BACKGROUND: Many clinicians use restaging after induction therapy as a way to select patients for surgery. METHODS: A systematic review was conducted to define the reliability of restaging tests after induction therapy for stage III(N2) lung cancer, when compared with pathologic findings at surgery. RESULTS: A complete response at all sites carries a false-negative (FN) rate of 50% for computed tomography and 30% for positron emission tomography. Mediastinal node involvement has FN and false-positive rates of 33% and 33% by computed tomography, and 25% and 33% by positron emission tomography. The FN rate of invasive restaging is 22% by repeat mediastinoscopy, 14% by esophageal ultrasound and needle aspiration in expert hands (reliable results are not yet available for endobronchial ultrasound), and 9% by primary mediastinoscopy done with optimal thoroughness. These results are not significantly affected by the type of induction therapy or the timing of restaging. CONCLUSION: The ability to identify patients who have achieved mediastinal downstaging other than by a careful primary mediastinoscopy is poor.
BACKGROUND: Many clinicians use restaging after induction therapy as a way to select patients for surgery. METHODS: A systematic review was conducted to define the reliability of restaging tests after induction therapy for stage III(N2) lung cancer, when compared with pathologic findings at surgery. RESULTS: A complete response at all sites carries a false-negative (FN) rate of 50% for computed tomography and 30% for positron emission tomography. Mediastinal node involvement has FN and false-positive rates of 33% and 33% by computed tomography, and 25% and 33% by positron emission tomography. The FN rate of invasive restaging is 22% by repeat mediastinoscopy, 14% by esophageal ultrasound and needle aspiration in expert hands (reliable results are not yet available for endobronchial ultrasound), and 9% by primary mediastinoscopy done with optimal thoroughness. These results are not significantly affected by the type of induction therapy or the timing of restaging. CONCLUSION: The ability to identify patients who have achieved mediastinal downstaging other than by a careful primary mediastinoscopy is poor.
Authors: R Taylor Ripley; Kei Suzuki; Kay See Tan; Prasad S Adusumilli; James Huang; Bernard J Park; Robert J Downey; Nabil P Rizk; Valerie W Rusch; Manjit Bains; David R Jones Journal: J Thorac Cardiovasc Surg Date: 2015-10-19 Impact factor: 5.209