FDG-PET/CT imaging for mediastinal staging in patients with potentially resectable non-small cell lung cancer.

CLINICAL QUESTION: What is the sensitivity and specificity of 18F-fludeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging for detecting mediastinal lymph node involvement in patients with potentially resectable non-small cell lung cancer (NSCLC)? BOTTOM LINE: Sensitivity and specificity of FDG-PET/CT imaging ranged from 0.77 to 0.81 for sensitivity and 0.79 to 0.90 for specificity, and were related to the brand of scanner, NSCLC subtype, FDG dose, and country of study origin. These sensitivities and specificities are not sufficiently accurate to warrant reliance on FDG-PET/CT scanning alone to make decisions about surgery as a single option for patients with potentially resectable NSCLC. Instead FDG-PET/CT imaging should be used to determine whether the next step should be biopsy (endobronchial ultrasound-guided biopsy or mediastinoscopy) or surgical resection.