Abstract
OBJECTIVE: To assess positron emission tomography (PET)-chest computed tomography (CT) scan in non-small-cell lung cancer (NSCLC) for mediastinal staging.
MATERIAL and METHOD: Fifty patients with NSCLC were assessed by thoracic CT scan and 18-fluoro-2-deoxy-d-glucose PET-CT for mediastinal staging and were prospectively included in the study. All operable stages were included along with Stage IIIa and IIIb after downstaging with chemotherapy. CT scan was considered negative if lymph nodes were<1 cm at the smaller diameter. 18FDG PET-CT was considered negative when the high maximum standard uptake value (SUVmax) was < 2.5. Surgical staging was carried out in Group A (no induction chemotherapy, N=35) and Group B (with induction chemotherapy, N=15), and curative resection plus systematic mediastinal dissection was performed.
RESULTS: There were 3 of 35 (8.6%) false-negatives (FNs) in Group A and none in Group B. Multilevel pN2 was detected in one case, while in 2 cases there was only subcarinal involvement. One FP was detected in Group A (station 5) and 6 FPs in Group B (multilevel pN2). PET-CT for mediastinal staging showed 8.6% of FNs in Group A, representing the incidence of pN2 in thoracotomy, while 40% of FPs in Group B, representing the percentage of downstaged patients who normally would have been denied surgery.
CONCLUSION: A PET-CT should be considered a tool that is carefully evaluated by the multidisciplinary team of thoracic surgeons, pulmonologists and oncologists in order to individualize every patient and offer him the best treatment, especially in cases after induction chemotherapy.
- © 2014 ERS