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Issa M, Abadin ZU. A Nearly Missed Pancoast Tumour From Isolated Persistent Leg Pain. Cureus 2021; 13:e15328. [PMID: 34221774 PMCID: PMC8240066 DOI: 10.7759/cureus.15328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/05/2022] Open
Abstract
Pancoast tumours (PTs) are apical tumours of the lung that manifest with a variety of symptoms. Herein, we describe a rare case of a 56-year-old female with a one-month history of persistent left leg pain despite advanced imaging, such as magnetic resonance imaging (MRI), and orthopaedic input, which was focused onto her left knee being the prime cause of her pain. Her non-resolving symptoms prompted her to attend the Emergency Department. A careful clinical examination pointed towards the left proximal tibia being the most probable cause. Basic radiographic imaging (x-ray) of the left tibia revealed a lytic lesion which was later confirmed to be metastatic disease arising from a Pancoast tumour (PT) following further advanced imaging and diagnostics. This case highlights a unique presentation of a Pancoast tumour that, to our knowledge, has never been reported before in the medical literature. A high index of suspicion, careful examination, and investigation were essential to reach this diagnosis.
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Affiliation(s)
- Moussa Issa
- Emergency Medicine Department, Midland Regional Hospital at Tullamore, Tullamore, IRL
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Bendzsak A, Waddell TK, Yasufuku K, Keshavjee S, de Perrot M, Cypel M, Pierre AF, Darling GE. Invasive Mediastinal Staging Guideline Concordance. Ann Thorac Surg 2017; 103:1736-1741. [DOI: 10.1016/j.athoracsur.2016.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/24/2016] [Accepted: 12/02/2016] [Indexed: 12/12/2022]
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van der Stok EP, Spaander MCW, Grünhagen DJ, Verhoef C, Kuipers EJ. Surveillance after curative treatment for colorectal cancer. Nat Rev Clin Oncol 2016; 14:297-315. [DOI: 10.1038/nrclinonc.2016.199] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Yang Y, Han G, Xu W. The diagnostic value of 99Tc M-2-(2-methyl-5-nitro-1 H-imidazol-1-yl) ethyl dihydrogen phosphate hypoxia imaging and its evaluation performance for radiotherapy efficacy in non-small-cell lung cancer. Onco Targets Ther 2016; 9:6499-6509. [PMID: 27799797 PMCID: PMC5085314 DOI: 10.2147/ott.s109163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and aim This study was designated to assess the diagnostic value of 99TcM-2-(2-methyl-5-nitro-1H-imidazol-1-yl) ethyl dihydrogen phosphate (99TcM-MNLS) hypoxia imaging and its evaluation performance for radiotherapy efficacy in patients with non-small-cell lung cancer (NSCLC). Patients and methods A total of 61 patients with NSCLC were selected for this study. All patients were injected with 99TcM-MNLS within 1 week prior to radiotherapy and they were injected with 99TcM-MNLS again 3 months after radiotherapy. Qualitative analysis along with semiquantitative analysis results were obtained from hypoxia imaging. Meanwhile, the effect of radiotherapy on patients with NSCLC was evaluated based on the solid tumor curative effect evaluation standard. Finally, SPSS 19.0 statistical software was implemented for statistical analysis. Results There was no significant difference in age or sex between the NSCLC patient group and benign patient group (P>0.05). 99TcM-MNLS was selectively concentrated in tumor tissues with a clear imaging in 24 hours. Results from both qualitative analysis and semiquantitative analysis indicated that the sensitivity and specificity of 99TcM-MNLS hypoxia imaging in diagnosing NSCLC were 93.8% and 84.6% and 72.9% and 100%, respectively. Moreover, the receiver operating characteristic curve provided evidence that 99TcM-MNLS hypoxia imaging was a powerful diagnostic tool in distinguishing malignant lung cancer from benign lesions. As suggested by 24-hour imaging, the tumor-to-normal ratio of patients in the 99TcM-MNLS high-intake group and low-intake group had a decline of 24.7% and 14.4% after radiotherapy, respectively. The decline in the tumor-to-normal ratio between the two dosage groups was significantly different (P<0.05). Conclusion 99TcM-MNLS hypoxia imaging had reliable values in both diagnosing NSCLC and evaluating therapeutic effects of radiotherapy on patients with NSCLC.
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Affiliation(s)
- Yongkun Yang
- Department of Oncology, Taizhou People's Hospital, Taizhou, Jiangsu, People's Republic of China
| | - Gaohua Han
- Department of Oncology, Taizhou People's Hospital, Taizhou, Jiangsu, People's Republic of China
| | - Wansong Xu
- Department of Oncology, Taizhou People's Hospital, Taizhou, Jiangsu, People's Republic of China
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Vielva LR, Jaen MW, Alcácer JAM, Cardona MC. State of the art in surgery for early stage NSCLC-does the number of resected lymph nodes matter? Transl Lung Cancer Res 2015; 3:95-9. [PMID: 25806287 DOI: 10.3978/j.issn.2218-6751.2014.02.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/16/2014] [Indexed: 01/22/2023]
Abstract
Surgery is the treatment of choice in patients with early stage NSCLC. However, the results remain poor in these patients. Lymph node involvement is the main prognostic factor in patients with NSCLC, but there is still no clear definition of the number of nodes required to consider a lymphadenectomy as complete. Although there is no defined minimum number of lymph nodes required for a complete lymphadenectomy, there are some recommendations to perform this procedure, published by different scientific societies. Current practice in thoracic surgery regarding lymphadenectomy, differs on some points from the guidelines recommendations, with data regarding patients with no mediastinal assessment between 30-45% according to some of the published data. Different studies have probed the fact that the probability of finding a positive node increases with the number of lymph nodes analyzed. Therefore, a complete lymphadenectomy provides proper staging, which helps to identify the patient's real prognosis. Several nonrandomized studies and retrospective series have shown that survival increases in the group of patients with a higher number of lymph nodes removed. There is no contraindication to performing a complete lymphadenectomy. The increase in survival in patients with a complete lymphadenectomy may be due to more accurate staging. Therefore, complete lymphadenectomy should be mandatory even in early stage patients.
