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Ann Thorac Surg 2002;73:394-402
© 2002 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, College of Public Health, University of Iowa, Iowa City, Iowa, USA
b Division of Nuclear Medicine, College of Public Health, University of Iowa, Iowa City, Iowa, USA
c Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
d Iowa City Veterans Administration Medical Center, Iowa City, Iowa, USA
* Address reprint requests to Dr Kernstine, Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Room 1616 JCP, Iowa City, IA, USA 52242-1038
e-mail: kemp-kernstine{at}uiowa.edu
Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.
Background. Few fluoro-deoxy-glucose (FDG)-positron emission tomography (PET) nonsmall cell lung cancer (NSCLC) trials have had sufficient patients to adequately evaluate PET for mediastinal staging. We question whether once PET is performed, is mediastinoscopy necessary?
Methods. We performed a 5-year retrospective analysis of operable patients with known or suspicious NSCLC. Standard PET techniques were used. Inclusion criteria were (1) surgical mediastinal nodal sampling by mediastinoscopy within 31 days of the PET and (2) definitive diagnosis.
Results. There were 237 patients who met the evaluation criteria; ninety-nine patients with NSCLC and 138 with suspicious lesions (137 men and 100 women; aged 20 to 88 years). The PETs were performed from 0 to 29 days before mediastinoscopy (median, 7 days). The standardized uptake value for the primary lesion was 0 to 24.6 (7.9 ± 5.0). Nine primary lesions had no FDG uptake (1 benign, 8 NSCLCs). Seventy-one patients (31%) had mediastinal PET positive disease, and 44 patients (19%) had histologic positive mediastinal disease; N2 41 patients (17%) and N3 9 patients (4%). In 6 patients (3%), the initial frozen sections were negative, but PET positivity encouraged further biopsies that were positive for cancer. The PET sensitivity was 82%, specificity 82%, accuracy 82%, negative predictive value 95%, and positive predictive value was 51%. All primary lesions with a standardized uptake value less than 2.5 and a negative mediastinal PET were negative histologically (n = 29). Logistic regression analysis resulted in 100% specificity for PET in this group.
Conclusions. In NSCLC PET may reduce the necessity for mediastinoscopy when the primary lesion standardized uptake value is less than 2.5 and the mediastinum is PET negative. Accepting this approach in our patient population, the need for mediastinoscopy would have been reduced by 12%.
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