Jingbo Wang1, Kathy Welch, Luhua Wang, Feng-Ming Spring Kong. 1. Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, PR China.
Abstract
BACKGROUND: Nodal staging of non-small-cell lung cancer (NSCLC) is crucial in evaluation of prognosis and determination of therapeutic strategy. This study aimed to determine the negative predictive value (NPV) of combined positron emission tomography and computed tomography (PET-CT) in patients with stage I (T1-2N0) NSCLC and to investigate the possible risk factors for occult nodal disease. METHODS: Studies investigating the performance of PET in conjunction with CT in the nodal staging of stage I NSCLC were identified in the MEDLINE database. The initiative of standards for reporting of diagnostic accuracy (STARD) was used to ensure study quality. Pathologic assessments through mediastinoscopy or thoracotomy were required as the reference standard for evaluation of PET-CT accuracy. Stata-based meta-analysis was applied to calculate the individual and pooled NPVs. RESULTS: Ten studies with a total of 1122 patients with stage I (T1-2N0) NSCLC were eligible for analysis. The NPVs of combined PET and CT for mediastinal metastases were 0.94 in T1 disease and 0.89 in T2 disease. Including both T1 disease and T2 disease, the NPVs were 0.93 for mediastinal metastases and 0.87 for overall nodal metastases. Adenocarcinoma histology type (risk ratio [RR], 2.72) and high fluorine-18 (18F) fluorodeoxyglucose (FDG) uptake in the primary lesion were associated with greater risk of occult nodal metastases. CONCLUSIONS: Although overall occult nodal metastases in clinical stage T1-2N0 NSCLC is not infrequent, combined PET and CT provide a favorable NPV for mediastinal metastases in T1N0 NSCLC, suggesting a low yield from routine invasive staging procedures for this subgroup of patients. Published by Elsevier Inc.
BACKGROUND: Nodal staging of non-small-cell lung cancer (NSCLC) is crucial in evaluation of prognosis and determination of therapeutic strategy. This study aimed to determine the negative predictive value (NPV) of combined positron emission tomography and computed tomography (PET-CT) in patients with stage I (T1-2N0) NSCLC and to investigate the possible risk factors for occult nodal disease. METHODS: Studies investigating the performance of PET in conjunction with CT in the nodal staging of stage I NSCLC were identified in the MEDLINE database. The initiative of standards for reporting of diagnostic accuracy (STARD) was used to ensure study quality. Pathologic assessments through mediastinoscopy or thoracotomy were required as the reference standard for evaluation of PET-CT accuracy. Stata-based meta-analysis was applied to calculate the individual and pooled NPVs. RESULTS: Ten studies with a total of 1122 patients with stage I (T1-2N0) NSCLC were eligible for analysis. The NPVs of combined PET and CT for mediastinal metastases were 0.94 in T1 disease and 0.89 in T2 disease. Including both T1 disease and T2 disease, the NPVs were 0.93 for mediastinal metastases and 0.87 for overall nodal metastases. Adenocarcinoma histology type (risk ratio [RR], 2.72) and high fluorine-18 (18F) fluorodeoxyglucose (FDG) uptake in the primary lesion were associated with greater risk of occult nodal metastases. CONCLUSIONS: Although overall occult nodal metastases in clinical stage T1-2N0 NSCLC is not infrequent, combined PET and CT provide a favorable NPV for mediastinal metastases in T1N0 NSCLC, suggesting a low yield from routine invasive staging procedures for this subgroup of patients. Published by Elsevier Inc.
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: David E Smith; Julian Fernandez Aramburu; Alejandro Da Lozzo; Juan A Montagne; Enrique Beveraggi; Agustin Dietrich Journal: Updates Surg Date: 2019-09-24
Authors: Eric M Robinson; Ilkka K Ilonen; Kay See Tan; Andrew J Plodkowski; Matthew Bott; Manjit S Bains; Prasad S Adusumilli; Bernard J Park; Valerie W Rusch; David R Jones; James Huang Journal: Ann Thorac Surg Date: 2019-08-31 Impact factor: 4.330
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
Authors: Julian M M Rogasch; Ingo G Steffen; Sandra Riedel; Ivayla Apostolova; Heinz Wertzel; H Jost Achenbach; Ferdinand L G A Steinkrüger; Thomas Kalinski; Meinald Schultz; Jens Schreiber; Holger Amthauer; Christian Furth Journal: Eur Radiol Date: 2015-11-11 Impact factor: 5.315