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Affiliation(s)
- Laura Romero Vielva
- 1 Thoracic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain ; 2 Instituto Oncológico, Dr. Rosell Quirón Dexeus University Hospital, Barcelona, Spain
| | - Manuel Wong Jaen
- 1 Thoracic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain ; 2 Instituto Oncológico, Dr. Rosell Quirón Dexeus University Hospital, Barcelona, Spain
| | - José A Maestre Alcácer
- 1 Thoracic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain ; 2 Instituto Oncológico, Dr. Rosell Quirón Dexeus University Hospital, Barcelona, Spain
| | - Mecedes Canela Cardona
- 1 Thoracic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain ; 2 Instituto Oncológico, Dr. Rosell Quirón Dexeus University Hospital, Barcelona, Spain
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Kim HS, Lee KS, Ohno Y, van Beek EJ, Biederer J. PET/CT versus MRI for diagnosis, staging, and follow-up of lung cancer. J Magn Reson Imaging 2014; 42:247-60. [DOI: 10.1002/jmri.24776] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/27/2014] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hyun Su Kim
- Department of Radiology and Center for Imaging Science; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science; Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
| | - Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research; Department of Radiology; and Advanced Biomedical Imaging Research Centre, Kobe University Graduate School of Medicine; Kobe Japan
| | | | - Juergen Biederer
- Radiologie Darmstadt; Gross-Gerau County Hospital; Gross-Gerau Germany
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Systematic mediastinal lymphadenectomy or mediastinal lymph node sampling in patients with pathological stage I NSCLC: a meta-analysis. World J Surg 2014; 39:410-6. [PMID: 25277979 DOI: 10.1007/s00268-014-2804-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate the evidence comparing systematic mediastinal lymphadenectomy (SML) and mediastinal lymph node sampling (MLS) in the treatment of pathological stage I NSCLC using meta-analytical techniques. METHODS A literature search was undertaken until January 2014 to identify the comparative studies evaluating 1-, 3-, and 5-year survival rates. The pooled odds ratios (OR) and the 95 % confidence intervals (95 % CI) were calculated with either the fixed or random effect models. RESULTS One RCT study and four retrospective studies were included in our meta-analysis. These studies included a total of 711 patients: 317 treated with SML, and 394 treated with MLS. The SML and the MLS did not demonstrate a significant difference in the 1-year survival rate. There were significant statistical differences between the 3-year (P = 0.03) and 5-year survival rates (P = 0.004), which favored SML. CONCLUSIONS This meta-analysis suggests that in pathological stage I NSCLC, the MLS can get the similar outcome to the SML in terms of 1-year survival rate. However, the SML is superior to MLS in terms of 3- and 5-year survival rates.
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The role of 18F-FDG PET/CT for evaluation of metastatic mediastinal lymph nodes in patients with lung squamous-cell carcinoma or adenocarcinoma. Lung Cancer 2014; 85:53-8. [DOI: 10.1016/j.lungcan.2014.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/26/2014] [Accepted: 04/08/2014] [Indexed: 11/20/2022]
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Taus Á, Aguiló R, Curull V, Suárez-Piñera M, Rodríguez-Fuster A, Rodríguez de Dios N, Pijuan L, Zuccarino F, Vollmer I, Sánchez-Font A, Belda-Sanchis J, Arriola E. Impact of 18F-FDG PET/CT in the treatment of patients with non-small cell lung cancer. Arch Bronconeumol 2013; 50:99-104. [PMID: 24360985 DOI: 10.1016/j.arbres.2013.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/05/2013] [Accepted: 09/19/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Disease stage is the most important prognostic factor in lung cancer, and optimal staging is important to determine the best therapeutic option. FDG-PET/CT has demonstrated its value in early stage non-small cell lung cancer (NSCLC) but there is still insufficient data to define its role in other stages. HYPOTHESIS Information provided by FDG-PET/CT has an impact on the therapeutic management of patients with NSCLC. METHODS A retrospective review was made of patients who underwent FDG-PET/CT between January 2008 and December 2010 for the diagnosis of NSCLC. Clinical stage before and after FDG-PET/CT and information about any change in therapeutic decision due to information provided by FDG-PET/CT were collected. Using pathologic evaluation as the gold standard, sensitivity, specificity, and positive and negative predictive values for CT and FDG-PET/CT were calculated. RESULTS Of the 522 patients diagnosed of NSCLC, FDG-PET/CT was performed in 246 (47.1%). In 85 cases (34.6%) FDG-PET/CT led to stage migration. Treatment was modified in 60 patients (24.4% of all FDG-PET/CT performed), avoiding a futile thoracotomy in 13 cases (5.2%), and allowing treatment with curative intent in 26 (10.5%). Out of 90 patients (36.5%) evaluated as stage iii by CT staging, FDG-PET/CT modified the therapeutic approach in 36 (40%). For the 133 cases (54%) with pathological assessment of the mediastinal lymph nodes, sensitivity, specificity, positive predictive value and negative predictive value were 0.57, 0.64, 0.48 and 0.72 for CT, and 0.68, 0.86, 0.75 and 0.81 for FDG-PET/CT. DISCUSSION Our data support previous reports that FDG-PET/CT is essential in the staging process not only for patients with potentially operable NSCLC but also for stage iii patients, as demonstrated by our data.
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Affiliation(s)
- Álvaro Taus
- Departamento de Oncología Médica, Hospital del Mar-Parc de Salut Mar, Barcelona, España.
| | - Rafael Aguiló
- Departamento de Cirugía Torácica, Hospital del Mar-Parc de Salut Mar, Barcelona, España
| | - Víctor Curull
- Departamento de Neumología, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias, Barcelona, España
| | - Marina Suárez-Piñera
- Departamento de Medicina Nuclear, Hospital del Mar-Parc de Salut Mar, Barcelona, España
| | | | | | - Lara Pijuan
- Departamento de Anatomía Patológica, Hospital de la Esperança-Parc de Salut Mar, Barcelona, España
| | - Flavio Zuccarino
- Departamento de Radiología, Hospital del Mar-Parc de Salut Mar, Barcelona, España
| | - Iván Vollmer
- Departamento de Radiología, Hospital del Mar-Parc de Salut Mar, Barcelona, España
| | - Albert Sánchez-Font
- Departamento de Neumología, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias, Barcelona, España
| | - José Belda-Sanchis
- Departamento de Cirugía Torácica, Hospital del Mar-Parc de Salut Mar, Barcelona, España
| | - Edurne Arriola
- Departamento de Oncología Médica, Hospital del Mar-Parc de Salut Mar, Barcelona, España
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Wang L, Yin X, Wang F, Gu J, Lu L, Wu Q, Shen B, Li XF. The usefulness of combined diagnostic CT and (99m)Tc-octreotide somatostatin receptor SPECT/CT imaging on pulmonary nodule characterization in patients. Cancer Biother Radiopharm 2013; 28:731-6. [PMID: 24094076 DOI: 10.1089/cbr.2013.1482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED The objective of this study was to evaluate the clinical value of combination of diagnostic computed tomography (CT) and somatostatin receptor imaging with (99m)Tc-octreotide acetate SPECT/CT in differentiation of benign pulmonary nodules from cancers. METHODS This was a retrospective study, 29 patients with suspected pulmonary neoplasm underwent diagnostic CT and (99m)Tc-octreotide SPECT/CT scans, and the tumor-to-normal tissue tracer value (T/N) for (99m)Tc-octreotide was measured. Diagnosis was confirmed by histological analysis. RESULTS Eighteen of the 29 patients included in this study had lung cancer: 2 with small cell lung cancer and 16 with nonsmall cell lung cancer. The other 11 patients had benign lung lesions: 5 with tuberculosis, 4 with nontuberculosis infection, 1 with hematoma, and 1 with fibroma. (99m)Tc-octreotide uptake (expressed as mean T/N±SD) was significantly higher in lung cancers (2.58±0.91) than benign lesions (1.38±0.79) (p=0.002). Specificity for pulmonary malignant nodule diagnosis was 63.6% for diagnostic CT, 72.7% for somatostatin receptor SPECT/CT imaging, and 81.8% for the combined use of diagnostic CT and somatostatin receptor SPECT/CT imaging. CONCLUSION Somatostatin receptor imaging with (99m)Tc-octreotide SPECT/CT is useful for the differentiation of benign pulmonary nodules from lung cancers, the combination of diagnostic CT and (99m)Tc-octreotide SPECT/CT further increases the specificity of malignant pulmonary nodule detection.
