Integrated positron emission tomography and computed tomography in preoperative lymph node staging of non-small cell lung cancer.
- Author:
Na XU
1
;
Mengzhao WANG
2
;
Zhaohui ZHU
3
;
Yingqiang ZHANG
3
;
Yang JIAO
1
;
Weigang FANG
1
Author Information
- Publication Type:Journal Article
- MeSH: Adult; Aged; Carcinoma, Non-Small-Cell Lung; pathology; Female; Humans; Lung Neoplasms; pathology; Lymph Nodes; pathology; Lymphatic Metastasis; pathology; Male; Middle Aged; Multimodal Imaging; Neoplasm Staging; methods; Positron-Emission Tomography; Preoperative Period; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
- From: Chinese Medical Journal 2014;127(4):607-613
- CountryChina
- Language:English
-
Abstract:
BACKGROUNDIntegrated positron emission tomography and computed tomography (PET/CT) is increasingly used for the preoperative nodal staging of non-small cell lung cancer (NSCLC). The aim of this study was to evaluate the accuracy of PET/CT in comparison with CT in detection of nodal metastasis and preoperative nodal staging in patients with NSCLC, and to analyze the causes of the PET/CT false-negative and false-positive results.
METHODSConsecutive patients with pathologically proven NSCLC who underwent staging using PET/CT from July 2008 to February 2012 were evaluated retrospectively. Nodal staging was pathologically confirmed on tissue specimens obtained at thoracotomy. The accuracy of PET/CT and CT in the assessment of intrathoracic nodal involvement was determined using histological results as the reference standard. Logistic regression was used to define the causes of the false-negative and false-positive results.
RESULTSA total of 528 lymph node stations were evaluated in 101 patients. Lymph nodes were positive for malignancy in 43 out of 101 patients (42.6%), and 101 out of 528 nodal stations (19.2%). PET/CT was significantly more accurate for nodal staging than CT. The sensitivity, specificity, positive and negative predictive values, and accuracy of PET/CT for detecting nodal metastasis were 51.5%, 95.8%, 74.3%, 89.3%, and 87.3% and the corresponding data by CT were 45.5%, 87.1%, 45.5%, 87.1%, and 79.2%, respectively. PET/CT confers significantly higher specificity, positive predictive value, and accuracy than CT in detecting nodal metastasis. False-negative results by PET/CT are significantly associated with smaller lymph node size, whereas false-positive results are related to a combination of inflammatory disorders and larger lymph node size.
CONCLUSIONPET/CT confers significantly higher accuracy than CT in nodal staging, and is more specific and accurate than CT in detecting nodal metastasis but has a low sensitivity and high false-negative rate.