BACKGROUND: Staging of non-small cell lung cancer (NSCLC) is important for determining choice of treatment and prognosis. The accuracy of FDG-PET scans for staging of lymph nodes is too low to replace invasive nodal staging. It is unknown whether the accuracy of integrated FDG-PET/CT scanning makes invasive staging redundant. METHODS: In a prospective study, the mediastinal and/or hilar lymph nodes in patients with proven NSCLC were investigated with integrated FDG-PET/CT scanning. Pathological confirmation of all suspect lymph nodes was obtained to calculate the accuracy of the fusion images. In addition, the use of the standardised uptake value (SUV) in the staging of intrathoracic lymph nodes was analysed. RESULTS: 105 intrathoracic lymph node stations from 52 patients with NSCLC were characterised. The prevalence of malignancy in the lymph nodes was 36%. The sensitivity of the integrated FDG-PET/CT scan to detect malignant lymph nodes was 84% and its specificity was 85% (positive likelihood ratio 5.64, negative likelihood ratio 0.19). SUV(max), SUV(mean) and the SUV(max)/SUV(liver) ratio were all significantly higher in malignant than in benign lymph nodes. The area under the receiver operating curve did not differ between these three quantitative variables, but the highest accuracy was found with the SUV(max)/SUV(liver) ratio. At a cut-off value of 1.5 for the SUV(max)/SUV(liver )ratio, the sensitivity and specificity to detect malignant lymph node invasion were 82% and 93%, respectively. CONCLUSION: The accuracy of integrated FDG-PET/CT scanning is too low to replace invasive intrathoracic lymph node staging in patients with NSCLC. The visual interpretation of the fusion images of the integrated FDG-PET/CT scan can be replaced by the quantitative variable SUV(max)/SUV(liver) without loss of accuracy for intrathoracic lymph node staging.
BACKGROUND: Staging of non-small cell lung cancer (NSCLC) is important for determining choice of treatment and prognosis. The accuracy of FDG-PET scans for staging of lymph nodes is too low to replace invasive nodal staging. It is unknown whether the accuracy of integrated FDG-PET/CT scanning makes invasive staging redundant. METHODS: In a prospective study, the mediastinal and/or hilar lymph nodes in patients with proven NSCLC were investigated with integrated FDG-PET/CT scanning. Pathological confirmation of all suspect lymph nodes was obtained to calculate the accuracy of the fusion images. In addition, the use of the standardised uptake value (SUV) in the staging of intrathoracic lymph nodes was analysed. RESULTS: 105 intrathoracic lymph node stations from 52 patients with NSCLC were characterised. The prevalence of malignancy in the lymph nodes was 36%. The sensitivity of the integrated FDG-PET/CT scan to detect malignant lymph nodes was 84% and its specificity was 85% (positive likelihood ratio 5.64, negative likelihood ratio 0.19). SUV(max), SUV(mean) and the SUV(max)/SUV(liver) ratio were all significantly higher in malignant than in benign lymph nodes. The area under the receiver operating curve did not differ between these three quantitative variables, but the highest accuracy was found with the SUV(max)/SUV(liver) ratio. At a cut-off value of 1.5 for the SUV(max)/SUV(liver )ratio, the sensitivity and specificity to detect malignant lymph node invasion were 82% and 93%, respectively. CONCLUSION: The accuracy of integrated FDG-PET/CT scanning is too low to replace invasive intrathoracic lymph node staging in patients with NSCLC. The visual interpretation of the fusion images of the integrated FDG-PET/CT scan can be replaced by the quantitative variable SUV(max)/SUV(liver) without loss of accuracy for intrathoracic lymph node staging.
Authors: W De Wever; S Ceyssens; L Mortelmans; S Stroobants; G Marchal; J Bogaert; J A Verschakelen Journal: Eur Radiol Date: 2006-05-09 Impact factor: 5.315
Authors: V Kalff; R J Hicks; M P MacManus; D S Binns; A F McKenzie; R E Ware; A Hogg; D L Ball Journal: J Clin Oncol Date: 2001-01-01 Impact factor: 44.544
Authors: Gonzalo V Gonzalez-Stawinski; Anthony Lemaire; Faisal Merchant; Elizabeth O'Halloran; R Edward Coleman; David H Harpole; Thomas A D'Amico Journal: J Thorac Cardiovasc Surg Date: 2003-12 Impact factor: 5.209
Authors: J F Vansteenkiste; S G Stroobants; P R De Leyn; P J Dupont; J Bogaert; A Maes; G J Deneffe; K L Nackaerts; J A Verschakelen; T E Lerut; L A Mortelmans; M G Demedts Journal: J Clin Oncol Date: 1998-06 Impact factor: 44.544
Authors: Robert J Cerfolio; Buddhiwardhan Ojha; Ayesha S Bryant; Cynthia S Bass; Alfred A Bartalucci; James M Mountz Journal: Ann Thorac Surg Date: 2003-09 Impact factor: 4.330
Authors: Didier Lardinois; Walter Weder; Thomas F Hany; Ehab M Kamel; Stephan Korom; Burkhardt Seifert; Gustav K von Schulthess; Hans C Steinert Journal: N Engl J Med Date: 2003-06-19 Impact factor: 91.245
Authors: Michael K Gould; Ware G Kuschner; Chara E Rydzak; Courtney C Maclean; Anita N Demas; Hidenobu Shigemitsu; Jo Kay Chan; Douglas K Owens Journal: Ann Intern Med Date: 2003-12-02 Impact factor: 25.391
Authors: Paul Flechsig; Peter Choyke; Clemens Kratochwil; Arne Warth; Gerald Antoch; Tim Holland Letz; Daniel Rath; Viktoria Eichwald; Peter E Huber; Hans-Ulrich Kauczor; Uwe Haberkorn; Frederik L Giesel Journal: Diagn Interv Radiol Date: 2016 Jan-Feb Impact factor: 2.630
Authors: Andrzej Lebioda; Roman Makarewicz; Bogdan Małkowski; Maciej Dancewicz; Janusz Kowalewski; Wieslawa Windorbska Journal: Rep Pract Oncol Radiother Date: 2013-01-05
Authors: Julian Kirchner; Lino M Sawicki; Felix Nensa; Benedikt M Schaarschmidt; Henning Reis; Marc Ingenwerth; Simon Bogner; Clemens Aigner; Christian Buchbender; Lale Umutlu; Gerald Antoch; Ken Herrmann; Philipp Heusch Journal: Eur J Nucl Med Mol Imaging Date: 2018-08-03 Impact factor: 9.236