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Affiliation(s)
- Liwei Wang
- 1 Department of Radiology, Nanjing Hospital, Nanjing Medical University , Nanjing, Jiangsu, China
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Ronan L, D'Souza S. Pancoast's tumour presenting as shoulder pain in an orthopaedic clinic. BMJ Case Rep 2013; 2013:bcr-2012-008131. [PMID: 23389720 DOI: 10.1136/bcr-2012-008131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 71-year-old lady was referred by her general practitioner to an orthopaedic clinic for management of shoulder pain. The patient complained of pain in the shoulder and chest region but also described reduced sensation and power in her arm and a worsening of her respiratory symptoms. These prompted further investigation with an isotope bone scan which showed a large soft tissue mass posteriorly in the apex of the right lung with chest wall extension and destruction of adjacent ribs. A subsequent CT scan identified Pancoast's tumour. This case highlights the importance of considering non-musculoskeletal causes of shoulder region pain.
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Affiliation(s)
- Lynne Ronan
- Department of Orthopaedics, Royal Bolton Foundation Trust, Bolton, UK.
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Boyero L, Sánchez-Palencia A, Miranda-León MT, Hernández-Escobar F, Gómez-Capilla JA, Fárez-Vidal ME. Survival, classifications, and desmosomal plaque genes in non-small cell lung cancer. Int J Med Sci 2013; 10:1166-73. [PMID: 23869193 PMCID: PMC3714393 DOI: 10.7150/ijms.5747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/15/2013] [Indexed: 11/05/2022] Open
Abstract
Novel biomarkers are required to improve prognostic predictions obtained with lung cancer staging systems. This study of 62 surgically-treated Non-Small Cell Lung Cancer (NSCLC) patients had two objectives: i) to compare the predictive value of T-stage classifications between the 6(th) and 7(th) editions of the Tumor, Node, and Metastasis staging system (TNM); and ii) to examine the association of Pkp1 and/or Krt15 gene expression with survival and outcomes. Multivariate and Kaplan-Meier survival analyses were performed, examining the relationship of survival with T-stage, recurrence, and TNM-stage (by each TNM edition) and with the single/combined expression of Pkp1 and/or Krt15 genes. Five-year survival rates only significantly differed as a function of T-stage in patients without recurrence when estimated using the 6(th) edition of the TNM classification and only in patients in pathologic TNM-stage IA using the 7(th). Overall survival for patients with elevated expression of both genes was 13.5 months in those with adenocarcinoma and 34.6 months in those with squamous cell carcinoma. Overall survival was 30.4 months in patients with Pkp1 gene upregulation and 30.9 months in those with Krt15 gene upregulation. In conclusion, survival estimations as a function of T-staging differed between the 6(th) and 7(th) editions of TNM. Overall survival differed according to the expression of Pkp1 and/or Krt15 genes, although this relationship did not reach statistical significance.
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Affiliation(s)
- Laura Boyero
- Department of Biochemistry and Molecular Biology, University of Granada School of Medicine, Granada, Spain
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El-Hariri MA, Gouhar GK, Refat AM. Integrated PET/CT in the preoperative staging of lung cancer: A prospective comparison of CT, PET and integrated PET/CT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2012.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Quantitative modifications of TNM staging, clinical staging and therapeutic intent by FDG-PET/CT in patients with non small cell lung cancer scheduled for radiotherapy — A retrospective study. Lung Cancer 2012; 78:148-52. [DOI: 10.1016/j.lungcan.2012.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 06/19/2012] [Accepted: 08/02/2012] [Indexed: 12/25/2022]
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Ohno Y, Koyama H, Yoshikawa T, Nishio M, Aoyama N, Onishi Y, Takenaka D, Matsumoto S, Maniwa Y, Nishio W, Nishimura Y, Itoh T, Sugimura K. N Stage Disease in Patients with Non–Small Cell Lung Cancer: Efficacy of Quantitative and Qualitative Assessment with STIR Turbo Spin-Echo Imaging, Diffusion-weighted MR Imaging, and Fluorodeoxyglucose PET/CT. Radiology 2011; 261:605-15. [DOI: 10.1148/radiol.11110281] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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New technique performed by using EUS access for biopsy of para-aortic (station 6) mediastinal lymph nodes without traversing the aorta (with video). Gastrointest Endosc 2011; 73:1048-51. [PMID: 21429489 DOI: 10.1016/j.gie.2011.01.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 01/10/2011] [Indexed: 12/11/2022]
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease. Anesth Analg 2010; 111:279-315. [DOI: 10.1213/ane.0b013e3181dd869b] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J Am Coll Cardiol 2010; 55:e27-e129. [PMID: 20359588 DOI: 10.1016/j.jacc.2010.02.015] [Citation(s) in RCA: 998] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary. J Am Coll Cardiol 2010. [DOI: 10.1016/j.jacc.2010.02.010] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Freudenberg LS, Rosenbaum SJ, Beyer T, Bockisch A, Antoch G. PET Versus PET/CT Dual-Modality Imaging in Evaluation of Lung Cancer. Thorac Surg Clin 2010; 20:25-30. [DOI: 10.1016/j.thorsurg.2009.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM, Jacobs AK, Smith SC, Anderson JL, Adams CD, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Stevenson WG, Tarkington LG, Yancy CW. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary. Catheter Cardiovasc Interv 2010; 76:E43-86. [DOI: 10.1002/ccd.22537] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Prévost A, Papathanassiou D, Jovenin N, Menéroux B, Cuif-Job A, Bruna-Muraille C, Domange-Testard A, Liehn JC. [Comparison between PET(-FDG) and computed tomography in the staging of lung cancer. Consequences for operability in 94 patients]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:341-349. [PMID: 19995654 DOI: 10.1016/j.pneumo.2009.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 05/29/2009] [Accepted: 08/03/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Lung cancer, a major application of FDG/PET-CT, has recently been introduced in daily practice in France. The authors retrospectively studied its impact on the management of this disease. METHODS The results of PET-CT and conventional assessment (brain imaging, chest and abdominal CT and possibly bone scintigraphy) were compared in 94 patients, referred for the staging of non-small cell lung cancer, or the assessment of a solitary lung lesion. The impact of thoracic lymph node involvement on the operability of patients was studied in 44 patients. RESULTS PET-CT revealed metastases in 20% of the patients without metastases found by conventional imaging and modified the stage of the disease in 28% of the cases. It changed the indication of surgical treatment in 19% of the cases and led to induction chemotherapy in two patients. In addition, two synchronous cancers were discovered. Regarding lymph node involvement, PET-CT remains of diagnostic value regardless of the scanner results. CONCLUSION The impact of PET-CT in assessing non-small cell lung cancer was confirmed in the authors' practice. Its interest and the consequences in some patients misclassified with conventional assessment have been demonstrated.
