Abstract
Routine preoperative examinations should contain PET/CT for proper staging. Series have different results about its efficiency in mediastinal nodal staging. Here we aimed to determine the efficiency of PET/CT in mediastinal lymph node involvement of lung cancer in our clinic.
There were 91 patients (82 male, 9 female) with lung carcinoma who underwent operation for treatment or staging. Patients with PET/CT positive lymph node involvement underwent mediastinoscopy. Thoracotomy was performed in patients with operable disease. Age, sex preoperative diagnosis, diameter of tumor, localization of tumor, mediastinal lymph nodes, surgical procedure, postoperative pathologic examinations, SUV max values in PET/CT were reviewed. Clinical and postsurgery staging were compared.
The sensitivity and specifity of thorax CT in determining the pathological lymph nodes were found 39% and 63% respectively. Positive predictive value (PPV) was 32%, negative predictive value (NPV) was found as 70%. For PET/CT examination, sensitivity was 67%, specivity was 73%, whereas PPV and NPV were 50% and 80% respectively. PET/CT had 80%sensitivity, 91% specivity, PPV 36% and NPV%98 for detecting distant metastasis. Regarding satellit nodules PET/CT had 54% sensitivity, 91% specivity, 50% PPV and 93% NPV.
When clinical staging was compared with surgical staging results, PPV was lower for detecting N2 N3 metastasis. That's why biopsy was definitely needed. NPV of PET/CT was higher, the need of invasive staging methods was getting decreased. For unsuspected N2 and M1 disease PET/CT was very useful. PET/CT was found superior in detecting lymph node metastasis, more sensitive in distant metastasis and similar to find patients without metastasis when compared with CT alone.
- © 2011 ERS