Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography☆

Billè, Andrea; Pelosi, Ettore; Skanjeti, Andrea; Arena, Vincenzo; Errico, Luca; Borasio, P.; Mancini, Maurizio; Ardissone, Francesco

doi:10.1016/j.ejcts.2009.04.003

Cited by 173 publications

(104 citation statements)

References 25 publications

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“…However, approach of applying routine mediastinoscopy to all patients is not widely favored considering its advantages and disadvantages. 12,13 The same studies report that mediastinoscopy is not required in the patients with negative test results because of high specificity and negative predictive values of PET/CT. Several meta-analyses in the mediastinal staging of NSCLC have calculated a mean sensitivity and specificity of 0.79 and 0.91, respectively for PET.…”

Section: Discussionmentioning

confidence: 98%

Are Ratio of Lymph Node to Primary Focus SUV-max and PET/CT 18FDG Standard Uptake Value of Lymph Nodes Meaningful in Staging Non-Small Cell Lung Cancer?

Çirak¹

2011

UHOD

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Surgical treatment for mediastinal lymph node involvement in non-small cell lung cancer (NSCLC) will not have positive impact on survival. The present study aimed at investigating the role of positron emission tomography/computerized tomography (PET/CT) in staging NSCLC. Ninety-nine patients with maximal standard mediastinal lymph node involvement value (SUVmax) of 2.5 or more on PET/CT scanning were included in this study. All patients underwent invasive staging or pathological staging with direct thoracotomy. Relationship between lymph node SUVmax and lymph node/primary mass SUVmax ratio and presence of lymph node metastasis was investigated. Mean SUVmax ratio was 3.87 in the group with positive mediastinal lymph node on PET/CT but pathologically benign lymph nodes whereas it was 5.69 in those with pathologically malignant lymph nodes. Although there was a numeric difference between two groups, the difference was statistically insignificant (p= 0.65). Lymph node/mass SUVmax ratio was 0.49 in the patients with positive lymph nodes on PET/CT and benign pathology whereas it was 0.65 in those with malignant pathology and the difference between them was found to be not significant (p= 0.61). It was observed, however, that as SUVmax ratio increased, possibility of detecting malignant lymph node raised. Rate of malignancy was 52.38% in the group with SUVmax ratio of 0.1 to 0.3 whereas it was 91.66% in those with SUVmax ratio of 1 or greater. No significant relationship was found between lymph node SUVmax rate and presence of metastatic lymph node. We believe that more multi-center studies are needed with more patients.

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Section: Discussionmentioning

confidence: 98%

Are Ratio of Lymph Node to Primary Focus SUV-max and PET/CT 18FDG Standard Uptake Value of Lymph Nodes Meaningful in Staging Non-Small Cell Lung Cancer?

Çirak¹

2011

UHOD

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“…The utility of the SUV for disease staging or its role after neoadjuvant chemotherapy for NSCLC has been described before (3,(24)(25)(26)(27). However, the usefulness of the extent of reduction in SUV after definitive RT, particularly in LNs, for assessing prognosis remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Large Decreases in Standardized Uptake Values After Definitive Radiation Are Associated with Better Survival of Patients with Locally Advanced Non–Small Cell Lung Cancer