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Affiliation(s)
- A Prévost
- Département d'oncologie médicale, institut Jean-Godinot, 1, rue du Général-Koenig, BP 171, 51056 Reims cedex, France.
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Nam EJ, Yun MJ, Oh YT, Kim JW, Kim JH, Kim S, Jung YW, Kim SW, Kim YT. Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI. Gynecol Oncol 2009; 116:389-94. [PMID: 19926121 DOI: 10.1016/j.ygyno.2009.10.059] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 10/15/2009] [Accepted: 10/18/2009] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT), pelvic Doppler ultrasonography (US), abdomino-pelvic computed tomography (CT), and pelvic magnetic resonance imaging (MRI) for detection of ovarian cancer and to assess the role of PET/CT in evaluating the dissemination of ovarian cancer. PATIENTS AND METHODS One hundred thirty-three women suspected to have ovarian cancer were enrolled in a prospective study before surgery between March 2005 and August 2007. The accuracy of each modality in detection of malignancy was estimated by computing the relevant areas under a receiver operating characteristics curve. Histopathologic results served as the reference standard. RESULTS Histopathology showed benign tumors in 25 patients, borderline tumors in 13 patients, and malignant tumors in 95 patients. In distinguishing malignant/borderline from benign ovarian tumors, the accuracy of PET/CT (0.921) was higher than that of pelvis US (0.830) and abdomino-pelvic CT or pelvis MRI (0.749; P=0.013). Radiologic staging by PET/CT was concordant with surgical staging in 78% of patient and PET/CT revealed 15 (15.8%) unpredicted extra-abdominal lymph node metastasis in 95 patients with ovarian cancer. In addition, PET/CT detected new, unexpected co-existing malignant tumors in five (3.8%) cases including two thyroid tumors, two breast tumors, and one pancreatic neuroendocrine cancer. CONCLUSION PET/CT is superior to pelvis US, abdomino-pelvic CT, and pelvic MRI for diagnosis of malignant ovarian tumors and is useful in revealing metastatic ovarian cancer and co-existing malignant tumors. Therefore, we suggest that PET/CT could be used during pre-operative evaluation of patients suspected to have ovarian cancer.
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Affiliation(s)
- Eun Ji Nam
- Women's Cancer Clinic, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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Ishiguro F, Matsuo K, Fukui T, Mori S, Hatooka S, Mitsudomi T. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg 2009; 139:1001-6. [PMID: 19733863 DOI: 10.1016/j.jtcvs.2009.07.024] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 05/20/2009] [Accepted: 07/08/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Lobectomy with systematic complete mediastinal lymph node dissection is standard surgical treatment for localized non-small cell lung cancer. However, selective mediastinal lymph node dissection based on lobe-specific metastases (selective dissection) has often been performed. This study was designed to evaluate the validity of the selective lymph node dissection. METHODS From 1995 through 2003, 625 patients in our hospital had surgery for complete mediastinal lymph node dissection and 147 for selective dissection. We evaluated whether selective dissection adversely affected overall survival. To minimize possible biases due to confounding by treatment indication, we performed a retrospective cohort analysis by applying a propensity score. The propensity score was calculated by logistic regression based on 15 factors available that were potentially associated with treatment indication. Patients were divided into 4 groups according to quartile, and comparison between selective dissection and complete mediastinal lymph node dissection was made using propensity score quartile-stratified Cox proportional hazard models. RESULTS Comparison of baseline characteristics between patients having selective dissection and patients having complete mediastinal lymph node dissection according to propensity score quartile supported comparability of the 2 groups. The 5-year overall survival rates were 76.0% for selective dissection versus 71.9% for complete mediastinal lymph node dissection. The 5-year survival probabilities stratified by propensity score quartile consistently showed no marked difference. In multivariate models, there was no significant difference between the 2 groups (hazard ratio = 1.17, P = .500) as also seen in the analysis without propensity score (hazard ratio = 1.06; 95% confidence interval, 0.68-1.64; P = .810). Therefore, selective dissection showed no significant impact on poor survival compared with complete mediastinal lymph node dissection. CONCLUSIONS Selective lymph node dissection did not worsen the survival of patients with non-small cell lung cancer.
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Affiliation(s)
- Futoshi Ishiguro
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya 461-8681, Japan
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Bar I, Papiashvilli M, Fink G, Sandbank J, Stav D. Cervical mediastinoscopic lymphadenectomy for accurate staging in lung cancer. Asian Cardiovasc Thorac Ann 2009; 17:357-61. [PMID: 19713330 DOI: 10.1177/0218492309338097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accurate preoperative staging of the mediastinum is important in the treatment of non-small-cell lung cancer. Enlarged mediastinal lymph nodes on chest computed tomography are positive for malignancy on mediastinoscopy in only half of these patients. After negative mediastinoscopy, some positive nodes are found at thoracotomy. The aim of this study was to attempt to remove all lymph nodes accessible by cervical mediastinoscopic lymphadenectomy and reevaluate the same mediastinal stations at thoracotomy for missed lymph nodes. Between 1999 and 2003, 30 patients with operable non-small-cell lung cancer and enlarged mediastinal lymph nodes (>1 cm in diameter on computed tomography) that were negative on cervical mediastinoscopy underwent pulmonary resection with complete lymph node dissection. The total number of lymph nodes dissected in these 30 patients was 329 (143 at mediastinoscopy and 186 at thoracotomy); the mean numbers of nodes dissected were 4.8 at mediastinoscopy and 6.2 at thoracotomy. Ten (6.5%) residual lymph nodes were detected at thoracotomy in mediastinal stations R4, L4, and 7. The low number of missed lymph nodes demonstrates the accuracy of the technique of cervical mediastinoscopic lymphadenectomy.
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Affiliation(s)
- Ilan Bar
- General Thoracic Surgery Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
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Abstract
INTRODUCTION Hybrid imaging systems providing morphological and functional data in a single session have been available for oncological imaging for some time. So far, computed tomography (CT) has been the morphological method-of-choice for inclusion into these hybrid imaging systems. However, recently, research has focused on hardware-based fusion of function with magnetic resonance imaging (MRI) rather than CT. OBJECTIVES Now that the first head-only positron emission tomography (PET)/MRI systems have been installed and whole-body systems are to be expected in the near future, potential indications in clinical oncology have to be addressed. DISCUSSION This article discusses potential indications of PET/MRI in whole-body oncology imaging. Potential advantages and disadvantages compared with currently available hybrid imaging systems will be reviewed.
