Test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumors

• Published in: Journal of clinical oncology Vol. 31; no. 15_suppl; p. 7544
• Main Authors: Pattenden, Holly, Beddow, Emma, Dusmet, Michael, Nicholson, Andrew G, Swetha, Iyer, Marchbank, Adrian, Greenwood, Amy, West, Douglas, Ariyaratnam, Priyadharshanan, Loubani, Mahmoud, Granato, Felice, Kirk, Alan, Lim, Eric Kian Saik
• Format: Journal Article
• Language: English
• Published: 20.05.2013
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2013.31.15_suppl.7544

Abstract only 7544 Background: PET-CT is a standard investigation to stage the mediastinum in non-small cell lung cancer when radical management is planned. The clinical utility of PET-CT in carcinoid tumours is uncertain as its test performance at identifying mediastinal lymph node disease in these tumours is as yet undefined with such tumours being rare and FDG avidity often variable or low. We sought to determine the test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours. Methods: We collated retrospective data from 5 institutions for a consecutive series of patients who underwent thoracic surgery for carcinoid tumours and had preoperative PET-CT staging prior to surgery (with lymph nodal dissection). PET-CT results were compared against the reference standard of pathologic results obtained from lymph node dissection, and test performance reported using sensitivity and specificity. Results: From November 1999 to May 2012, a total of 153 patients with a preoperative PET-CT scan from 5 institutions underwent surgery for a carcinoid tumour. The mean age of the patients was 60 (SD 16) and 67 were male (44%). The pathologic sub-type was typical carcinoid in 138 patients (90%) and atypical carcinoid in 15 patients (10%). The mean SUV uptake in the primary tumour was 4.9 (SD 5). Results from lymph node dissection were obtained in 125 patients and the sensitivity and specificity of PET-CT to identify mediastinal lymph node disease was 40% (95% CI 5-85%) and 93% (93-99%) respectively. Conclusions: In this largest cohort study to date, our results suggest that PET-CT has a poor sensitivity but good specificity for mediastinal lymph node metastases for pulmonary carcinoid tumours. Therefore lymph node metastases cannot accurately be ruled out in carcinoid tumours with a negative PET-CT. If treatment decisions are based on the N2 status, invasive mediastinal staging should be undertaken in carcinoid tumours.