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Prospective preoperative mediastinal lymph node staging by integrated positron emission tomography–computerised tomography in patients with non-small-cell lung cancer

^a Department of Thoracic and Cardiovascular Surgery, CHU Nantes, l’institut du thorax, Nantes, France
^b Faculté de médecine, Université de Nantes, Nantes, France
^c Department of Nuclear Medicine, Rene Gauducheau Cancer Centre, Nantes Saint Herblain, France
^d Pathology Department, CHU Nantes, Nantes, France

Received 14 September 2008; received in revised form 29 April 2009; accepted 19 May 2009.

^_* Corresponding author. Address: Service de Chirurgie Thoracique et Cardiovasculaire, Hôpital G et R Laënnec, Boulevard J. Monod, 44093 Nantes cedex 01, France. Tel.: +33 2 40 16 51 33; fax: +33 2 40 16 54 02. (Email: christianperigaud{at}free.fr).

Objective: Mediastinal lymph node staging determines the treatment strategy for non-small-cell lung cancer. This study aims to evaluate prospectively the accuracy of preoperative integrated 18-fluoro-2-deoxy-D-glucose positron emission tomography–computerised tomography (¹⁸FDG PET-CT) for mediastinal lymph node staging. Methods: Preoperative integrated ¹⁸FDG PET-CT was used to analyse mediastinal lymph nodes in patients with non-small-cell lung cancer. Nodal stations were identified according to the American Thoracic Society mapping system. Lymph nodes with a standardised uptake value (SUVmax) >3 were considered to be positive. The mediastinal lymph nodes were harvested during lung resection and the results of integrated ¹⁸FDG PET-CT were compared to the mediastinal lymph node histology results. Results: A total of 51 patients were enrolled in this study. The mean interval between integrated ¹⁸FDG PET-CT and surgery was 31 ± 15.8 days (range: 2–78 days). The mean mediastinal lymph node harvested and station number per patient during surgery were 11.8 ± 5.6 (range: 2–27) and 3.8 ± 1 (range: 2–6), respectively. The incidence of N2 pathological disease was 19.6%. The integrated ¹⁸FDG PET-CT sensitivity and specificity were 40 ± 30% and 85 ± 11%, respectively. The positive and negative predictive values were 40 ± 30% and 85 ± 11%, respectively. False-positive results (six patients) were mainly due to inflammatory lymph nodes. False-negative results (six patients) were mainly due to infra-centimetrical, malignant lymph node invasion. Conclusion: The sensitivity of integrated ¹⁸FDG PET-CT for mediastinal lymph node staging in patients selected for surgery is low. When positive mediastinal lymph nodes are detected, invasive mediastinal staging must be performed. On the other hand, the specificity is high: patients with negative integrated ¹⁸FDG PET-CT can be operated upon without invasive mediastinal staging.

Key Words: Integrated PET-CT • Lung cancer • Mediastinal lymph node • Staging