Mediastinoscopy might not be necessary in patients with non–small cell lung cancer with mediastinal lymph nodes having a maximum standardized uptake value of less than 5.3

Abstract

The maximum standardized uptake value is a predictor of individual lymph node metastasis in non-small cell lung cancer. Accuracy of integrated positron emission tomography/computed tomography is significantly improved by using a maximum standardized uptake value of 5.3 to assign malignancy, thereby dramatically decreasing the number of false-positive results. More importantly, these results suggest that some patients with non-small cell lung cancer with a maximum standardized uptake value less than 5.3 in their N2 lymph nodes might be able to forego mediastinoscopy and proceed directly to thoracotomy. This represents a significant change in the current management of standardized uptake value-positive mediastinal lymph nodes in non-small cell lung cancer.

Rendimiento del Positron Emission Tomography/Computed Tomography (PET/CT) en etapificación de cáncer pulmonar

“…La cuantificación de la captación de FDG en los linfonodos es esencial en su adecuada caracterización, y el índice SUV es el más empleado para este efecto. Valores de corte de entre 2,5 y 5,3 han sido mencionados como útiles para diferenciar ganglios reactivos/residuales de ganglios metastáticos, aunque estos valores pueden variar según el equipo PET/CT y la técnica de adquisición empleadas, por lo que se recomienda tener valores de corte propios en cada centro 9,10 . Los valores de SUVmax de 4,0 para mediastino y 4,4 para hilio obtenidos en este estudio apuntan en ese sentido, y permiten etapificar el mediastino con una sensibilidad de 86% y especificidad cercana a 100%.…”

Validating guideline concordant care in lung cancer also validates good surgical judgement and skill

“…It has been suggested that the optimal maximum standard uptake value (maxSUV) threshold for declaring positive mediastinal lymph nodes is 5.3 (10). In that study, the investigators stratified PET-CT scan results into four categories based on primary tumor maxSUV and mediastinal lymph node maxSUV.…”

Surgery for nonsmall cell lung cancer

“…Recently, the development of EBUS transbronchial needle aspiration or endooesophageal ultrasound-guided needle aspiration (EUS) has allowed for more accurate staging of proximal hilar and all mediastinal stations [24,25]. As chest CT, PET-CT or PET scan do not have a specificity, negative predictive value or accuracy of 100%, it is recommended that patients with negative lymph nodes on PET or PET-CT, but enlarged nodes on staging CT still undergo proper staging of mediastinal nodes through EBUS/EUS or mediastinoscopy, before thoracotomy [26,27]. Again, if results remain inconclusive, a surgical biopsy (VATS preferably) may help stage mediastinal lymph nodes accurately.…”