ATS
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 Similar articles in PubMed
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):
Kemp H. Kernstine
Nicholas P. Rossi
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kernstine, K. H.
Right arrow Articles by Madsen, M. T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kernstine, K. H.
Right arrow Articles by Madsen, M. T.
Related Collections
Right arrow Lung - cancer

Ann Thorac Surg 2002;73:394-402
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

Can FDG-PET reduce the need for mediastinoscopy in potentially resectable nonsmall cell lung cancer?

Kemp H. Kernstine, MD, PhD*a, Kelley A. McLaughlin, RNa, Yusuf Menda, MDb, Nicholas P. Rossi, MDa,c, Daniel J. Kahn, MDb,c, David L. Bushnell, MDb,c, Michael M. Graham, MD, PhDb, Carl K. Brown, MSd, Mark T. Madsen, PhDb

a Division of Cardiothoracic Surgery, College of Public Health, University of Iowa, Iowa City, Iowa, USA
b Division of Nuclear Medicine, College of Public Health, University of Iowa, Iowa City, Iowa, USA
c Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
d Iowa City Veterans Administration Medical Center, Iowa City, Iowa, USA

* Address reprint requests to Dr Kernstine, Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Room 1616 JCP, Iowa City, IA, USA 52242-1038
e-mail: kemp-kernstine{at}uiowa.edu

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

Background. Few fluoro-deoxy-glucose (FDG)-positron emission tomography (PET) nonsmall cell lung cancer (NSCLC) trials have had sufficient patients to adequately evaluate PET for mediastinal staging. We question whether once PET is performed, is mediastinoscopy necessary?

Methods. We performed a 5-year retrospective analysis of operable patients with known or suspicious NSCLC. Standard PET techniques were used. Inclusion criteria were (1) surgical mediastinal nodal sampling by mediastinoscopy within 31 days of the PET and (2) definitive diagnosis.

Results. There were 237 patients who met the evaluation criteria; ninety-nine patients with NSCLC and 138 with suspicious lesions (137 men and 100 women; aged 20 to 88 years). The PETs were performed from 0 to 29 days before mediastinoscopy (median, 7 days). The standardized uptake value for the primary lesion was 0 to 24.6 (7.9 ± 5.0). Nine primary lesions had no FDG uptake (1 benign, 8 NSCLCs). Seventy-one patients (31%) had mediastinal PET positive disease, and 44 patients (19%) had histologic positive mediastinal disease; N2 41 patients (17%) and N3 9 patients (4%). In 6 patients (3%), the initial frozen sections were negative, but PET positivity encouraged further biopsies that were positive for cancer. The PET sensitivity was 82%, specificity 82%, accuracy 82%, negative predictive value 95%, and positive predictive value was 51%. All primary lesions with a standardized uptake value less than 2.5 and a negative mediastinal PET were negative histologically (n = 29). Logistic regression analysis resulted in 100% specificity for PET in this group.

Conclusions. In NSCLC PET may reduce the necessity for mediastinoscopy when the primary lesion standardized uptake value is less than 2.5 and the mediastinum is PET negative. Accepting this approach in our patient population, the need for mediastinoscopy would have been reduced by 12%.




This article has been cited by other articles:


Home page
 JNMHome page
D. Uesaka, Y. Demura, T. Ishizaki, S. Ameshima, I. Miyamori, M. Sasaki, Y. Fujibayashi, and H. Okazawa
Evaluation of Dual-Time-Point 18F-FDG PET for Staging in Patients with Lung Cancer
J. Nucl. Med., October 1, 2008; 49(10): 1606 - 1612.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. Radiol.Home page
N FUWA, T DAIMON, T MITSUDOMI, Y YATABE, T KODAIRA, H TACHIBANA, T NAKAMURA, T KATO, and Y SATO
Identifying patients with peripheral-type early non-small cell lung cancer (T1N0M0) for whom irradiation of the primary focus alone could lead to successful treatment
Br. J. Radiol., October 1, 2008; 81(970): 815 - 820.
[Abstract] [Full Text] [PDF]

Home page
 The OncologistHome page
R. Bordoni
Consensus Conference: Multimodality Management of Early- and Intermediate-Stage Non-Small Cell Lung Cancer
Oncologist, September 1, 2008; 13(9): 945 - 953.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
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]

Home page
 Ann. Thorac. Surg.Home page
B. D. Vincent, E. El-Bayoumi, B. Hoffman, P. Doelken, J. DeRosimo, C. Reed, and G. A. Silvestri
Real-Time Endobronchial Ultrasound-Guided Transbronchial Lymph Node Aspiration
Ann. Thorac. Surg., January 1, 2008; 85(1): 224 - 230.
[Abstract] [Full Text] [PDF]

