Kyung Min Shin MD, Presenter: Nothing to Disclose

Kyung Soo Lee MD, Abstract Co-Author: Nothing to Disclose

Young Mog Shim MD, Abstract Co-Author: Nothing to Disclose

Byung-Tae Kim MD, Abstract Co-Author: Nothing to Disclose

Joon Young Choi MD, Abstract Co-Author: Nothing to Disclose

Hojoong Kim MD, Abstract Co-Author: Nothing to Disclose

O. Jung Kwon, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate diagnostic and prognostic implications of 18Flurorine fluorodeoxyglucose (18F-FDG) PET/CT in patients triage regarding N2 disease in stage T1 non-small cell lung cancer (NSCLC).

From September 2003 to July 2006, 186 patients (127 men and 59 women, mean age, 60 + 9.8 years) with stage T1 NSCLC at CT underwent integrated PET/CT and surgical staging (thoracotomy only in 163 and both mediastinoscopy and thoracotomy in 23). We subdivided patients into three groups according to PET/CT findings and pathology: true negative (TN), false negative (FN), and true positive (TP) groups. Median follow-up period was 18.5 + 9.2 months. Disease-free survival (DFS) and overall survival (OS) were determined using the Kaplan-Meier analysis, and the differences between the groups were compared with the log-rank test. All study factors were entered into a Cox proportional hazards model to provide multivariate hazard ratios. The model was adjusted for the effects of pathologic groups, patient age, cell type, tumor size and maximum standardized uptake value (SUV) of the tumor.

N2 disease was observed in 23 (12%) patients. PET/CT had diagnostic efficacy for N2 disease detection of sensitivity (48%, 11/23), specificity (97%, 158/163), accuracy (91%, 169/186), positive (69%, 11/16), and negative (93%, 158/170) predictive values. Median OS of FN group (26 months) was similar to that of TP group (27 months) (p=0.68), but both groups had significantly shorter median OS compared with TN group (37 months) (p < 0.001). Median DFS of FN group (23 months) was lower than that of TN group (34 months) (p <0.005), but there was no significant difference between FN and TP groups (14 months) (p=0.06). In this cohort, the patient age, cell type, tumor size or mSUV of tumors had no significant impact on OS.

PET/CT shows high specificity and negative predictive values but low sensitivity for detecting N2 disease in NSCLC. Sensitivity enhancing measures should be devised, because patients with false negative N2 disease at PET/CT have similarly reduced survival to true positive N2 patients compared with true negative patients.

High negative predictive value may allow omission of mediastinoscopy.

Shin, K, Lee, K, Shim, Y, Kim, B, Choi, J, Kim, H, Kwon, O, et al, , et al, , 18Flurorine Fluorodeoxyglucose PET/CT and Mediastinal Nodal Metastasis Detection in Stage T1 Non-Small Cell Lung Cancer: Diagnostic and Prognostic Implications.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5007341.html