ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The accuracy of positron emission tomography in mediastinal staging of non-small cell lung cancer
Deniz Akpınar1, Kenan Can Ceylan2, Elif Duman2, Şaban Ünsal2, Şeyda Örs Kaya2
1Tekirdağ Devlet Hastanesi, Göğüs Cerrahisi Kliniği, Tekirdağ, Türkiye
2Dr. Suat Seren Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Cerrahisi Kliniği, İzmir, Türkiye
DOI : 10.5606/tgkdc.dergisi.2013.7006
Background: This study aims to evaluate the accuracy rate of integrated positron emission tomography (PET) with 18F-flouro-2-deoxy-Dglucose and computed tomography (CT) in mediastinal staging of nonsmall cell lung cancer (NSCLC) with the possible factors.

Methods: Between January 2006 - September 2009, 302 patients with histopathologically confirmed NSCLC were prospectively analyzed and 264 patients (30 females, 234 males; mean age 58±9.3 years; range 27 to 84 years) who underwent PET-CT for treatment or staging were included. Lymph nodes with standardized uptake value (SUVmax) ≥2.5 were considered malignant. Cervical mediastinoscopy was performed for suspicious lymph node involvement of 2R, 4R and 7 nodal stations. Video-assisted thoracoscopy was performed for suspicious lymph node involvement of 5, 6 and contralateral 10, 11 nodal stations. Through right-sided thoracotomy 2,4,7,8,9,10,11 nodal stations were samples, while 5,6,7,8,9,10,11 nodal stations were sampled by the left-sided thoracotomy. 1997 6th version of staging system were used.

Results: Squamous cell carcinoma was reported in 57.8%, adenocarcinoma in 38%, large cell carcinoma in 3%, and carcinoid tumor in 1.1%. The false positive rate of PET-CT was 26.2%, whereas the false negative rate was 13.1%. The overall sensitivity, specificity, negative predictive value, positive predictive value and accuracy of PET-CT for detecting mediastinal lymph node involvement were 76.8%, 86.6%, 73.7%, 86.7% and 81.8%, respectively. The diameter of lymph nodes and the presence of N1 disease were statistically significant in terms of the accurate staging of mediastinal lymph nodes through PET-CT (p<0.001, p=0.002).

Conclusion: Positron emission tomography-CT is required for the clinical staging of NSCLC on a regular basis and in the presence of lymph nodes of >1 cm, we believe that invasive staging is beneficial for the patients with N1 positive, even if SUVmax value at N2 stations was below the malignancy threshold, as indicated in the PET-CT scan.

Keywords : Lung cancer; mediastinal staging; positron emission tomography; computed tomography
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