HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Langen, A. J. Articles by Hoekstra, O. S. Search for Related Content PubMed PubMed Citation Articles by de Langen, A. J. Articles by Hoekstra, O. S. Related Collections Lung - cancer Mediastinum

Eur J Cardiothorac Surg 2006;29:26-29
© 2006 Elsevier Science NL

Review

The size of mediastinal lymph nodes and its relation with metastatic involvement: a meta-analysis

^a Department of Nuclear Medicine and PET Research, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
^b VU University Medical Center, Amsterdam, The Netherlands
^c Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
^d Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

Received 9 August 2005; received in revised form 26 September 2005; accepted 3 October 2005.

^_* Corresponding author. Tel.: +31 20 4444214; fax: +31 20 4443090. (Email: os.hoekstra{at}vumc.nl).

Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) seems to be superior to computed tomography (CT) in staging the mediastinum in patients with non-small-cell lung cancer (NSCLC). However, recent results suggest that FDG-PET performance characteristics are conditional for nodal size as shown by CT: FDG-PET is more sensitive but less specific with lymph node enlargement on CT. The association between size and the probability of malignancy needs to be known to predict the post-test probabilities after PET, and finally, stratify patients for mediastinoscopy or thoracotomy depending on the PET and CT results. Therefore, we performed a meta-analysis of available studies reporting on the prevalence of metastatic involvement for different size categories of enlarged lymph nodes in patients with NSCLC and were able to include 14 studies. The prevalence of metastatic involvement and conditional test performance of CT and FDG-PET were calculated for lymph nodes measuring 10–15 mm, 16–20 mm and >20 mm. We found a post-test probability for N2 disease of 5% for lymph nodes measuring 10–15 mm on CT in patients with a negative FDG-PET result, suggesting that these patients should be planned for thoracotomy because the yield of mediastinoscopy will be extremely low. For patients with lymph nodes measuring 16 mm on CT and a negative FDG-PET result a post-test probability for N2 disease of 21% was found, suggesting that these patients should be planned for mediastinoscopy prior to possible thoracotomy to prevent too many unnecessary thoracotomies in this subset.

Key Words: Carcinoma, non-small-cell lung • Fluorodeoxyglucose F18 • Tomography, X-ray computed • Lymphatic metastasis • Sensitivity and specificity

This article has been cited by other articles:

				C. Perigaud, B. Bridji, J. C. Roussel, C. Sagan, A. Mugniot, D. Duveau, O. Baron, and P. Despins Prospective preoperative mediastinal lymph node staging by integrated positron emission tomography-computerised tomography in patients with non-small-cell lung cancer Eur. J. Cardiothorac. Surg., October 1, 2009; 36(4): 731 - 736. [Abstract] [Full Text] [PDF]

				B. Hwangbo, S. K. Kim, H.-S. Lee, H. S. Lee, M. S. Kim, J. M. Lee, H.-Y. Kim, G.-K. Lee, B.-H. Nam, and J. I. Zo Application of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Following Integrated PET/CT in Mediastinal Staging of Potentially Operable Non-small Cell Lung Cancer Chest, May 1, 2009; 135(5): 1280 - 1287. [Abstract] [Full Text] [PDF]

				S. M Woolley and P. B. Rajesh The Use of PET and PET/CT Scanning in Lung Cancer Asian Cardiovasc Thorac Ann, October 1, 2008; 16(5): 353 - 354. [Full Text] [PDF]

				A. Watanabe, T. Mishina, S. Ohori, T. Koyanagi, S. Nakashima, T. Mawatari, Y. Kurimoto, and T. Higami Is video-assisted thoracoscopic surgery a feasible approach for clinical N0 and postoperatively pathological N2 non-small cell lung cancer? Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 812 - 818. [Abstract] [Full Text] [PDF]

				H. Melek, M. Z. Gunluoglu, A. Demir, H. Akin, A. Olcmen, and S. I. Dincer Role of positron emission tomography in mediastinal lymphatic staging of non-small cell lung cancer Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 294 - 299. [Abstract] [Full Text] [PDF]

				M. Muraoka Reply to Ismail Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 949 - 950. [Full Text] [PDF]

				M. E. Craanen, E. F.I. Comans, M. A. Paul, and E. F. Smit Endoscopic ultrasound guided fine-needle aspiration and 18FDG-positron emission tomography in the evaluation of patients with non-small cell lung cancer Interactive CardioVascular and Thoracic Surgery, August 1, 2007; 6(4): 433 - 436. [Abstract] [Full Text] [PDF]

				K G Tournoy, S Maddens, R Gosselin, G Van Maele, J P van Meerbeeck, and A Kelles Integrated FDG-PET/CT does not make invasive staging of the intrathoracic lymph nodes in non-small cell lung cancer redundant: a prospective study Thorax, August 1, 2007; 62(8): 696 - 701. [Abstract] [Full Text] [PDF]

				P. De Leyn, D. Lardinois, P. E. Van Schil, R. Rami-Porta, B. Passlick, M. Zielinski, D. A. Waller, T. Lerut, and W. Weder ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer Eur. J. Cardiothorac. Surg., July 1, 2007; 32(1): 1 - 8. [Abstract] [Full Text] [PDF]

				W A H Wallace, H M Monaghan, D M Salter, M A Gibbons, and K M Skwarski Endobronchial ultrasound-guided fine-needle aspiration and liquid-based thin-layer cytology J. Clin. Pathol., April 1, 2007; 60(4): 388 - 391. [Abstract] [Full Text] [PDF]