Utility of PET-CT in non-small cell lung cancer clinical stage IB-IIA according to AJCC 8th edition staging system: an alternative to invasive mediastinal staging? (original) (raw)
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Impact of 18F-FDG PET/CT, CT and EBUS/TBNA on preoperative mediastinal nodal staging of NSCLC
BMC Medical Imaging
Background Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC. Methods We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories. Results 18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3%...
Advantages of Combined PET-CT in Mediastinal Staging in Patients with Non-small Cell Lung Carcinoma
Acta Informatica Medica, 2016
Introduction: Precise mediastinal lymph node staging in patients with non-small cell lung carcinoma (NSCLC) provides important prognostic information and it is obligatory in treatment strategy planning. 18Fluoro-deoxy-glucose (18F-FDG) positron emission tomography-computerized tomography (PET-CT) based on detection of metabolic activity showed superiority in preoperative staging of lung carcinoma. Materials and Methods: Total number of 26 patients diagnosed with NSCLC were included in this retrospective, cross-sectional study. Status of mediastinal lymph nodes was assessed in all patients comparing contrast enhanced CT and 18F-FDG PET-CT findings. Discussion: We found in our study that 50% of patients had different N stage on contrast enhanced CT comparing to 18F-FDG PET-CT findings. Among the total number of patients which had different nodal status on PET-CT comparing to CT alone, we found in our study that 54% of patients had change in further therapy protocol after PET-CT change of nodal stage. Conclusion: Combined PET-CT which offers advantages of both modalities is excellent method for nodal (N) staging, so it is recommended in initial staging in patients with NSCLC. PET-CT used preopratively for mediastinal nodal staging has significant impact on further therapy planning and also has an consequential impact on health system savings.
Thorax, 2011
Background Correct mediastinal staging is a cornerstone in the treatment of patients with non-small cell lung cancer. A large range of methods is available for this purpose, making the process of adequate staging complex. The objective of this study was to describe faults and benefits of positron emission tomography (PET)-CT in multimodality mediastinal staging. Methods A randomised clinical trial was conducted including patients with a verified diagnosis of non-small cell lung cancer, who were considered operable. Patients were assigned to staging with PET-CT (PET-CT group) followed by invasive staging (mediastinoscopy and/or endoscopic ultrasound with fine needle aspiration (EUS-FNA)) or invasive staging without prior PET-CT (conventional work up (CWU) group). Mediastinal involvement (dichotomising N stage into N0e1 versus N2e3) was described according to CT, PET-CT, mediastinoscopy, EUS-FNA and consensus (based on all available information), and compared with the final N stage as verified by thoracotomy or a conclusive invasive diagnostic procedure. Results A total of 189 patients were recruited, 98 in the PET-CT group and 91 in the CWU group. In an intentionto-treat analysis the overall accuracy of the consensus N stage was not significantly higher in the PET-CT group than in the CWU group (90% (95% confidence interval 82% to 95%) vs 85% (95% CI 77% to 91%)). Excluding the patients in whom PET-CT was not performed (n¼14) the difference was significant (95% (95% CI 88% to 98%) vs 85% (95% CI 77% to 91%), p¼0.034). This was mainly based on a higher sensitivity of the staging approach including PET-CT. Conclusion An approach to lung cancer staging with PET-CT improves discrimination between N0e1 and N2e3. In those without enlarged lymph nodes and a PET-negative mediastinum the patient may proceed directly to surgery. However, enlarged lymph nodes on CT needs confirmation independent of PET findings and a positive finding on PET-CT needs confirmation before a decision on surgery is made. Clinical trial number NCT00867412.
