JTCS St. Jude Medical
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
David Follette
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lee, B. E.
Right arrow Articles by Follette, D.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Lee, B. E.
Right arrow Articles by Follette, D.
Related Collections
Right arrow Lung - cancer
Right arrow Mediastinum

J Thorac Cardiovasc Surg 2008;135:615-619
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Mediastinoscopy might not be necessary in patients with non–small cell lung cancer with mediastinal lymph nodes having a maximum standardized uptake value of less than 5.3

Benjamin Enoch Lee, MDa, Jonathon Redwine, MDa, Cameron Foster, MDb, Elma Abella, MDc, Teri Lown, RN, OCNd, Derick Lau, MD, PhDe, David Follette, MDa,*

a Division of Cardiothoracic Surgery, University of California at Davis, Sacramento, Calif
b Department of Radiology, Division of Nuclear Medicine, University of California at Davis, Sacramento, Calif
e Department of Internal Medicine, Division of Oncology, University of California at Davis, Sacramento, Calif
d University of California at Davis, Cancer Center, Sacramento, Calif
c Northern California PET Imaging Center, Sacramento, Calif

Received for publication June 26, 2007; revisions received August 27, 2007; accepted for publication September 14, 2007.

* Address for reprints: David Follette, MD, Division of Cardiothoracic Surgery, University of California at Davis, UC Davis Cancer Center, 4501 X Street, Sacramento, CA 95817 (Email: david.follette{at}ucdmc.ucdavis.edu).

Objective: Accurate pretreatment staging in non–small cell lung cancer remains tantamount in formulating an appropriate treatment plan. The maximum standardized uptake value obtained with integrated fluorodeoxyglucose–positron emission tomography/computed tomography has been proposed to be a predictor of malignancy in mediastinal lymph nodes. A recent study has also suggested that accuracy of integrated fluorodeoxyglucose–positron emission tomography/computed tomography might be improved by increasing the maximum standardized uptake value used for calling a lymph node positive from 2.5 to 5.3. We tested the hypotheses that the maximum standardized uptake value is a predictor of individual lymph node metastasis in non–small cell lung cancer and that pathologic staging with mediastinoscopy might not be necessary in patients with a maximum standardized uptake value of less than 5.3 in their mediastinal lymph nodes.

Methods: This is a retrospective review of 765 lymph nodes sampled from 110 patients in a single institution with biopsy-proved non–small cell lung cancer. All patients underwent integrated fluorodeoxyglucose–positron emission tomography/computed tomography before biopsy or resection of their mediastinal lymph nodes. Surgical staging was the reference standard. All N2 lymph nodes were individually assessed according to station. Data were analyzed by using the Pearson {chi}2 test.

Results: Twenty-one (19%) of 110 patients had N2 disease, and a total of 765 N2 lymph nodes were pathologically examined. The mean and median maximum standardized uptake values for N2 nodes with metastatic disease were 9.2 (95% confidence interval, 7.0–11.4) and 7.2 (range, 2.2–25.8), respectively. For benign N2 nodes, the mean and median maximum standardized uptake values were 1.5 (95% confidence interval, 1.4–1.6) and 1.0 (range, 1.0–9.6), respectively (P < .05). When integrated fluorodeoxyglucose–positron emission tomographic/computed tomographic scans were reinterpreted by using a maximum standardized uptake value of 5.3 as a cutoff for malignancy, sensitivity decreased from 93% to 81% (P = .15), specificity increased from 86% to 98% (P < .01), positive predictive value increased from 22% to 64% (P < .01), negative predictive value was unchanged at 99%, and overall accuracy of integrated positron emission tomography/computed tomography increased from 87% to 97% (P < .01).

Conclusions: The maximum standardized uptake value is a predictor of individual lymph node metastasis in non–small cell lung cancer. Accuracy of integrated positron emission tomography/computed tomography is significantly improved by using a maximum standardized uptake value of 5.3 to assign malignancy, thereby dramatically decreasing the number of false-positive results. More importantly, these results suggest that some patients with non–small cell lung cancer with a maximum standardized uptake value less than 5.3 in their N2 lymph nodes might be able to forego mediastinoscopy and proceed directly to thoracotomy. This represents a significant change in the current management of standardized uptake value–positive mediastinal lymph nodes in non–small cell lung cancer.

Abbreviations and Acronyms CT = computed tomography; FDG = fluorodeoxyglucose; FNA = fine-needle aspiration; maxSUV = maximum standardized uptake value; NSCLC = non–small cell lung cancer; PET = positron emission tomography






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The American Association for Thoracic Surgery.