Korean J Radiol.  2008 Dec;9(6):481-489. 10.3348/kjr.2008.9.6.481.

FDG PET/CT and Mediastinal Nodal Metastasis Detection in Stage T1 Non-Small Cell Lung Cancer: Prognostic Implications

• Shin KM
• Lee KS
• Shim YM
• Kim J
• Kim BT
• Kwon OJ
• Park K

• KMID: 1118868
• DOI: http://doi.org/10.3348/kjr.2008.9.6.481

Abstract

OBJECTIVE
We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test. RESULTS: Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001). CONCLUSION: The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.

Keyword

Lung neoplasms; Lung neoplasms, CT; Lung neoplasms, PET; Lung neoplasms, staging

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung/mortality/*radiography/*radionuclide imaging
Disease-Free Survival
Female
Fluorodeoxyglucose F18/diagnostic use
Humans
Lung Neoplasms/mortality/*radiography/*radionuclide imaging
Lymphatic Metastasis
Male
Mediastinum
Middle Aged
*Positron-Emission Tomography
Prognosis
Radiopharmaceuticals/diagnostic use
Sensitivity and Specificity
Survival Rate
*Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Flowchart illustrating study design and number of patients enrolled in this study from each group. P-TN = pathologically true negative, TN = true negative, FP = false positive, FN = false negative, TP = true positive, *Neither FDG uptake amount of primary tumor or PET/CT mediastinal nodal FDG uptake result was determinant for performing mediastinoscopy.

• 

  Fig. 2 False negative PET/CT interpretation for mediastinal nodal staging in 42-year-old woman with stage T1 adenocarcinoma of lung showing recurrent disease on follow-up examination. A, B. Transverse (A) and coronal (B) images of initial PET/CT show 20-mm-sized nodule (arrows) in right lower lobe (maximum SUV = 9.5). There was no identifiable mediastinal uptake, but thoracotomy disclosed malignant cells in right lower paratracheal (nodal station 4R) and subcarinal (station 7) nodes. C, D. 9-month follow-up transverse CT (C) and coronal PET (D) scans demonstrate 20-mm-sized right anterior diaphragmatic node (arrows) with high amount FDG uptake (maximum SUV = 7.0), which is suggestive of recurrent disease.

• 

  Fig. 3 True positive PET/CT interpretation for mediastinal nodal staging in 46-year-old man with stage T1 adenocarcinoma of lung showing metastatic disease on follow-up examination. A, B. Transverse images of initial PET/CT show 29-mm-sized nodule (arrow in A) with high amount of FDG uptake (maximum SUV = 10.4) in right lower lobe and right lower paratracheal lymph node (nodal station 4R, arrow in B) of high FDG uptake. Nodes contained malignant cells upon examination of mediastinoscopic biopsy. C, D. Initial (C) and follow-up (D) enhanced sagittal T1-weighted MR images over seven month follow-up period show newly developed metastatic nodule (arrow in D) in cerebellar vermis.

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  Fig. 4 Diagram illustrating comparison of overall survival of 184 patients belonging to pathologic true negative (TN), PET/CT false negative (FN), and true positive (TP) groups. Survival is significantly better in true negative group than false negative or true positive group.

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  Fig. 5 Diagram illustrating comparison of disease-free survival of 184 patients belonging to pathologic true negative (TN), PET/CT false negative (FN), and true positive (TP) groups. Disease-free survival is significantly greater in true negative group than false negative or true positive group.

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