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 Author home page(s): Rashid Aziz Vincent Young Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Al-Sarraf, N. Articles by Young, V. Search for Related Content PubMed PubMed Citation Articles by Al-Sarraf, N. Articles by Young, V. Related Collections Lung - cancer Lung - other Mediastinum

Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography

^a Department of Cardiothoracic Surgery, St. James's Hospital, Dublin 8, Ireland
^b Department of Nuclear Medicine, Blackrock Clinic, Dublin, Ireland

Received 28 June 2007; received in revised form 22 September 2007; accepted 27 September 2007.

^_* Corresponding author. Tel.: +353 1 4103389; fax: +353 1 4103700. (Email: trinityq8{at}hotmail.com).

Objective: We sought to assess the incidence, pattern and predictors of occult mediastinal lymph node involvement (N2) in non-small cell lung cancer patients with negative mediastinal uptake of 2-deoxy-2-[¹⁸F]-fluoro-D-glucose (¹⁸FDG) on integrated positron emission tomography-computerised tomography (PET-CT). Methods: All patients who underwent surgical resection in our unit over a 30-month period were reviewed (n = 215). All patients had preoperative PET-CT prior to lung resection as an adjunct to a dedicated chest CT. Diabetic patients, patients who received neoadjuvant chemotherapy and those with positive mediastinal nodes on PET-CT (N2/N3) were excluded from this study. The population of interest was 153 non-small cell cancer patients (NSCLC), all of which had no FDG uptake in the mediastinum. No preoperative mediastinoscopy was carried out in this group and all underwent curative intent surgical resection. The pathological results were retrospectively reviewed and correlated with CT and integrated PET-CT findings. Results: The incidence of occult N2 disease in NSCLC patients with negative mediastinal uptake of ¹⁸FDG on PET-CT was 16% (25 of 153). The highest incidence of occult N2 involvement was in American thoracic society (ATS) 7 (16 of 25 patients, 64%) followed by ATS 4 (seven patients of 25, 28%). In univariate analysis, the following were significant predictors of occult N2 disease: centrally located tumours (P = 0.049), right upper lobe tumours (P = 0.04), enlarged lymph nodes (>1 cm) on CT (P = 0.048) and PET positive uptake in N1 nodes (P = 0.006). In multivariate analysis, the following were independent predictors of occult N2 disease: centrally located tumours, right upper lobe tumours and PET positive uptake in N1 nodes (P < 0.05). Conclusions: In NSCLC patients who are clinically staged as N2/N3 negative in the mediastinum by integrated PET-CT, 16% will have occult N2 disease following resection. Patients with the following: centrally located tumours, right upper lobe tumours and positive N1 nodes on PET should have preoperative cervical mediastinoscopy to rule out N2 nodal involvement, especially in ATS stations 7 and 4 as the incidence of occult nodal metastasis in these nodes is high. This study has potential implications in decision-making and planning best treatment approach.

Key Words: Positron emission tomography • Lymph node staging • Cervical mediastinoscopy

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]

				A. Bille, E. Pelosi, A. Skanjeti, V. Arena, L. Errico, P. Borasio, M. Mancini, and F. Ardissone Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography Eur. J. Cardiothorac. Surg., September 1, 2009; 36(3): 440 - 445. [Abstract] [Full Text] [PDF]

				F. M. Carnochan and W. S. Walker Positron emission tomography may underestimate the extent of thoracic disease in lung cancer patients Eur. J. Cardiothorac. Surg., May 1, 2009; 35(5): 781 - 785. [Abstract] [Full Text] [PDF]

				N. Al-Sarraf, K. Gately, J. Lucey, R. Aziz, K. Doddakula, L. Wilson, E. McGovern, and V. Young Clinical implication and prognostic significance of standardised uptake value of primary non-small cell lung cancer on positron emission tomography: analysis of 176 cases Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 892 - 897. [Abstract] [Full Text] [PDF]