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The mediastinal staging accuracy of 18F-Fluorodeoxyglycose positron emission tomography/computed tomography in non-small cell lung cancer with variable time intervals to surgery.

Booth K, Hanna GG, McGonigle N, McManus KG, McGuigan J, O'Sullivan J, Lynch T, McAleese J - Ulster Med J (2013)

Bottom Line: Those scanned <9 weeks before pathological sampling were significantly more sensitive (64% >9 weeks, 0% ≥ 9 weeks, p=0.013) and more accurate (94% <9 weeks, 81% ≥ 9 weeks, p=0.007).Differences in specificity were not seen (97% <9 weeks, 91% ≥ 9 weeks, p=0.228).No significant difference in specificity was found at any time point.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Royal Victoria Hospital, Belfast.

ABSTRACT

Background: PET/CT scanning can determine suitability for curative therapy and inform decision making when considering radical therapy in patients with non-small cell lung cancer (NSCLC). Metastases to central mediastinal lymph nodes (N2) may alter such management decisions. We report a 2 year retrospective series assessing N2 lymph node staging accuracy with PET/CT compared to pathological analysis at surgery.

Methods: Patients with NSCLC attending our centre (excluding those who had induction chemotherapy) who had staging PET/CT scans and pathological nodal sampling between June 2006 and June 2008 were analysed. For each lymph node assessed pathologically, the corresponding PET/CT status was determined. 64 patients with 200 N2 lymph nodes were analysed.

Results: Sensitivity of PET/CT scans for indentifying involved N2 lymph nodes was 39%, specificity 96% and overall accuracy 90%. For individual lymph node analysis, logistic regression demonstrated a significant linear association between PET/CT sensitivity and time from scanning to surgery (p=0.031) but not for specificity and accuracy. Those scanned <9 weeks before pathological sampling were significantly more sensitive (64% >9 weeks, 0% ≥ 9 weeks, p=0.013) and more accurate (94% <9 weeks, 81% ≥ 9 weeks, p=0.007). Differences in specificity were not seen (97% <9 weeks, 91% ≥ 9 weeks, p=0.228). No significant difference in specificity was found at any time point.

Conclusions: We recommend that if a PET/CT scan is older than 9 weeks, and management would be altered by the presence of N2 nodes, re-staging of the mediastinum should be undertaken.

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Sensitivity, Specificity and Accuracy of PET/CT staging of N2 lymph node status, for each patient at various time intervals between scanning and surgery.
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fig02: Sensitivity, Specificity and Accuracy of PET/CT staging of N2 lymph node status, for each patient at various time intervals between scanning and surgery.

Mentions: Analysing the staging accuracy based on the performance of each scan for staging N2 disease, similar results were found (see table 4 and figure 2). For all 64 patients, the sensitivity was 30%, specificity was 87%, and accuracy was 78%. In the comparison of sensitivity, specificity and accuracy with the time interval between PET/CT scanning and surgery, no association was found using logistic regression analysis (sensitivity p=0.112, specificity p=0.448, accuracy p=0.205). When the three various time intervals described above were compared, although early scans had greater staging accuracy, no significance difference in sensitivity, specificity and accuracy was observed between the various time intervals.


The mediastinal staging accuracy of 18F-Fluorodeoxyglycose positron emission tomography/computed tomography in non-small cell lung cancer with variable time intervals to surgery.

Booth K, Hanna GG, McGonigle N, McManus KG, McGuigan J, O'Sullivan J, Lynch T, McAleese J - Ulster Med J (2013)

Sensitivity, Specificity and Accuracy of PET/CT staging of N2 lymph node status, for each patient at various time intervals between scanning and surgery.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3756862&req=5

fig02: Sensitivity, Specificity and Accuracy of PET/CT staging of N2 lymph node status, for each patient at various time intervals between scanning and surgery.
Mentions: Analysing the staging accuracy based on the performance of each scan for staging N2 disease, similar results were found (see table 4 and figure 2). For all 64 patients, the sensitivity was 30%, specificity was 87%, and accuracy was 78%. In the comparison of sensitivity, specificity and accuracy with the time interval between PET/CT scanning and surgery, no association was found using logistic regression analysis (sensitivity p=0.112, specificity p=0.448, accuracy p=0.205). When the three various time intervals described above were compared, although early scans had greater staging accuracy, no significance difference in sensitivity, specificity and accuracy was observed between the various time intervals.

Bottom Line: Those scanned <9 weeks before pathological sampling were significantly more sensitive (64% >9 weeks, 0% ≥ 9 weeks, p=0.013) and more accurate (94% <9 weeks, 81% ≥ 9 weeks, p=0.007).Differences in specificity were not seen (97% <9 weeks, 91% ≥ 9 weeks, p=0.228).No significant difference in specificity was found at any time point.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Royal Victoria Hospital, Belfast.

ABSTRACT

Background: PET/CT scanning can determine suitability for curative therapy and inform decision making when considering radical therapy in patients with non-small cell lung cancer (NSCLC). Metastases to central mediastinal lymph nodes (N2) may alter such management decisions. We report a 2 year retrospective series assessing N2 lymph node staging accuracy with PET/CT compared to pathological analysis at surgery.

Methods: Patients with NSCLC attending our centre (excluding those who had induction chemotherapy) who had staging PET/CT scans and pathological nodal sampling between June 2006 and June 2008 were analysed. For each lymph node assessed pathologically, the corresponding PET/CT status was determined. 64 patients with 200 N2 lymph nodes were analysed.

Results: Sensitivity of PET/CT scans for indentifying involved N2 lymph nodes was 39%, specificity 96% and overall accuracy 90%. For individual lymph node analysis, logistic regression demonstrated a significant linear association between PET/CT sensitivity and time from scanning to surgery (p=0.031) but not for specificity and accuracy. Those scanned <9 weeks before pathological sampling were significantly more sensitive (64% >9 weeks, 0% ≥ 9 weeks, p=0.013) and more accurate (94% <9 weeks, 81% ≥ 9 weeks, p=0.007). Differences in specificity were not seen (97% <9 weeks, 91% ≥ 9 weeks, p=0.228). No significant difference in specificity was found at any time point.

Conclusions: We recommend that if a PET/CT scan is older than 9 weeks, and management would be altered by the presence of N2 nodes, re-staging of the mediastinum should be undertaken.

Show MeSH
Related in: MedlinePlus