PET-CT in presurgical lymph node staging in non-small cell lung cancer: The importance of false-negative and false-positive findings

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

doi:10.1016/j.rxeng.2016.12.005

Cited by 23 publications

(16 citation statements)

References 38 publications

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“…Clinical N stage (cN stage) is established by imaging studies, usually with contrast‐enhanced computed tomography (CT) or positron emission (PET)‐CT. However, the accuracy of cN staging by imaging studies is limited and is often revised according to the results of pathological examinations after surgery (pN stage) . pN stage is the main determinant factor for postoperative treatment and prognosis of NSCLC patients.…”

Section: Introductionmentioning

confidence: 99%

“…However, the accuracy of cN staging by imaging studies is limited and is often revised according to the results of pathological examinations after surgery (pN stage). [3][4][5] pN stage is the main determinant factor for postoperative treatment and prognosis of NSCLC patients. For stage IA (c-T1N0M0) peripheral NSCLC patients, postoperative adjuvant therapy is seldom needed.…”

Section: Introductionmentioning

confidence: 99%

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Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

et al. 2018

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BackgroundIntrapulmonary lymph nodes (LNs, stations 11–14) are usually omitted in postoperative pathological examination. Some non‐small cell lung cancer (NSCLC) patients with intrapulmonary LN metastasis are incorrectly diagnosed as N0 cases. Furthermore, underestimation of intrapulmonary LN involvement in clinically early stage NSCLC may lead to the incorrect choice of surgical procedure: lobectomy or sublobar resection. This study was conducted to determine the status of intrapulmonary LN involvement in clinically staged IA (c‐T1N0M0) peripheral adenocarcinoma of the lung.MethodsSeventy‐five lobectomy specimens of c‐T1N0M0 peripheral adenocarcinoma of the lung were carefully dissected to find intrapulmonary LNs. The longest diameter of each intrapulmonary LN was measured and sent for pathological examination, together with hilar and mediastinal LNs, to investigate the relationship between LN metastasis and primary tumor size.ResultsIntrapulmonary LN metastasis was detected in 22.7%(17/75) of patients. Positive LNs were detected in 21.7% (10/46) of T1b patients and 45% (11/24) of T1c patients, while no metastasis (0/5) was observed in T1a patients (P = 0.036). The mean longest diameter of the 17 involved intrapulmonary LNs was only 6.5 ± 2.1 mm, which was not significantly different to the size of negative intrapulmonary LNs (5.2 ± 1.4 mm).ConclusionsIntrapulmonary LN metastasis is common in clinically staged IA peripheral adenocarcinoma of the lung. LN metastasis is related to tumor size, and this should be taken into account to determine appropriate surgical procedures and postoperative treatment. Computed tomography is not a reliable method to judge LN metastasis, particularly intrapulmonary LN metastasis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

et al. 2018

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“…We conducted this retrospective analysis to evaluate the necessity of preoperative whole-body PET/CT and contrast-enhanced brain MRI in patients with SMGGNs. Although false-positive uptake of 18 F-FDG is often seen in daily PET/CT studies [11] , none of our 51 patients undergoing PET/CT had other primary or secondary lesions in distant organs or metastasis to mediastinal lymph nodes. In all patients undergoing surgery, no metastatic lymph nodes were found in postoperative pathological examination.…”

Section: Discussionmentioning

confidence: 69%

Application Value of Whole-Body Pet/ct and Contrast-enhanced Brain Mri in the Diagnosis and Treatment of Patients With Synchronous Multiple Pulmonary Ground-glass Nodules

Xie

Wang

et al. 2021

Preprint

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Background: Synchronous multiple ground-glass nodules (SMGGNs) in synchronous multiple lung cancers (SMLCs) are associated with specific imaging findings. It is difficult to distinguish whether multiple nodules are primary tumors or metastatic lesions in the lungs. The need for positron-emission tomography/computed tomography (PET/CT) and contrast-enhanced brain magnetic resonance imaging (MRI) for these patients remains unclear. This study investigated the necessity of these two imaging examinations for SMGGN patients by means of retrospective analysis. Methods: SMGGN patients who were diagnosed and treated in the Department of Thoracic Surgery in our hospital from October 2017 to May 2020 and underwent whole-body PET/CT and/or contrast-enhanced brain MRI examinations were enrolled in this study. We analyzed the imaging and clinical characteristics of these patients to evaluate SMGGN patients’ need to undergo whole-body PET/CT and brain MRI examination. Results: A total of 87 SMGGN patients (26 men and 61 women, with a median age of 58 years at onset) were enrolled. Fifty-one patients underwent whole-body PET/CT examinations and did not show signs of primary tumors in other organs, metastatic foci in other organs, or metastasis to surrounding lymph nodes. Eighty-seven patients underwent whole-brain MRI, which did not reveal brain metastases but did detect an old cerebral infarction in 23 patients and a new cerebral infarction in one patient. Eighty-seven patients underwent surgical treatment in which 219 nodules were removed. All nodules were diagnosed as adenocarcinoma or atypical adenomatous hyperplasia. No lymph node metastasis was noted. Conclusion: For SMGGN patients, it is not necessary to perform a whole-body PET/CT examination before surgery. Contrast-enhanced brain MRI can assess the patient’s cerebrovascular function before surgery and reduce the risk of perioperative cerebrovascular accidents. Thus, it is a necessary examination.

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“…In addition, the high rate of false negative N-stagings was seen in the light of close neighboring of NSCLC primary and hilar lymph node metastasis as well as in insu cient spatial resolution of the PET/CT scanner used in their study. Likewise, Bustos García de Castro et al investigated the performance of FDG PET/CT N-staging in NSCLC in comparison to histopathology and demonstrated limited sensitivity of 54% and speci city of 77% [20]. Additional data from Darling et al also point to a considerably impaired performance of FDG PET/CT in N-staging of NSCLC, especially in terms of sensitivity (70%) while the speci city (94%) was even higher when compared to our ndings in LCNEC [21].…”

Section: Discussionmentioning

confidence: 99%

N-Staging in Large Cell Neuroendocrine Carcinoma of the Lung: Diagnostic Value of FDG PET/CT Compared to the Histopathology Reference Standard

Hautzel

Alnajdawi

Fendler

et al. 2021

Preprint

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

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PET-CT in presurgical lymph node staging in non-small cell lung cancer: The importance of false-negative and false-positive findings

Cited by 23 publications

References 38 publications

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

Application Value of Whole-Body Pet/ct and Contrast-enhanced Brain Mri in the Diagnosis and Treatment of Patients With Synchronous Multiple Pulmonary Ground-glass Nodules

N-Staging in Large Cell Neuroendocrine Carcinoma of the Lung: Diagnostic Value of FDG PET/CT Compared to the Histopathology Reference Standard

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