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Pinilla I, Gómez León N. [The usefulness of PET/CT in lung cancer]. RADIOLOGIA 2009; 51:248-60. [PMID: 19406442 DOI: 10.1016/j.rx.2009.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 01/09/2009] [Indexed: 12/20/2022]
Abstract
Lung cancer is the leading cause of cancer-related death. Accurate staging is essential for the optimal management and treatment of these patients. Positron emission tomography (PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms for oncologic patients because they provide valuable functional information. The hybrid PET/CT technique acquires both anatomic (CT) and metabolic (PET) images in a single session, combining the benefits of each modality and minimizing their limitations. This article reviews the role of PET/CT in lung cancer staging, with emphasis on non-small cell carcinoma, evaluating the advantages and limitations of the technique. Other applications of the technique, such as planning radiotherapy, are also discussed.
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Affiliation(s)
- I Pinilla
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, España.
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Video-assisted mediastinoscopy as a therapeutic tool. Surg Endosc 2009; 23:2466-72. [DOI: 10.1007/s00464-009-0418-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 01/12/2009] [Accepted: 02/16/2009] [Indexed: 11/27/2022]
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Santos PARD, Rocha RSD, Pipkin M, Silveira MLD, Cypel M, Rios JO, Pinto JALDF. [Concordance between clinical and pathological staging in patients with stages I or II non-small cell lung cancer subjected to surgical treatment]. J Bras Pneumol 2008; 33:647-54. [PMID: 18200364 DOI: 10.1590/s1806-37132007000600007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 04/03/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare clinical and pathological staging in patients with non-small cell lung cancer submitted to surgical treatment, as well as to identify the causes of discordance. METHODS Data related to patients treated at the Department of Thoracic Surgery of the Pontifical Catholic University of Rio Grande do Sul São Lucas Hospital were analyzed retrospectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for clinical stages IA, IB, and IIB. The kappa index was used to determine the concordance between clinical and pathological staging. RESULTS Of the 92 patients studied, 33.7% were classified as clinical stage IA, 50% as IB, and 16.3% as IIB. The concordance between clinical and pathological staging was 67.5% for stage IA, 54.3% for IB, and 66.6% for IIB. The accuracy of the clinical staging was greater for stage IA, and a kappa of 0.74, in this case, confirmed a substantial association with pathological staging. The difficulty in evaluating nodal metastatic disease is responsible for the low concordance in patients with clinical stage IB. CONCLUSIONS The concordance between clinical and pathological staging is low, and patients are frequently understaged (in the present study, only one case was overstaged). Strategies are necessary to improve clinical staging and, consequently, the treatment and prognosis of patients with non-small cell lung cancer.
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Affiliation(s)
- Pedro Augusto Reck Dos Santos
- Serviço de Cirurgia Torácica, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil.
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Antoch G, Bockisch A. Staging Solid Tumors with 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Freudenberg LS, Rosenbaum SJ, Beyer T, Bockisch A, Antoch G. PET versus PET/CT dual-modality imaging in evaluation of lung cancer. Radiol Clin North Am 2007; 45:639-44, v. [PMID: 17706528 DOI: 10.1016/j.rcl.2007.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Non-small cell lung cancer (NSCLC) accounts for approximately 80% of bronchogenic malignancies. The choice of therapy options, including surgery, radiation therapy, and chemotherapy-used alone or in combination-is based on the tumor stage. Consequently, the accurate determination of tumor size, potential infiltration of adjacent structures, mediastinal lymph node involvement, and the detection of distant metastases are of central importance. The purpose of this article is to summarize the accuracy of dual-modality FDG-PET/CT imaging in staging of NSCLC as compared with FDG-PET alone, and with FDG-PET as well as CT read side by side. Furthermore, an optimized PET/CT protocol for patients who have lung cancer is outlined.
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Affiliation(s)
- Lutz S Freudenberg
- Department of Nuclear Medicine, University of Duisburg, Hufelandstrasse 55 D-45122, Essen, Germany.
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HSU LH, KO JS, YOU DL, LIU CC, CHU NM. Transbronchial needle aspiration accurately diagnoses subcentimetre mediastinal and hilar lymph nodes detected by integrated positron emission tomography and computed tomography. Respirology 2007; 12:848-55. [DOI: 10.1111/j.1440-1843.2007.01164.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Trousse D, Barlesi F, Loundou A, Tasei AM, Doddoli C, Giudicelli R, Astoul P, Fuentes P, Thomas P. Synchronous multiple primary lung cancer: An increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg 2007; 133:1193-200. [PMID: 17467428 DOI: 10.1016/j.jtcvs.2007.01.012] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 12/16/2006] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE No guidelines detailing recommendations for the selection and treatment of patients with synchronous multiple primary lung cancer have been published. We report on a single-institution experience with synchronous multiple primary lung cancer, with emphasis on long-term survival. METHODS We performed a retrospective study of 125 consecutive patients with synchronous multiple primary lung cancer who underwent operation between 1985 and 2006. Various treatment strategies were applied, including perioperative therapy. Potential prognosticators were submitted to univariate and multivariate analyses. RESULTS Tumors were bilateral (n = 34) or ipsilateral (n = 91). Optimal surgical treatment (complete anatomic resection with radical lymphadenectomy) was possible in 65.6% of the cases. pN0 disease was present in 32.3% of the patients; 30-day and 90-day mortality rates were 4.5% and 11%, respectively. Two- and 5-year overall survivals were 61.6% and 34%, respectively, with a median survival of 35 months. On univariate analysis, smoking status, high Charlson index, low forced expiratory volume in 1 second, occurrence of postoperative complications, and performance of a pneumonectomy affected the overall survival adversely. Conversely, bilateral disease, location in the same lobe, and pN0 disease were favorable prognosticators. On multivariate analysis, low forced expiratory volume in 1 second, nonoptimal surgical treatment, and performance of a pneumonectomy were independent predictors of poor long-term survival, whereas female sex, younger age, asymptomatic disease, pN0 status, and performance of an adjuvant treatment affected the survival favorably. CONCLUSIONS Provided there is an appropriate selection process, patients with synchronous multiple primary lung cancer are expected to benefit from surgery. Optimal surgery should be performed, but pneumonectomy should be avoided whenever possible. Adjuvant treatment is suggested to provide an added survival advantage.
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Affiliation(s)
- Delphine Trousse
- Department of Thoracic Surgery, Sainte Marguerite University Hospital, Marseille, France
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Sasaki H, Kawano O, Endo K, Suzuki E, Yukiue H, Kobayashi Y, Yano M, Fujii Y. Human MOB1 expression in non-small-cell lung cancer. Clin Lung Cancer 2007; 8:273-6. [PMID: 17311693 DOI: 10.3816/clc.2007.n.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Human MOB1 (hMOB1) is a recently isolated gene that is a human homologue of the Schizosaccharomyces mitotic checkpoint gene MOB1. The loss of checkpoint control in mammalian cells results in genomic instability, leading to the amplification, rearrangement, or loss of chromosomes, events associated with tumor progression. We hypothesized that hMOB1 might be expressed in non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS We attempted to determine the influence of hMOB1 expression on clinicopathologic features in patients with NSCLC who had undergone surgery. Expression of hMOB1 messenger RNA (mRNA) was evaluated by reverse transcription-polymerase chain reaction in 60 NSCLCs and adjacent histologic normal lung samples using LightCycler. RESULTS Human MOB1/glyseraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA expression was significantly decreased in the tumor of lung cancer tissue (3.347 +/- 4.306) compared with normal lung tissue (4.833 +/- 4.306; P = 0.0437), although 22 of 60 lung cancer tissue samples had > 1 tumor-normal ratio of MOB1/GAPDH mRNA expression. There was no relationship between hMOB1 gene expression and age, sex, pathologic stages, or pN status. However, decreased hMOB1/GAPDH expression was especially seen in pT1 lung cancer (tumor-normal ratio; 0.318 +/- 0.328) when compared with pT4 lung cancer (1.915 +/- 1.895; P = 0.0362). CONCLUSION The decreased expression of hMOB1 mRNA might be the early phase phenomenon for tumor invasion from NSCLC. Alternatively, loss of mitotic checkpoint might play a role in oncogenesis for lung cancer.
