PT  - JOURNAL ARTICLE
AU  - Matthew Evison
AU  - Philip Crosbie
AU  - Julie Martin
AU  - Philip Barber
AU  - Richard Booton
AU  - Katie Hilton
TI  - Should all lung cancer patients requiring pathological nodal staging undergo PET-CT first?
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P343
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/P343.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/P343.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - Introduction: The optimal sequence of investigations for patients with suspected lung cancer, stage I-III on CT, is not clear. In particular, the timing of Positron Emission Tomography (PET) imaging, before or after pathological nodal staging, has not been defined.Methods: The University Hospital South Manchester provides EBUS-TBNA for a large UK cancer Network. This prospective study was completed over a 3 year period, 2010-2013, and included all patients referred for EBUS-TBNA nodal sampling whom also underwent PET-CT during their staging pathway.Results: 510 patients with suspected lung cancer underwent both EBUS-TBNA and PET-CT in the study period. PET-CT suggested distant metastatic disease in 83/510 patients (16%).The prevalence of distant disease was significantly higher in patients with nodal stage N2/3 on CT compared to N0/1 (66/305, 22% vs. 17/205, 8% p=<0.0001). PET-CT demonstrated additional nodal disease (defined as abnormal FDG uptake in a lymph node deemed normal by size criteria on CT) in 171/510 patients (34%). The prevalence of additional nodal disease is higher in patients with nodal stage N0/1 CT compared to N2/3 (92/205, 45% vs. N2/3 79/305, 26% p=<0.0001).Discussion: 1 in 5 patients with N2/3 nodal stage on CT referred for EBUS-TBNA nodal staging have extra-thoracic disease on PET-CT, which may dictate an alternative biopsy technique. 1 in 2 patients with N0/1 nodal stage on CT have additional nodal pathology on PET thereby dictating the need for meticulous sampling of that node during EBUS-TBNA regardless of appearances during systematic examination. In summary, patients with both (N0/1) and advanced nodal stage (N2/3) on CT could benefit from pre-EBUS PET.