Positron Emission Tomography-Computed Tomography Compared with Invasive Mediastinal Staging in Non-small Cell Lung Cancer: Results of Mediastinal Staging in the Early Lung Positron Emission Tomography Trial

Darling, Gail; Maziak, Donna E.; Inculet, Richard; Gulenchyn, Karen Y.; Driedger, Albert A.; Ung, Yee C.; Gu, Chu‐Shu; Kuruvilla, M. Sara; Cline, K.; Julian, Jim A.; Evans, William K.; Levine, Mark

doi:10.1097/jto.0b013e318220c912

Cited by 113 publications

(71 citation statements)

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“…Several previous studies have documented poor correlation between clinical and pathologic staging in patients with NSCLC. 20–22 In 2011, Darling and colleagues evaluated 149 patients undergoing both positron emission tomography / computed tomography (PET-CT) and invasive mediastinal staging (either mediastinoscopy, thoracotomy, or both) to evaluate the accuracy of the pre-operative staging workup. 22 Overall they found fairly poor correlation between the two methods (64% positive predictive value, 95% negative predictive value).…”

Section: Discussionmentioning

confidence: 99%

“…20–22 In 2011, Darling and colleagues evaluated 149 patients undergoing both positron emission tomography / computed tomography (PET-CT) and invasive mediastinal staging (either mediastinoscopy, thoracotomy, or both) to evaluate the accuracy of the pre-operative staging workup. 22 Overall they found fairly poor correlation between the two methods (64% positive predictive value, 95% negative predictive value). Of 13 patients with clinical N1 disease on PET-CT, 1 (8%) was found to be pathologic node negative and 4 (31%) were found to have N2 disease on final pathology.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of care in hilar node-positive (N1) non–small cell lung cancer: A missed treatment opportunity?

Bott

Patel

Verma

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Background For patients with non-small cell lung cancer (NSCLC) metastatic to hilar lymph nodes (N1), guidelines recommend surgery and adjuvant chemotherapy in operable patients and chemoradiation (CRT) for those deemed inoperable. However, it is unclear how these recommendations are applied nationally. Methods The National Cancer Database (NCDB) was queried to identify patients with tumors < 7cm (T1/T2) with clinically positive N1 nodes. Patients undergoing CRT (chemotherapy and radiation >45Gy) or surgical resection were considered adequately treated. Remaining patients were classified as receiving inadequate or no treatment. Results Of 20,366 patients that met study criteria, 63% underwent adequate treatment [48% surgical resection, 15% CRT]. The remainder received inadequate (23%) or no treatment (14%). In univariate analysis, patients undergoing inadequate or no treatment were older, non-Caucasian, had lower income, and a higher comorbidity score. Patients undergoing adequate treatment had improved overall survival (OS) compared with those receiving inadequate or no treatment (median OS=34.0 vs. 11.7 months, p<0.001). Of those receiving adequate treatment, logistic regression identified several variables associated with surgical resection including treatment at an academic facility, Caucasian race, and annual income >$35,000. Increasing age and T2 stage were associated with non-operative management. Following propensity score matching of 2,308 patient-pairs undergoing surgery or CRT, resection was associated with longer median OS (34.1 vs. 22.0 months, p<0.001). Conclusions Despite established guidelines, many patients with T1-2N1 NSCLC do not receive adequate treatment. Surgery is associated with prolonged survival in selected patients. Surgical input in the multidisciplinary evaluation of these patients should be mandatory.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patterns of care in hilar node-positive (N1) non–small cell lung cancer: A missed treatment opportunity?

Bott

Patel

Verma

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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“…In another study published in 2011 (Darling et al), researchers found that PET scans can wrongly diagnosed metastatic disease to the lymph nodes inasmuch as 35% of cases, again resulting in denial of potentially curative surgery 3 .…”

Section: Discussionmentioning

confidence: 99%

PET scan Misleads to Diagnosis but Leads to Correct Operative Approach

Badhe¹

2017

jmscr

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“…Darling et al [21] determined the accuracy of PET-CT in mediastinal staging compared with invasive mediastinal staging either by mediastinoscopy alone or by a mediastinoscopy combined with a thoracotomy. They reported the sensitivity of PET-CT as 70% [95% confidence interval (CI), 48-85%] and the specificity as 94% (95% CI, 88-97%).…”

Section: Discussionmentioning

confidence: 99%

A comparision of endobronchial ultrasound-guided transbronchial needle aspiration and integrated positron emission tomography-computed tomography in the diagnosis of malignant mediastinal/hilar lymph nodes

