Prospective Comparative Study of Integrated Positron Emission Tomography-Computed Tomography Scan Compared With Remediastinoscopy in the Assessment of Residual Mediastinal Lymph Node Disease After Induction Chemotherapy for Mediastinoscopy-Proven Stage IIIA-N2 Non–Small-Cell Lung Cancer: A Leuven Lung Cancer Group Study

• Published in: Journal of clinical oncology Vol. 24; no. 21; pp. 3333 - 3339
• Main Authors: GOLDSTRAW, Peter, DE LEYN, Paul, NACKAERTS, Kristiaan, VANSTEENKISTE, Johan, STROOBANTS, Sigrid, DE WEVER, Walter, LERUT, Toni, COOSEMANS, Willy, DECKER, Georges, NAFTEUX, Philippe, VAN RAEMDONCK, Dirk, MORTELMANS, Luc
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 20.07.2006; Lippincott Williams & Wilkins
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - secondary; Female; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Lymph Node Excision; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis - diagnostic imaging; Male; Mediastinoscopy; Medical sciences; Middle Aged; Neoplasm Staging - methods; Pneumology; Positron-Emission Tomography; Predictive Value of Tests; Prospective Studies; Remission Induction; Sensitivity and Specificity; Thoracotomy; Tomography, X-Ray Computed; Tumors; Tumors of the respiratory system and mediastinum; Radionuclide study; Lung disease; Scanner; Radiodiagnosis; Lymph node; Respiratory disease; Mediastinum; Lung cancer; Minimal residual disease; Malignant tumor; Mediastinoscopy; non-small cell lung carcinoma; Prospective; Chemotherapy; Clinical stage; Cancerology; Treatment; Bronchus disease; Medical imagery; Computerized axial tomography; Endoscopy; Positron emission tomography; Comparative study; Emission tomography
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2006.05.6341

Mediastinal restaging after induction therapy for non-small-cell lung cancer remains a difficult and controversial issue. The goal of this prospective study was to compare the performance of integrated positron emission tomography (PET)--computed tomography (CT) and remediastinoscopy in the evaluation of mediastinal lymph node metastasis after induction chemotherapy. Thirty consecutive stage IIIA-N2 non-small-cell lung cancer patients surgically treated at our institution were entered onto this prospective study. N2 disease was proven by cervical mediastinoscopy, at which a mean number of 3.8 lymph node levels were biopsied. After completion of induction chemotherapy, the mediastinum was reassessed by integrated PET-CT and remediastinoscopy. All patients underwent thoracotomy with attempted complete resection and systematic nodal dissection. PET-CT showed no evidence of nodal disease (N0) in 13 patients, Hilar nodal disease (N1) disease in three patients, and residual mediastinal disease (N2) in 14 patients. Remediastinoscopy was positive in only five patients. The preinduction involved lymph node level could be accurately re-evaluated in 18 patients. This was not the case in the other 12 because of extensive fibrosis and adhesions. In 17 patients, persistent N2 disease was found at thoracotomy. The sensitivity, specificity, and accuracy of PET-CT were 77%, 92%, and 83%, respectively. These parameters for remediastinoscopy were 29%, 100%, and 60%, respectively. Sensitivity (P < .0001) and accuracy (P = .012) were significantly better for PET-CT. After a thorough staging mediastinoscopy, postinduction remediastinoscopy had a disappointing sensitivity because of adhesions and fibrosis. Integrated PET-CT yielded a better result than that obtained in previous studies with side-by-side PET and CT images.