Home page
 JNCI J Natl Cancer InstHome page
Y. C. Ung, D. E. Maziak, J. A. Vanderveen, C. A. Smith, K. Gulenchyn, C. Lacchetti, W. K. Evans, and Lung Cancer Disease Site Group of Cancer Care Onta
18Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis and Staging of Lung Cancer: A Systematic Review
J Natl Cancer Inst, December 5, 2007; 99(23): 1753 - 1767.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
G. A. Silvestri, M. K. Gould, M. L. Margolis, L. T. Tanoue, D. McCrory, E. Toloza, and F. Detterbeck
Noninvasive Staging of Non-small Cell Lung Cancer: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition)
Chest, September 1, 2007; 132(3_suppl): 178S - 201S.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
P. C. Lee, J. L. Port, R. J. Korst, Y. Liss, D. N. Meherally, and N. K. Altorki
Risk Factors for Occult Mediastinal Metastases in Clinical Stage I Non-Small Cell Lung Cancer
Ann. Thorac. Surg., July 1, 2007; 84(1): 177 - 181.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
V. Gregoire, K. Haustermans, X. Geets, S. Roels, and M. Lonneux
PET-Based Treatment Planning in Radiotherapy: A New Standard?
J. Nucl. Med., January 1, 2007; 48(1_suppl): 68S - 77S.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
C. Schimmer, K. Neukam, and O. Elert
Staging of non-small cell lung cancer: clinical value of positron emission tomography and mediastinoscopy
Interactive CardioVascular and Thoracic Surgery, August 1, 2006; 5(4): 418 - 423.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
D. Lardinois
New Horizons in Staging for Non-Small-Cell Lung Cancer
J. Clin. Oncol., April 20, 2006; 24(12): 1785 - 1787.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. L. Port, R. S. Andrade, M. A. Levin, R. J. Korst, P. C. Lee, D. E. Becker, and N. K. Altorki
Positron emission tomographic scanning in the diagnosis and staging of non-small cell lung cancer 2 cm in size or less
J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1611 - 1615.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. Tamura, M. Oda, Y. Tsunezuka, I. Matsumoto, K. Kawakami, Y. Ohta, and G. Watanabe
Chest CT and Serum Vascular Endothelial Growth Factor-C Level To Diagnose Lymph Node Metastasis in Patients With Primary Non-small Cell Lung Cancer
Chest, August 1, 2004; 126(2): 342 - 346.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
F. C. Detterbeck, S. Falen, M. P. Rivera, J. S. Halle, and M. A. Socinski
Seeking a Home for a PET, Part 2: Defining the Appropriate Place for Positron Emission Tomography Imaging in the Staging of Patients With Suspected Lung Cancer
Chest, June 1, 2004; 125(6): 2300 - 2308.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
I. Matsumoto, M. Oda, Y. Tsunezuka, M. Tamura, K. Kawakami, and G. Watanabe
Experimental study of extracorporeal lung resection in dogs: Ex situ sleeve resection and autotransplantation of the pulmonary lobe after extended pneumonectomy for central lung cancer
J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1343 - 1349.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Inoue, N. Sawabata, S.-i. Takeda, M. Ohta, Y. Ohno, and H. Maeda
Results of surgical intervention for p-stage IIIA (N2) non-small cell lung cancer: Acceptable prognosis predicted by complete resection in patients with single N2 disease with primary tumor in the upper lobe
J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1100 - 1106.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
D. G. Pfister, D. H. Johnson, C. G. Azzoli, W. Sause, T. J. Smith, S. Baker Jr, J. Olak, D. Stover, J. R. Strawn, A. T. Turrisi, et al.
American Society of Clinical Oncology Treatment of Unresectable Non-Small-Cell Lung Cancer Guideline: Update 2003
J. Clin. Oncol., January 15, 2004; 22(2): 330 - 353.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. L. Port, M. S. Kent, R. J. Korst, R. Keresztes, M. A. Levin, and N. K. Altorki
Positron emission tomography scanning poorly predicts response to preoperative chemotherapy in non-small cell lung cancer
Ann. Thorac. Surg., January 1, 2004; 77(1): 254 - 259.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
M. K. Gould, W. G. Kuschner, C. E. Rydzak, C. C. Maclean, A. N. Demas, H. Shigemitsu, J. K. Chan, and D. K. Owens
Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non-Small-Cell Lung Cancer: A Meta-Analysis
Ann Intern Med, December 2, 2003; 139(11): 879 - 892.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
K. H. Kernstine
Positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose: can it be used to accurately stage the mediastinum in non-small cell lung cancer as an alternative to mediastinoscopy?
J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1700 - 1703.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
G. V. Gonzalez-Stawinski, A. Lemaire, F. Merchant, E. O'Halloran, R. E. Coleman, D. H. Harpole, and T. A. D'Amico
A comparative analysis of positron emission tomography and mediastinoscopy in staging non-small cell lung cancer
J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1900 - 1904.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
C. E. Reed, D. H. Harpole, K. E. Posther, S. L. Woolson, R. J. Downey, B. F. Meyers, R. T. Heelan, H. A. MacApinlac, S.-H. Jung, G. A. Silvestri, et al.
Results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer
J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1943 - 1951.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
H. Vesselle, E. Turcotte, L. Wiens, and D. Haynor
Application of a Neural Network to Improve Nodal Staging Accuracy with 18F-FDG PET in Non-Small Cell Lung Cancer
J. Nucl. Med., December 1, 2003; 44(12): 1918 - 1926.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
D. Lardinois, W. Weder, T. F. Hany, E. M. Kamel, S. Korom, B. Seifert, G. K. von Schulthess, and H. C. Steinert
Staging of Non-Small-Cell Lung Cancer with Integrated Positron-Emission Tomography and Computed Tomography
N. Engl. J. Med., June 19, 2003; 348(25): 2500 - 2507.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
H. Kimura, N. Iwai, S. Ando, K. Kakizawa, N. Yamamoto, H. Hoshino, and T. Anayama
A prospective study of indications for mediastinoscopy in lung cancer with CT findings, tumor size, and tumor markers
Ann. Thorac. Surg., June 1, 2003; 75(6): 1734 - 1739.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
D. Lardinois, T. Brack, A. Gaspert, T. Spahr, D. Schneiter, H.C. Steinert, and W. Weder
Bronchoscopic radioisotope injection for sentinel lymph-node mapping in potentially resectable non-small-cell lung cancer
Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 824 - 827.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. Lardinois, A. Schallberger, D. Betticher, and H.-B. Ris
Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non-small cell lung cancer
Ann. Thorac. Surg., April 1, 2003; 75(4): 1102 - 1106.
[Abstract] [Full Text] [PDF]


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 © 2002 by The Society of Thoracic Surgeons.