et al. 2012

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We evaluated potential associations between maximum standardized uptake value (SUV max ) on 18 F-FDG PET before and after radiation therapy (RT) and survival outcomes for patients with locally advanced non-small cell lung cancer. Methods: Patients with stage III non-small cell lung cancer (n 5 49) who had undergone 18 F-FDG PET at the M.D. Anderson Cancer Center both before and up to 3.5 mo after undergoing radiochemotherapy were studied; exclusion criteria were patients with a history of thoracic surgery, RT, or other cancer or those who had received a total radiation dose less than 60 Gy. We assessed associations between overall survival (OS) or disease-free survival (DFS) and post-RT SUV max and the extent of decrease in SUV max in the primary tumor (PT) and regional lymph nodes (LNs). SUV max was assessed as a continuous variable by Cox proportional hazards regression analysis. Results: Univariate and multivariate analyses showed that having a high post-RT SUV max (either PT or LNs) was associated with a higher risk of death (univariate analyses: hazard ratio [HR] for PT SUV max , 1.27, P , 0.0001; HR for LN SUV max , 1.32, P 5 0.004) and disease recurrence (univariate analyses: HR for PT SUV max , 1.16, P 5 0.004; HR for LN SUV max , 1.32, P 5 0.001). Moreover, after definitive RT, the greater the decrease in SUV max in the lesion that had the highest SUV max at diagnosis, the longer the OS (HR, 0.06; P 5 0.002), DFS (HR, 0.03; P 5 0.001), local-regional control (HR, 0.04; P 5 0.002), and distant metastasis-free survival (HR, 0.07; P 5 0.028). Conclusion: The post-RT SUV max in both the PT and the LNs was a predictor of survival-specifically, the higher the residual SUV max after RT, the poorer the OS and DFS; and the greater the decrease in SUV max in the lesion with the highest SUV max at diagnosis, the longer the OS and DFS. This information should help to identify patients who are at high risk of recurrence and for whom additional treatments can be designed accordingly.

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“…18 F-FDG PET/CT suffers from a high number of false-positive mediastinal lymph nodes caused by its low specificity in distinguishing inflammatory and granulomatous lymph nodes from lymph node metastases (7)(8)(9). This results in a high negative predictive value for detection of thoracic lymph node metastases of 18 F-FDG PET/CT, but a lower positive predictive value requires verification with invasive techniques such as optical bronchoscopy or biopsy, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), or mediastinoscopy (10)(11)(12)(13)(14)(15)(16).…”

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confidence: 99%

Thoracic Staging in Lung Cancer: Prospective Comparison of ¹⁸F-FDG PET/MR Imaging and ¹⁸F-FDG PET/CT

et al. 2014

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Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography☆

Abstract: Our data show that integrated PET/CT provides high specificity but low sensitivity and accuracy in intrathoracic nodal staging of NSCLC patients and underscore the continued need for surgical staging.

Cited by 173 publications

References 25 publications

Are Ratio of Lymph Node to Primary Focus SUV-max and PET/CT 18FDG Standard Uptake Value of Lymph Nodes Meaningful in Staging Non-Small Cell Lung Cancer?

Are Ratio of Lymph Node to Primary Focus SUV-max and PET/CT 18FDG Standard Uptake Value of Lymph Nodes Meaningful in Staging Non-Small Cell Lung Cancer?

Large Decreases in Standardized Uptake Values After Definitive Radiation Are Associated with Better Survival of Patients with Locally Advanced Non–Small Cell Lung Cancer

Thoracic Staging in Lung Cancer: Prospective Comparison of ¹⁸F-FDG PET/MR Imaging and ¹⁸F-FDG PET/CT

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Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography☆

Abstract: Our data show that integrated PET/CT provides high specificity but low sensitivity and accuracy in intrathoracic nodal staging of NSCLC patients and underscore the continued need for surgical staging.

Cited by 173 publications

References 25 publications

Are Ratio of Lymph Node to Primary Focus SUV-max and PET/CT 18FDG Standard Uptake Value of Lymph Nodes Meaningful in Staging Non-Small Cell Lung Cancer?

Are Ratio of Lymph Node to Primary Focus SUV-max and PET/CT 18FDG Standard Uptake Value of Lymph Nodes Meaningful in Staging Non-Small Cell Lung Cancer?

Large Decreases in Standardized Uptake Values After Definitive Radiation Are Associated with Better Survival of Patients with Locally Advanced Non–Small Cell Lung Cancer

Thoracic Staging in Lung Cancer: Prospective Comparison of 18F-FDG PET/MR Imaging and 18F-FDG PET/CT

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Thoracic Staging in Lung Cancer: Prospective Comparison of ¹⁸F-FDG PET/MR Imaging and ¹⁸F-FDG PET/CT