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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

True positive PET/CT interpretation for mediastinal nodal staging in 46-year-old man with stage T1 adenocarcinoma of lung showing metastatic disease on follow-up examination.A, B. Transverse images of initial PET/CT show 29-mm-sized nodule (arrow in A) with high amount of FDG uptake (maximum SUV = 10.4) in right lower lobe and right lower paratracheal lymph node (nodal station 4R, arrow in B) of high FDG uptake. Nodes contained malignant cells upon examination of mediastinoscopic biopsy.C, D. Initial (C) and follow-up (D) enhanced sagittal T1-weighted MR images over seven month follow-up period show newly developed metastatic nodule (arrow in D) in cerebellar vermis.
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Figure 3: True positive PET/CT interpretation for mediastinal nodal staging in 46-year-old man with stage T1 adenocarcinoma of lung showing metastatic disease on follow-up examination.A, B. Transverse images of initial PET/CT show 29-mm-sized nodule (arrow in A) with high amount of FDG uptake (maximum SUV = 10.4) in right lower lobe and right lower paratracheal lymph node (nodal station 4R, arrow in B) of high FDG uptake. Nodes contained malignant cells upon examination of mediastinoscopic biopsy.C, D. Initial (C) and follow-up (D) enhanced sagittal T1-weighted MR images over seven month follow-up period show newly developed metastatic nodule (arrow in D) in cerebellar vermis.

Mentions: A total of 161 patients were classified in the P-TN group, as opposed to 12 in the PET/CT FN group (Fig. 2) and 11 in the PET/CT TP (Fig. 3) group. The patient characteristics of the P-TN, PET/CT FN, and PET/CT TP groups were based on the various clinicopathologic factors shown in Table 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)

True positive PET/CT interpretation for mediastinal nodal staging in 46-year-old man with stage T1 adenocarcinoma of lung showing metastatic disease on follow-up examination.A, B. Transverse images of initial PET/CT show 29-mm-sized nodule (arrow in A) with high amount of FDG uptake (maximum SUV = 10.4) in right lower lobe and right lower paratracheal lymph node (nodal station 4R, arrow in B) of high FDG uptake. Nodes contained malignant cells upon examination of mediastinoscopic biopsy.C, D. Initial (C) and follow-up (D) enhanced sagittal T1-weighted MR images over seven month follow-up period show newly developed metastatic nodule (arrow in D) in cerebellar vermis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: True positive PET/CT interpretation for mediastinal nodal staging in 46-year-old man with stage T1 adenocarcinoma of lung showing metastatic disease on follow-up examination.A, B. Transverse images of initial PET/CT show 29-mm-sized nodule (arrow in A) with high amount of FDG uptake (maximum SUV = 10.4) in right lower lobe and right lower paratracheal lymph node (nodal station 4R, arrow in B) of high FDG uptake. Nodes contained malignant cells upon examination of mediastinoscopic biopsy.C, D. Initial (C) and follow-up (D) enhanced sagittal T1-weighted MR images over seven month follow-up period show newly developed metastatic nodule (arrow in D) in cerebellar vermis.
Mentions: A total of 161 patients were classified in the P-TN group, as opposed to 12 in the PET/CT FN group (Fig. 2) and 11 in the PET/CT TP (Fig. 3) group. The patient characteristics of the P-TN, PET/CT FN, and PET/CT TP groups were based on the various clinicopathologic factors shown in Table 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