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FDG PET/CT and mediastinal nodal metastasis detection in stage T1 non-small cell lung cancer: prognostic implications.

Shin KM, Lee KS, Shim YM, Kim J, Kim BT, Kwon OJ, Park K - Korean J Radiol (2008 Nov-Dec)

Bottom Line: After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. kyungs.lee@samsung.com

ABSTRACT

Objective: We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC).

Materials and methods: Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.

Results: Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).

Conclusion: The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.

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Related in: MedlinePlus

Flowchart illustrating study design and number of patients enrolled in this study from each group. P-TN = pathologically true negative, TN = true negative, FP = false positive, FN = false negative, TP = true positive, *Neither FDG uptake amount of primary tumor or PET/CT mediastinal nodal FDG uptake result was determinant for performing mediastinoscopy.
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Figure 1: Flowchart illustrating study design and number of patients enrolled in this study from each group. P-TN = pathologically true negative, TN = true negative, FP = false positive, FN = false negative, TP = true positive, *Neither FDG uptake amount of primary tumor or PET/CT mediastinal nodal FDG uptake result was determinant for performing mediastinoscopy.

Mentions: Of these 199 patients, 10 were excluded because they did not undergo surgical treatment. In addition, another five patients were excluded because of death caused by an unrelated disease (post-operative adult respiratory distress in two, chronic empyema in the lobectomy space and its related pneumonia and sepsis in one, advanced gastric cancer in one, and acute pulmonary thromboembolism in one) during the follow-up period. The remaining patients make up the total of 184 patients included in the study (124 men and 60 women; mean age, 59 + 10 years [standard deviation]; range, 32-81 years) (Fig. 1).


FDG PET/CT and mediastinal nodal metastasis detection in stage T1 non-small cell lung cancer: prognostic implications.

Shin KM, Lee KS, Shim YM, Kim J, Kim BT, Kwon OJ, Park K - Korean J Radiol (2008 Nov-Dec)

Flowchart illustrating study design and number of patients enrolled in this study from each group. P-TN = pathologically true negative, TN = true negative, FP = false positive, FN = false negative, TP = true positive, *Neither FDG uptake amount of primary tumor or PET/CT mediastinal nodal FDG uptake result was determinant for performing mediastinoscopy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627243&req=5

Figure 1: Flowchart illustrating study design and number of patients enrolled in this study from each group. P-TN = pathologically true negative, TN = true negative, FP = false positive, FN = false negative, TP = true positive, *Neither FDG uptake amount of primary tumor or PET/CT mediastinal nodal FDG uptake result was determinant for performing mediastinoscopy.
Mentions: Of these 199 patients, 10 were excluded because they did not undergo surgical treatment. In addition, another five patients were excluded because of death caused by an unrelated disease (post-operative adult respiratory distress in two, chronic empyema in the lobectomy space and its related pneumonia and sepsis in one, advanced gastric cancer in one, and acute pulmonary thromboembolism in one) during the follow-up period. The remaining patients make up the total of 184 patients included in the study (124 men and 60 women; mean age, 59 + 10 years [standard deviation]; range, 32-81 years) (Fig. 1).

Bottom Line: After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. kyungs.lee@samsung.com

ABSTRACT

Objective: We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC).

Materials and methods: Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test.

Results: Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001).

Conclusion: The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.

Show MeSH
Related in: MedlinePlus