Chest

Chest

Volume 108, Issue 6, December 1995, Pages 1617-1621
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Clinical Investigations: Imaging
Thoracic Nodal Staging With PET Imaging With 18FDG in Patients With Bronchogenic Carcinoma

https://doi.org/10.1378/chest.108.6.1617Get rights and content

Purpose

To assess the role of positron emission tomographic (PET) imaging with 18-fluoro-2-deoxyglucose (18FDG) in detecting thoracic lymph node metastases in patients with bronchogenic carcinoma.

Materials and methods

Over a 2-year period, any patient presenting to our institution with newly diagnosed bronchogenic carcinoma who was to have thoracic nodes sampled was considered eligible. All PET studies were performed prior to nodal sampling and areas of increased uptake were mapped according to the American Thoracic Society classification. Studies were correlated with CT and pathology. Sensitivity and specificity for predicting nodal metastases was calculated.

Results

Forty-two patients had 62 nodal stations (40 hilar/lobar, 22 mediastinal) sampled. The sensitivity and specificity for hilar/lobar lymph node station metastases using PET imaging was 73% and 76%, respectively. With CT, the sensitivity and specificity were 27% and 86%. The sensitivity and specificity using PET imaging for mediastinal node station metastases was 92% and 100%, respectively, while with CT the figures were 58% and 80%. The sensitivity and specificity for combined thoracic nodal station metastases using PET imaging was 83% and 82%, respectively, while with CT it was 43% and 85%. There was a strong statistical relationship between positive PET imaging and lymph node abnormalities.

Conclusions

18FDG-PET imaging is accurate in detecting thoracic lymph node metastases in patients with bronchogenic carcinoma. Normal results of PET studies virtually preclude the need for mediastinal nodal sampling prior to surgery, whereas abnormal results of studies most likely represent mediastinal metastases. Treatment can be based on the extent of disease suggested by PET imaging.

Section snippets

MATERIALS AND Methods

Any patient 21 years or older with untreated bronchogenic carcinoma presenting between March 1992 and August 1994 to the Pulmonary, Hematology-Oncology, or Thoracic Surgery Clinic who was to have lymph node sampling in the thorax was eligible. An attempt was made to include all patients meeting these criteria; however, due to scheduling limitations and changes in patient treatment options, not all eligible patients were enrolled. Informed consent, approved by our Institutional Review Board was

Results

Eighteen patients (43%) had adenocarcinoma, 10 patients (24%) had squamous cell carcinoma, 5 patients (12%) had large cell carcinoma, 5 patients (12%) had non-small cell carcinoma, 2 patients (5%) had bronchoalveolar cell carcinoma, 1 patient (2%) had undifferentiated carcinoma, and 1 patient (2%) had small cell carcinoma (Table 1).

Sixty-two nodal stations were sampled, 40 were hilar/lobar (Nl) and 22 were mediastinal (N2/N3). Eleven hilar/lobar nodal stations (27%) and 12 mediastinal nodal

Discussion

There were more than 161,000 new cases of bronchogenic carcinoma in the United States this past year, and lung cancer accounts for approximately 25% of all cancer deaths.1 The overall 5-year survival is only 14%2 with prognosis dependent on a number of factors, including histologic type, weight loss, performance status, and most notably stage at presentation.

In 1985, the American Joint Committee Task Force on lung cancer proposed a revised, unified staging system to classify patients with

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    Copyright © 1995 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.