False-negative rate after positron emission tomography/computer tomography scan for mediastinal staging in cI stage non-small-cell lung cancer
Open Access
- 20 January 2012
- journal article
- clinical trial
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 42 (1), 93-100
- https://doi.org/10.1093/ejcts/ezr272
Abstract
OBJECTIVES To assess the false-negative (FN) rate of positron emission tomography (PET)-chest computed tomography (CT) scan in clinical non-central cIA and cIB non-small-cell lung cancer (NSCLC) for mediastinal staging. METHODS Between January 2007 and December 2010, 402 patients with potentially operable NSCLC were assessed by thoracic CT scan and 18-fluoro-2-deoxy-d-glucose PET-CT for mediastinal staging and to detect extrathoracic metastases, of which 153 surgically treated patients (79 cIA and 74 cIB cases) were prospectively included in the study. Central tumours were excluded on the basis of CT scan criteria, defined as contact with the intrapulmonary main bronchi, pulmonary artery, pulmonary veins or the origin of the first segmental branches. CT scan was considered negative if lymph nodes were max) was RESULTS Composite non-invasive staging (CT scan, PET-CT) showed a negative predictive value (NPV) of 92% (CI 83.6–96.8) in the cIA group and 85% (CI 74–92) in the cIB group. There were 6 of 79 (7.6%) false-negatives (FNs) in cIA and 11 of 74 (14.8%) in cIB. Multilevel pN2 were detected in four cases, all of them in the cIB group. The most frequently involved N2 was subcarinal (two cases) in cIA and right lower paratracheal (R4) and seven (five cases) in cIB. Occult (pN2) lymph nodes were more frequent in tumour sizes ≥5 cm (pT2b, nine cases, four FNs, P = 0.03), pN1, adenocarcinoma [excluding minimally invasive adenocarcinoma (MIA) and lepidic predominant growth (LPA)] (P = 0.029) and female patients, but no other risk factors for mediastinal metastases were identified (age, clinical stage, tumour location, central or peripheral, P > 0.05). Multilevel pN2 was significantly more frequent in the cIB group (P < 0.03). In pT ≤ 1 cm (T1a), NPV was significantly better (NPV = 100%, P < 0.05) than the other subgroups studied (IA > 1 cm and IB). CONCLUSIONS Composite results for non-invasive mediastinal staging (CT scan, PET-CT) showed 11% of FNs in cI stage (7.6% in non-central cIA and 14.8% in cIB). In tumours ≤1 cm, NPV makes surgical staging unnecessary. In women with adenocarcinoma and non-central cIB, however, the high FN rate makes invasive staging necessary, particularly in pT2b to decrease the incidence of unexpected pN2 in thoracotomy.Keywords
This publication has 20 references indexed in Scilit:
- Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trialThe Lancet, 2009
- Preoperative Staging of Lung Cancer with Combined PET–CTThe New England Journal of Medicine, 2009
- Impact of Postoperative Radiation Therapy on Survival in Patients With Complete Resection and Stage I, II, or IIIA Non–Small-Cell Lung Cancer Treated With Adjuvant Chemotherapy: The Adjuvant Navelbine International Trialist Association (ANITA) Randomized TrialInternational Journal of Radiation Oncology*Biology*Physics, 2008
- Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomographyEuropean Journal of Cardio-Thoracic Surgery, 2008
- ESTS guidelines for preoperative lymph node staging for non-small cell lung cancerEuropean Journal of Cardio-Thoracic Surgery, 2007
- Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB–IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trialThe Lancet Oncology, 2006
- Positron emission tomographic scanning in the diagnosis and staging of non–small cell lung cancer 2 cm in size or lessThe Journal of Thoracic and Cardiovascular Surgery, 2005
- FDG-PET in staging lung cancer: How does it change the algorithm?Lung Cancer, 2004
- Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trialThe Lancet, 2002
- A Randomized Trial Comparing Preoperative Chemotherapy Plus Surgery with Surgery Alone in Patients with Non-Small-Cell Lung CancerThe New England Journal of Medicine, 1994