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Affiliation(s)
- Hidefumi Sasaki
- Department of Surgery II, Nagoya City University Medical School, Japan.
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Pfannenberg C, Aschoff P, Schanz S, Eschmann SM, Plathow C, Eigentler TK, Garbe C, Brechtel K, Vonthein R, Bares R, Claussen CD, Schlemmer HP. Prospective comparison of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and whole-body magnetic resonance imaging in staging of advanced malignant melanoma. Eur J Cancer 2007; 43:557-64. [PMID: 17224266 DOI: 10.1016/j.ejca.2006.11.014] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 11/10/2006] [Accepted: 11/16/2006] [Indexed: 11/26/2022]
Abstract
The aim of our study was to compare the overall and site-based accuracy and impact on patient management of positron emission tomography/computed tomography (PET/CT) and whole-body (wb) magnetic resonance imaging (MRI) in staging of advanced melanoma. In a prospective blinded study, 64 patients with American Joint Committee on Cancer (AJCC) stage III/IV melanoma underwent 18F-fluorodeoxyglucose PET/CT and wbMRI. In total 420 lesions were evaluated. The overall accuracy of PET/CT was 86.7% compared to 78.8% for wbMRI (P=0.0007). PET/CT was significantly more accurate in N-staging and detecting of skin and subcutaneous metastases, whereas wbMRI was more sensitive in detecting liver, bone and brain metastases. WbMRI was less sensitive but more specific than PET/CT in classifying pulmonary lesions. In 41 patients (64%) whole-body imaging caused changes of treatment. Whole-body staging of patients with advanced melanoma is most accurate by combining wbPET/CT and organ-specific wbMRI including a brain, liver and bone marrow protocol.
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Affiliation(s)
- Christina Pfannenberg
- Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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Ohno Y, Koyama H, Nogami M, Takenaka D, Yoshikawa T, Yoshimura M, Ohbayashi C, Sugimura K. STIR turbo SE MR imaging vs. coregistered FDG-PET/CT: Quantitative and qualitative assessment of N-stage in non-small-cell lung cancer patients. J Magn Reson Imaging 2007; 26:1071-80. [PMID: 17896365 DOI: 10.1002/jmri.21106] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To conduct a prospective comparison of the accuracy of short inversion time (TI) inversion-recovery (STIR) turbo spin-echo (SE) imaging and coregistered 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) with computed tomography (CT) (coregistered FDG-PET/CT) to assess the N-stage in non-small-cell lung cancer (NSCLC) patients. MATERIALS AND METHODS A total of 115 consecutive NSCLC patients prospectively underwent CT, STIR turbo SE imaging, and FDG-PET, as well as surgical and pathological examinations. All STIR turbo SE images were obtained with a 0.9% saline phantom, which was placed alongside the chest wall of each patient, and coregistered FDG-PET/CTs were reconstructed using commercially available software. For quantitative assessments, the ratio of signal intensity (SI) of each lymph node to that of 0.9% saline phantom (lymph node-saline ratio [LSR]) and maximal standardized uptake value (SUV(max)) of each lymph node were calculated. Feasible threshold values were determined by using the receiver operating characteristic (ROC) curve-based positive test, and diagnostic capabilities of N-stage were compared by McNemar's test on a per patient basis. RESULTS When feasible, threshold values were adopted, quantitative sensitivity (90.1%) and accuracy (92.2%) of STIR turbo SE imaging were significantly higher than those of quantitative and qualitative sensitivities (76.7% and 74.4%) and accuracies (83.5% and 82.6%) of coregistered FDG-PET/CT on a per patient basis (P < 0.05). CONCLUSION STIR turbo SE imaging is at least as valid as coregistered FDG-PET/CT for quantitative and qualitative assessment of the N-stage for NSCLC patients.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Freudenberg LS, Rosenbaum SJ, Beyer T, Bockisch A, Antoch G. PET Versus PET/CT Dual-Modality Imaging in Evaluation of Lung Cancer. PET Clin 2006; 1:347-52. [DOI: 10.1016/j.cpet.2006.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim BT, Lee KS, Shim SS, Choi JY, Kwon OJ, Kim H, Shim YM, Kim J, Kim S. Stage T1 non-small cell lung cancer: preoperative mediastinal nodal staging with integrated FDG PET/CT--a prospective study. Radiology 2006; 241:501-9. [PMID: 16966480 DOI: 10.1148/radiol.2412051173] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the sensitivity and specificity of integrated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) (PET/CT) for the preoperative diagnosis of mediastinal nodal metastasis in stage T1 non-small cell lung cancer (NSCLC), with surgical and histologic results as reference standards. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. From June 2003 to February 2005, 150 patients (89 men and 61 women; mean age, 59 years) with stage T1 NSCLC at stand-alone CT underwent integrated PET/CT and surgical staging. Two observers (one radiologist and one nuclear medicine physician) evaluated prospectively and in consensus the mediastinal nodes by analyzing both PET (functional) and CT (anatomic) images. Nodal stages were determined by using the American Joint Committee on Cancer staging system and surgical and histologic findings as the reference standard. Statistical evaluation of malignant lymph nodes was performed on per-nodal-station and per-person bases. RESULTS A total of 568 mediastinal nodal stations were evaluated. Nodes were positive for malignancy in 34 (23%) of 150 patients and 55 (10%) of 568 nodal stations. For depiction of malignant nodes, the respective sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of integrated PET/CT were 42% (23 of 55), 100% (513 of 513), 100% (23 of 23), 94% (513 of 545), and 94% (536 of 568) on per-nodal-station basis and 47% (16 of 34), 100% (116 of 116), 100% (16 of 16), 87% (116 of 134), and 88% (132 of 150) on a per-patient basis. CONCLUSION Integrated FDG PET/CT provides high specificity and positive predictive value of mediastinal nodal staging in stage T1 NSCLC, although the sensitivity is low.
