and survival outcomes after ENI versus IFRT, respectively. Propensity scores were calculated for each group to adjust for confounding variables and facilitate well-balanced comparability by creating 1 : 1 matched study groups. Results. The median follow-up was 26.4 months for the whole study accomplice. The PSM analysis unveiled 1 : 1 matched 646 patients for the ENI (N = 323) and IFRT (N = 323) cohorts. Intergroup comparisons discovered that the 5-year isolated ENF incidence rates (3.4% versus 4.3%; P=0.52) and median overall survival (25.2 versus 24.6 months; P=0.69), locoregional progression-free survival (15.3 versus 15.1 months; P=0.52), and progression-free survival (11.7 versus 11.2 months; P=0.57) durations were similar between the ENI and IFRT cohorts, separately. However, acute grade 3-4 leukopenia (P=0.0012), grade 3 nausea-vomiting (P=0.006), esophagitis (P=0.003), pneumonitis (P=0.002), late grade 3-4 esophageal toxicity (P=0.038), and the need for hospitalization (P<0.001) were all significantly higher in the ENI than in the IFRT group, respectively. Conclusion. Results of the present large-scale PSM cohort established the absence of meaningful IENF or survival differences between the IFRT and ENI cohorts and, consequently, counseled the IFRT as the elected RT technique for such patients since ENI increased the toxicity rates.

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“…PET is an accurate tool for identifying lung nodules and detecting metastases from malignant tissues. Compared to CT, PET offers higher sensitivity and higher specificity for lung cancer detection [ 47 , 48 ]. A previous published report showed that PET has a high false-positive rate, especially with larger nodes (>1 cm) due to reactive or granulomatous nodal disease [ 49 ].…”

Section: Clinical Lung Screening Modalitiesmentioning

confidence: 99%

Screening and Biosensor-Based Approaches for Lung Cancer Detection

Wang

2017

Sensors

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Early diagnosis of lung cancer helps to reduce the cancer death rate significantly. Over the years, investigators worldwide have extensively investigated many screening modalities for lung cancer detection, including computerized tomography, chest X-ray, positron emission tomography, sputum cytology, magnetic resonance imaging and biopsy. However, these techniques are not suitable for patients with other pathologies. Developing a rapid and sensitive technique for early diagnosis of lung cancer is urgently needed. Biosensor-based techniques have been recently recommended as a rapid and cost-effective tool for early diagnosis of lung tumor markers. This paper reviews the recent development in screening and biosensor-based techniques for early lung cancer detection.

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La PET-TC en la estadificación ganglionar prequirúrgica del carcinoma de pulmón de células no pequeñas: implicación de los falsos negativos y falsos positivos

Cited by 22 publications

References 38 publications

18F-FDG primary tumor uptake to improve N status prediction in cT1 non-metastatic non-small cell lung cancer: development and validation of a positron emission tomography model

18F-FDG primary tumor uptake to improve N status prediction in cT1 non-metastatic non-small cell lung cancer: development and validation of a positron emission tomography model

Comparison of Involved Field Radiotherapy versus Elective Nodal Irradiation in Stage IIIB/C Non-Small-Cell Lung Carcinoma Patients Treated with Concurrent Chemoradiotherapy: A Propensity Score Matching Study

Screening and Biosensor-Based Approaches for Lung Cancer Detection

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