TNM staging of NSCLC: Comparison of PET/MR and PET/CT
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2015
To compare the diagnostic accuracy of whole-body non-contrast-enhanced PET/MR with that of PET/CT in determining the stage of non-small-cell lung cancer. This study was approved by the institutional review board and by national government authorities. Forty-two consecutive patients referred for the initial staging of non-small-cell lung cancer underwent whole-body imaging with a sequential trimodality PET/CT-MR system. PET/MR and PET/CT datasets were evaluated separately, and a tumor-node-metastasis (TNM) stage was assigned based on the image analysis. Nodal stations in the chest were identified according to the mapping system of the American Thoracic Society. The standard of reference was histopathology for the tumor stage in 20 subjects, for the nodal stage in 22 patients and for extrathoracic metastases in 5 subjects. All other lesions were confirmed by at least one different imaging method. Wilcoxon signed-ranks test was used for comparing PET/MR with PET/CT. PET/MR did not prov...
Asian Pacific journal of cancer prevention : APJCP, 2013
Of patients with non small cell lung cancer (NSCLC), around one third are locally advanced at the time of diagnosis. Because only a proprotion of stage III patients can be cured by surgery, in order to improve the outcomes, sequential or concurrent chemoradiation, or concurrent chemoradiation with induction or consolidation is offered to the patients with locally advanced NSCLC. Today, PET combined with computerized tomography (PET-CT) is accepted as the most sensitive technique for detecting mediastinal lymph node and extracranial metastases from NSCLC. We aimed to compare PET-CT and conventional staging procedures for decisions regarding curative treatment of locally advanced NSCLC. A total of 168 consecutive patients were included from Acibadem Kayseri Hospital, Acibadem Adana Hospital and Kayseri Research and Training Hospital in this study. While the median PFS was 13.0 ± 1.9 months in the PET-CT group, it was only 6.0 ± 0.9 in the others (p<0.001). The median OS values were...
The Annals of Thoracic Surgery, 2004
Background. The treatment of patients with nonsmall cell lung cancer (NSCLC) is determined by the stage. We evaluated the accuracy of staging using integrated positron emission tomography (PET) and computed tomography (CT) and compared it with dedicated PET visually correlated with CT scan. Methods. A prospective blinded trial was performed on a consecutive series of patients with NSCLC. Patients underwent integrated PET-CT scanning with 2-[18F]fluoro-2-deoxy-D-glucose (FDG-18). A radiologist assigned the T, N and M status. No sooner than 2 weeks the same radiologist read the dedicated PET alone, without the integrated CT images and a T, N and M status was assigned again. The most recent CT scan was available and visually correlated with both studies. All patients underwent biopsies of suspicious N2 or N3 lymph node or distant metastases and if negative, pulmonary resection with lymphadenectomy was performed. Results. There were 129 patients. Integrated PET-CT is a better predictor than PET for all stages of cancer and achieved statistical significance for stage I (52% versus 33%, p ؍ 0.03) and for stage II (70% versus 36%, p ؍ 0.04). It also is a better overall predictor for T status (70% versus 47%, p ؍ 0.001) and the N status (78% versus 56%, p ؍ 0.008). Nodal analysis shows that integrated PET-CT was more accurate for the total N2 nodes (96% versus 93%, p ؍ 0.01) and for the total N1 nodes (90% versus 80%, p ؍ 0.001). It was also more sensitive, specific, and had a higher positive predictive value for both N2 and N1 nodes (p < 0.05 for all). Integrated PET-CT is significantly more sensitive at the 4R, 5, 7, 10L and 11 stations and more accurate at the 7 and 11 lymph nodes stations than dedicated PET. Conclusions. Integrated PET-CT using FDG-18 better predicts stage I and II disease as well as the T and N status of patients with NSCLC when compared with dedicated PET alone. It is more accurate at some nodal stations but still only achieves an accuracy of 96% and 90% for the N2 and N1 nodes, respectively.
Is invasive mediastinal staging necessary in intermediate risk patients with negative PET/CT?