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Affiliation(s)
- Byung-Tae Kim
- Department of Nuclear Medicine, Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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Le Pimpec-Barthes F, Bagan P, Hubsch J, Bry X, Pereira Das Neves J, Riquet M. Évaluation des pratiques en chirurgie thoracique. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)71799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pfannenberg AC, Aschoff P, Brechtel K, Müller M, Bares R, Paulsen F, Scheiderbauer J, Friedel G, Claussen CD, Eschmann SM. Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2006; 34:36-44. [PMID: 16896664 DOI: 10.1007/s00259-006-0186-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 04/03/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate low dose non-enhanced CT and standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning of non-small cell lung cancer (NSCLC). METHODS Retrospective analysis was performed of 50 consecutive patients with proven NSCLC who had been referred for primary staging (n=41) or restaging (n=9). All patients underwent a multi-phase PET/CT consisting of a low dose non-enhanced attenuation scan and an arterial and portal-venous contrast-enhanced CT scan followed by whole-body PET. Fused datasets of non-enhanced and contrast-enhanced PET/CT were compared per patient by using the TNM staging system, and per lesion regarding localisation, characterisation and delineation of tumour lesions. The staging results were validated either by histopathology or by clinical-radiological follow-up for >or=6 months. RESULTS In 47/50 patients, the results of T staging did not differ between the two PET/CT protocols. Three patients could only be correctly classified as having T4 tumours after contrast application. Regarding N staging, both protocols yielded the same results. In M staging, there was only one patient with an improvement of the results as a result of contrast application. The lesion-based analysis of 92 sites showed no difference in the accuracy of lesion localisation and only one revision of lesion characterisation by contrast-enhanced PET/CT. The assessment of tumour delineation was altered by contrast application in 58/92 sites (p<0.0001). In 10/50 patients, contrast-enhanced PET/CT detected additional clinically important findings. CONCLUSION In patients with advanced NSCLC, contrast-enhanced CT as part of the PET/CT protocol more accurately assessed the TNM stage in 8% of patients compared with non-contrast PET/CT. However, for planning of 3D conformal radiotherapy and non-conventional surgery, contrast-enhanced PET/CT protocols are indispensable owing to their superiority in precisely defining the tumour extent.
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Affiliation(s)
- Anna C Pfannenberg
- Department of Diagnostic Radiology, Eberhard-Karls-University, Tübingen, Germany.
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Cancro do pulmão de não pequenas células – Comparação entre o estadiamento clínico e o patológico. REVISTA PORTUGUESA DE PNEUMOLOGIA 2006. [DOI: 10.1016/s0873-2159(15)30438-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mouroux J, Venissac N, Alifano M, Leo F, Poudenx M. Combined Video-Assisted Mediastinoscopy and Thoracoscopy in the Management of Lung Cancer: A Five-Year Experience. J Laparoendosc Adv Surg Tech A 2005; 15:460-9. [PMID: 16185117 DOI: 10.1089/lap.2005.15.460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the usefulness of combined video-assisted mediastinoscopy (VM) and video-assisted thoracoscopy (VT) in the management of patients with lung cancer. METHODS A prospective observational study was performed over a 5-year period. Indications for combined VM and VT included inconclusive findings from imaging techniques concerning locoregional extension and resectability; possible involvement of different structures not accessible to a single procedure; and failure to obtain a histologic diagnosis with a single technique. RESULTS An indication for combined exploration was established in 30 patients, representing 2.6% of all the patients referred to us for diagnosis, staging, and/or resection of lung cancer. Combined VM and VT was completed in 28 patients, as pleural carcinosis was found at VT in 2 cases. There was no mortality or morbidity in our series. Histologic diagnosis was obtained in 12/13 patients without preoperative histologic typing. In all the evaluated patients, combined VM and VT was useful in clinical decision-making, leading to immediate surgery (n=10), induction treatments (n=8), or nonsurgical therapy (n=12). Among the patients who underwent immediate surgery, combined VM and VT never failed to assess the T factor. The N factor was correctly evaluated in 8/10 patients, and in 2 patients it failed to recognize a minimal N2 disease. CONCLUSION Combined VM and VT is a safe and useful tool in the management of selected patients with lung neoplasms. Both the extent of primary tumor and the possible intrathoracic spread can be thoroughly evaluated.
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Affiliation(s)
- Jérôme Mouroux
- Service de Chirurgie Thoracique, CHU de Nice, Hôpital Pasteur, Nice, France
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Shim SS, Lee KS, Kim BT, Chung MJ, Lee EJ, Han J, Choi JY, Kwon OJ, Shim YM, Kim S. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology 2005; 236:1011-9. [PMID: 16014441 DOI: 10.1148/radiol.2363041310] [Citation(s) in RCA: 327] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate prospectively the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) with use of fluorodeoxyglucose (FDG), compared with that of stand-alone CT, for the preoperative staging of non-small cell lung cancer, with surgical and histologic findings used as the reference standard. MATERIALS AND METHODS Institutional review board approval and patient informed consent were obtained. From November 2003 to February 2004, 106 patients (78 men, 28 women; mean age, 56 years) with non-small cell lung cancer underwent curative surgical resection (tumor resection and lymph node dissection) after stand-alone CT followed by integrated FDG PET/CT. Tumor stages were determined by using the TNM and American Joint Committee on Cancer staging systems. Histopathologic results served as the reference standard. Statistically significant differences in tumor staging between integrated PET/CT and stand-alone CT were determined with P < .05 obtained by using the McNemar test or with a generalized estimating equation. RESULTS The primary tumor was correctly staged in 84 patients (79%) at stand-alone CT and in 91 patients (86%) at integrated FDG PET/CT (P = .25). For the depiction of malignant nodes, the sensitivity, specificity, and accuracy of CT were 70% (23 of 33 nodal groups), 69% (248 of 360), and 69% (271 of 393), respectively, whereas those of PET/CT were 85% (28 of 33), 84% (302 of 360), and 84% (330 of 393) (P = .25, P < .001, and P < .001, respectively). There were 112 false-positive interpretations at CT for 54 hilar, 16 subcarinal, 29 paratracheal, 10 subaortic, and two pulmonary ligament nodal groups and one upper paratracheal group, compared with only 58 false-positive interpretations at PET/CT for 32 hilar, seven subcarinal, 13 lower paratracheal, and six subaortic nodal groups. There were 10 false-negative interpretations at CT for four hilar, two lower paratracheal, and two subcarinal nodal groups, one prevascular and retrotracheal group, and one inferior pulmonary group, but only five false-negative interpretations at PET/CT (one each for paratracheal, subaortic, subcarinal, inferior pulmonary, and hilar nodal groups). CONCLUSION Integrated FDG PET/CT is significantly better than stand-alone CT for lung cancer staging and provides enhanced accuracy and specificity in nodal staging.
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Affiliation(s)
- Sung Shine Shim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
The D-glucose analog 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG) is the most commonly used radionuclide in positron emission tomography (PET) of lung cancer. FDG-PET is a molecular imaging technique that images the preferential accumulation of FDG in malignant tissues with increased metabolism. Although FDG-PET is sensitive in the detection of lung cancer, FDG is not tumor specific and may accumulate in a variety of nonmalignant conditions. Occasional false-negative results may also occur. Whole body FDG-PET is a useful noninvasive technique to stage known or suspected non-small-cell lung cancer. The results allow more efficient use of invasive methods for histopathological staging. The combined use of CT and PET in dual imaging increases the number of patients with correctly staged non-small-cell lung cancer. CT/PET is also useful in the assessment of recurrent or residual disease. Future imaging agents are being developed which may allow more selective accumulation of radiopharmaceutical in malignant tissues.
