Objectives: To compare the accuracy of integrated PET/CT for the preoperative assessment of intrathoracic nodal status between patients with adenocarcinoma (AD) and those with squamous cell carcinoma (SQ). Methods: Retrospective study of 353 consecutive patients with clinically resectable NSCLC who underwent surgical nodal staging after integrated PET/ CT had been obtained. Histological results were used as reference standard. Results: A total of 2286 nodal stations (1643 mediastinal, 333 hilar and 310 intrapulmonary) were assessed. Prevalence of N disease was 32.4% (79/244; N1=31; N2=47; N3=1) and 29.3% (32/109; N1=21; N2=11) in AD and SQ patients, respectively. PET/CT staged the disease correctly in 193/244 (79.1%) AD patients and 91/109 (83.5%) SQ patients. Understaging occurred in 37 (15.2%) and 4 (3.7%) patients, and overstaging in 14 (5.7%) and 14 (12.8%) patients, respectively. PET/CT had lower sensitivity [53.8% (43/80) vs. 87.5% (28/32); P=0.0005] and accuracy [79.1% (193/244) vs. 3.5% (91/109); P=0.2], and higher specificity [91.5% (105/164) vs. 81.8% (63/77); P=0.02] in AD patients than in SQ patients. In AD patients, median short-axis diameter of lymph node stations and median maximum standardized uptake value of primary tumors that yielded false-negative results on PET/CT were significantly lower compared with those that yielded true-positive results on PET/ CT (6.5 mm vs. 12.0 mm, P<0.001, and 7.5 vs. 11.2, P=0.002, respectively). In the detection of mediastinal nodal metastasis, PET/CT showed decreased sensitivity [38.8% (19/49) vs. 81.8% (9/11); P=0.01] and increased specificity [97.4% (190/195) vs. 91.8% (90/98); P=0.03] in AD patients in comparison with SQ patients. Accuracy did not differ between the two groups of patients [85.7% (209/244) vs. 90.8% (99/109), respectively; P=0.1]. Conclusions: In patients with clinically resectable NSCLC, diagnostic characteristics of integrated PET/CT remain suboptimal for the assessment of nodal status. Invasive procedures for confirmatory tissue diagnosis are needed for accurate preoperative nodal staging.
Non-small cell lung cancer (NSCLC) histologic types and accuracy of integrated positron emission tomography and computed tomography (PET/CT) for intrathoracic nodal staging.
BORASIO, Piero;ARDISSONE, Francesco
2011-01-01
Abstract
Objectives: To compare the accuracy of integrated PET/CT for the preoperative assessment of intrathoracic nodal status between patients with adenocarcinoma (AD) and those with squamous cell carcinoma (SQ). Methods: Retrospective study of 353 consecutive patients with clinically resectable NSCLC who underwent surgical nodal staging after integrated PET/ CT had been obtained. Histological results were used as reference standard. Results: A total of 2286 nodal stations (1643 mediastinal, 333 hilar and 310 intrapulmonary) were assessed. Prevalence of N disease was 32.4% (79/244; N1=31; N2=47; N3=1) and 29.3% (32/109; N1=21; N2=11) in AD and SQ patients, respectively. PET/CT staged the disease correctly in 193/244 (79.1%) AD patients and 91/109 (83.5%) SQ patients. Understaging occurred in 37 (15.2%) and 4 (3.7%) patients, and overstaging in 14 (5.7%) and 14 (12.8%) patients, respectively. PET/CT had lower sensitivity [53.8% (43/80) vs. 87.5% (28/32); P=0.0005] and accuracy [79.1% (193/244) vs. 3.5% (91/109); P=0.2], and higher specificity [91.5% (105/164) vs. 81.8% (63/77); P=0.02] in AD patients than in SQ patients. In AD patients, median short-axis diameter of lymph node stations and median maximum standardized uptake value of primary tumors that yielded false-negative results on PET/CT were significantly lower compared with those that yielded true-positive results on PET/ CT (6.5 mm vs. 12.0 mm, P<0.001, and 7.5 vs. 11.2, P=0.002, respectively). In the detection of mediastinal nodal metastasis, PET/CT showed decreased sensitivity [38.8% (19/49) vs. 81.8% (9/11); P=0.01] and increased specificity [97.4% (190/195) vs. 91.8% (90/98); P=0.03] in AD patients in comparison with SQ patients. Accuracy did not differ between the two groups of patients [85.7% (209/244) vs. 90.8% (99/109), respectively; P=0.1]. Conclusions: In patients with clinically resectable NSCLC, diagnostic characteristics of integrated PET/CT remain suboptimal for the assessment of nodal status. Invasive procedures for confirmatory tissue diagnosis are needed for accurate preoperative nodal staging.
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