FDG PET/CT and Mediastinal Nodal Metastasis Detection in Stage T1 Non-Small Cell Lung Cancer: Prognostic Implications.
- Author:
Kyung Min SHIN
1
;
Kyung Soo LEE
;
Young Mog SHIM
;
Jhingook KIM
;
Byung Tae KIM
;
O Jung KWON
;
Keunchil PARK
Author Information
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords: Lung neoplasms; Lung neoplasms, CT; Lung neoplasms, PET; Lung neoplasms, staging
- MeSH: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung/mortality/*radiography/*radionuclide imaging; Disease-Free Survival; Female; Fluorodeoxyglucose F18/diagnostic use; Humans; Lung Neoplasms/mortality/*radiography/*radionuclide imaging; Lymphatic Metastasis; Male; Mediastinum; Middle Aged; *Positron-Emission Tomography; Prognosis; Radiopharmaceuticals/diagnostic use; Sensitivity and Specificity; Survival Rate; *Tomography, X-Ray Computed
- From:Korean Journal of Radiology 2008;9(6):481-489
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test. RESULTS: Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001). CONCLUSION: The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.