Journal of thoracic disease, 2020
Background Tumor involvement of mediastinal lymph nodes is of high importance in non-small cell lung cancer (NSCLC). Invasive mediastinal staging is recommended in selected patients without evidence of mediastinal involvement on staging by imaging. In the present study we aimed to evaluate the effectiveness of invasive mediastinal staging in reducing pN2, its impact on survival and the risk factors for occult pN2. Methods Patients with NSCLC tumors larger than 3 cm, central tumors or cN1 cases treated in our institution between 2013 and 2018 were prospectively included in the study. Incidence of pN2 and overall survival was compared among invasively staged (IS) and non-invasively staged groups (NIS). Multivariate analysis was performed to identify risk factors of pN2. Results A total of 201 patients were included in the study, 79 (39.3%) of whom were not invasively staged (NIS group) and 122 (60.7%) were invasively staged (IS group). Incidence of cN1 and mean PET/CT uptake was diffe...
Turkish journal of medical sciences, 2014
Our purpose in this retrospective study was to determine the ratio of unexpected [metastases within the coverage area of thorax computed tomography (CT)] and unknown (metastases out of the coverage area of thorax CT) metastases by positron emission tomography/CT (PET/CT) in patients with newly diagnosed non-small cell lung cancer (NSCLC) who had no defined metastatic lesion, and to investigate the contribution of fludeoxyglucose (FDG)-PET/CT in metastasis staging. A total of 567 patients (489 males and 78 females, mean age 60.9 ± 10.7 years) were enrolled in this study. Among the 567 patients, a total of 156 patients who underwent PET/CT for metabolic characterization (group 1) and had solitary pulmonary nodules (group la, n = 39) or solitary pulmonary masses (group lb, n = 117) and the remaining 411 patients (group 2) with NSCLC who had PET/CT performed for staging formed the basis of this study In group 1, 5/39 (12.8%) patients with a solitary pulmonary nodule and 29/117 (24.8%) p...
Research Square (Research Square), 2022
Background In recent years, PET/MRI has been used clinically as a method to diagnose non-small cell lung cancer (NSCLC). However, no study has shown the usefulness of PET/MRI for lung tumor staging or its consistency with pathological staging compared to CT. This study aimed to evaluate the concordance of staging and prognostic ability of NSCLC patients using thin-section CT and 18 F-FDG PET/MRI. Methods This retrospective study was performed on consecutive NSCLC patients who underwent both diagnostic CT and 18 F-FDG PET/MRI before surgery between November 2015 and May 2019. The cTNM staging yielded from PET/MRI was compared with CT and pathological staging, and concordance was investigated. To assess the prognostic value of disease-free survival (DFS) and overall survival (OS), we dichotomized the typical prognostic factors and TNM classi cation staging (Stage I vs. Stage II or higher). Kaplan-Meier curves derived by the log-rank test were generated, and univariate and multivariate analyses were performed to identify the factors associated with DFS and OS. Results A total of 82 subjects were included; PET/MRI staging was more consistent (59 of 82) with pathological staging than with CT staging. There were a total of 21 cases of CT and 11 cases of PET/MRI that were judged as cStage I but were actually pStage II or pStage III. CT tended to judge pN0 as cN1 or cN2 compared to PET/MRI. There was a signi cant difference between NSCLC patients with Stage I and Stage II or higher by PET/MRI staging as well as prognosis prediction of DFS by pathological staging (P < 0.001). In univariate analysis, PET/MRI, CT, and pathological staging (Stage I or lower vs. Stage II or higher) all showed signi cant differences. In multivariate analysis, pathological staging was the only independent factor for recurrence (P = 0.009), and preoperative PET/MRI staging was a predictor of patient survival (P = 0.013). Conclusions In NSCLC, pathologic staging was better at predicting recurrence, and preoperative PET/MRI staging was better at predicting the patients' survival. Preoperative staging by PET/MRI was superior to CT in diagnosing hilar and mediastinal lymph node metastases, which contributed to the high concordance with pathologic staging.