Cömert¹

2012

Turk Gogus Kalp Dama

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A comparision of endobronchial ultrasound-guided transbronchial needle aspiration and integrated positron emission tomography-computed tomography in the diagnosis of malignant mediastinal/hilar lymph nodes Bul gu lar:Toplam 131 hastada 191 lenf nodu istasyonundan aspirasyon yapıldı. Yüz kırk iki malign lenf nodundan 134'üne EBUS-TBİA ile malignite tanısı konulurken, 127'sinin PET-BT'de SUD max değerinin ≥3.0 olduğu görüldü. EBUS-TBİA ve PET-BT'nin malign mediastinal ve hiler lenf nodlarının tanısındaki duyarlılık, özgüllük, tanı değeri ve negatif ve pozitif öngördürücü değerleri sırasıyla %94.3, %100, %95.8, %85.9, %100 ve %89.4, %18.3, %71.2, %37.5, %76.0 idi. EBUS-TBİA ve PET-BT'nin birlikte kullanımı ile duyarlılık %100'e ulaştı.So nuç: EBUS-TBİA'nın duyarlılık, özgüllük, tanı doğruluğu ve negatif öngördürücü değeri ve pozitif öngördürücü değeri PET-BT'den daha yük-sektir. Klasik bilgilere göre PET-BT'nin yanlış pozitiflik oranının yüksek olması nedeni ile mediastinal evrelemede histolojik doğrulamasının yapıl-ması gerekmektedir. EBUS-TBİA, PET-BT pozitif mediastinal/hiler lenf nodlarının histolojik doğrulamasında etkin, güvenilir ve minimal invasiv bir yöntemdir.Anah tar söz cük ler: Endonronşiyal ultrasonografi; ince iğne aspirasyonu; akciğer kanseri; lenf nodu; pozitron emisyon tomografisi-bilgisayarlı tomografi; evreleme.Background:In this study, we aimed to identify the sensitivity, specificity and diagnostic accuracy of integrated positron emission tomographycomputed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of malignant mediastinal/hilar lymph nodes and to compare with each other. Methods:Records of 131 patients (96 males, 35 females; mean age 58.3±8.4 years; range 42 to 75 years) with known primary or suspected malignancy who had enlarged and hypermetabolic hilar/mediastinal lymph nodes detected by thoracic CT and at PET-CT and in whom EBUS-TBNA performed for cytologic confirmation of the malignancy between October 2008 and April 2011 were retrospectively analyzed. More invasive procedures including mediastinoscopy/video-assisted thoracoscopic surgery (VATS) were performed in patients who did not receive definite diagnosis using EBUS-TBNA. The maximum standardised uptake value (SUVmax) cut-off level of PET-CT was considered ≥3.0. The sensitivity, specificity, diagnostic accuracy, and negative and positive predictive values of PET-CT and EBUS-TBNA in diagnosis of malignant hilar/mediastinal lymph nodes were calculated. The results were compared with each other.Results:A total of 191 lymph node stations of 131 patients were aspirated from the LN stations. Of the 142 lymph nodes, 134 were diagnosed with malignancy using EBUS-TBNA, while SUV max value was ≥3.0 in 127 by PET-CT. The sensitivity, spesificity, diagnostic accuracy, and negative and positive predictive values of EBUS-TBNA and PET-CT were 94.3%, 100%, 95.8%, 85.9%, 100% and 89.4%, 18.3%, 71.2%, 37.5%, 76.0%, respectively. With combined use of EBUS-TBNA and PET-CT, the...

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Positron Emission Tomography-Computed Tomography Compared with Invasive Mediastinal Staging in Non-small Cell Lung Cancer: Results of Mediastinal Staging in the Early Lung Positron Emission Tomography Trial

Abstract: PET-CT assessment of the mediastinum is associated with a clinically relevant false-positive rate. Our study confirms the need for pathologic confirmation of mediastinal lymph node abnormalities detected by PET-CT.

Cited by 113 publications

References 20 publications

Patterns of care in hilar node-positive (N1) non–small cell lung cancer: A missed treatment opportunity?

Patterns of care in hilar node-positive (N1) non–small cell lung cancer: A missed treatment opportunity?

PET scan Misleads to Diagnosis but Leads to Correct Operative Approach

A comparision of endobronchial ultrasound-guided transbronchial needle aspiration and integrated positron emission tomography-computed tomography in the diagnosis of malignant mediastinal/hilar lymph nodes

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