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Affiliation(s)
- Matthew D Gilman
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Abstract
Technical innovations such as the availability of movable patient platforms and the introduction of 32-channel systems have made whole-body MRI for tumor staging feasible. In addition, the development of dual-modality PET/CT systems offers the opportunity to perform anatometabolic tumor staging with whole-body coverage in a single session. Based on an increase in patient survival when applying a stage-adapted therapy in different malignant diseases the relevant question relates to the accuracies of whole-body MRI and whole-body PET/CT for TNM staging. This review article addresses whole-body tumor staging with MRI and FDG-PET/CT with special emphasis on diagnostic accuracies for staging different malignant diseases.
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Affiliation(s)
- G Antoch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen.
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Finke NM, Aubry MC, Tazelaar HD, Aughenbaugh GL, Lohse CM, Pankratz VS, Deschamps C. Autopsy results after surgery for non-small cell lung cancer. Mayo Clin Proc 2004; 79:1409-14. [PMID: 15544020 DOI: 10.4065/79.11.1409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the percentage of metastatic and unexpected residual lung cancer at autopsy in patients considered for curative resection of non-small cell lung cancer during a time when computed tomography was available as a preoperative staging tool. MATERIAL AND METHODS Clinical data and surgical and autopsy slides of all patients who underwent curative resection of nonsmall cell lung cancer at the Mayo Clinic in Rochester, Minn, between 1985 and 1999 and who underwent autopsy within 30 days of surgery were reviewed retrospectively for the presence of residual or metastatic disease. RESULTS The study group consisted of 25 men and 7 women, with a mean age of 70 years. A pulmonary metastasis was identified at surgery in 1 patient (3%). Metastases were found in an additional 5 patients (16%) at autopsy, 1 of whom had 2 sites involved. These sites included the liver in 2 and lung, epicardium, adrenal gland, and kidney in 1 each. The average diameter of metastases was 1.6 cm. No factor studied was found to be significantly associated with the presence of unrecognized metastatic disease at autopsy. CONCLUSION The advent of computed tomography as a staging tool has decreased the percentage of patients with undiagnosed metastatic disease at surgery; however, preoperative understaging in lung cancer remains a problem.
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Affiliation(s)
- Nicole M Finke
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Thomas-de-Montpréville V, Chapelier A, Fadel E, Mussot S, Dulmet E, Dartevelle P. Chest wall resection for invasive lung carcinoma, soft tissue sarcoma, and other types of malignancy. Pathologic aspects in a series of 107 patients. Ann Diagn Pathol 2004; 8:198-206. [PMID: 15290670 DOI: 10.1053/j.anndiagpath.2004.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With improvements in surgical techniques for resection and reconstruction of the chest wall, pathologists are confronted with complicated surgical specimens. There are no currently available guidelines specifically dedicated to the handling of these specimens. Extended resections of lung carcinoma chest wall invasions may change the clinical value of some TNM subsets. We reviewed a series of 107 consecutive malignant tumors involving the chest wall and resected in our institution during a 3-year period. The 107 patients included 39 females and 68 males aged 6 to 80 years (mean, 53 years). Ninety-eight cases (92%) were en bloc resection. There were 55 invasions by lung carcinomas including 19 Pancoast tumors. With the current TNM classification, five lung carcinomas, treated with vertebral body resection because of vertebral foramina invasion, were T3. Four lung carcinomas were N3 or M1 only because of supraclavicular or chest wall lymph node invasion. Other tumors included 20 primary soft-tissue tumors, 13 primary skeletal tumors, 12 metastases, four local invasions by breast tumors, and three miscellaneous lesions. Resected structures included one to six ribs (mean, 2.6; n = 89), thoracic inlet (n = 24), three or four vertebral bodies (n = 13), sternum (n = 17), clavicles (n = 15), shoulder blade (n = 4), upper limb (n = 2), skin (n = 29), lung (n = 64), diaphragm (n = 2), and mediastinum (n = 2). Ten cases were incomplete resections including five because of vertebral body or vertebral foramina tumor invasion. The study of surgical specimens resulting from resection of malignant tumors of the chest wall is complicated because of the variety of both tumor histologic types and involved anatomic structures. Specimen radiograms have a great informative value. Assessment of surgical margins, especially vertebral foramina, is imperative. In lung carcinomas invading the chest wall, we suggest that vertebral foramina invasion could be classified T4 and that the prognostic value of chest wall lymph nodes isolated invasions should be assessed for a possible N1 classification.
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Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C, Yoshimura M, Satouchi M, Nishimura Y, Sugimura K. Metastases in Mediastinal and Hilar Lymph Nodes in Patients with Non–Small Cell Lung Cancer: Quantitative and Qualitative Assessment with STIR Turbo Spin-Echo MR Imaging. Radiology 2004; 231:872-9. [PMID: 15163823 DOI: 10.1148/radiol.2313030103] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate short inversion time inversion-recovery (STIR) turbo spin-echo (TSE) magnetic resonance (MR) imaging for detection of metastases in lymph nodes by using quantitative and qualitative analyses. MATERIALS AND METHODS One hundred ten patients (68 men and 42 women) with non-small cell lung cancer who ranged in age from 36 to 82 years (mean age, 64 years) were examined with respiratory-triggered STIR TSE MR imaging. Ratios of signal intensity in a lymph node to that in a 0.9% saline phantom (lymph node-saline ratios [LSRs]) for all lymph nodes were classified into three groups according to nodal short-axis diameter. LSRs of each group were compared by using pathologic diagnosis as the standard of reference. For quantitative analysis, the LSR threshold value for a positive test was determined on a per-node basis and tested for ability to enable a correct diagnosis on a per-patient basis. For qualitative analysis, signal intensities of lymph nodes were assessed by using a five-point visual scoring system. Results of quantitative and qualitative analyses were compared on a per-patient basis with McNemar testing. RESULTS In 110 patients, 92 of 802 lymph nodes were pathologically diagnosed as containing metastases, while 710 lymph nodes did not contain metastases. Mean LSR in the lymph node group with metastasis was higher than that in the group without metastasis (P <.05). When an LSR of 0.6 was used as the positive-test threshold at quantitative analysis, sensitivity was 93% (37 of 40 patients) and specificity was 87% (61 of 70 patients) on a per-patient basis. With a score of 4 as the positive-test threshold at qualitative analysis, sensitivity was 88% (35 of 40 patients) and specificity was 86% (60 of 70 patients) on a per-patient basis. There was no significant difference (P >.05) between results of quantitative and those of qualitative analysis. CONCLUSION Quantitative and qualitative analyses of STIR TSE MR images enable differentiation of lymph nodes with metastasis from those without. Qualitative analysis can substitute for quantitative analysis of STIR TSE MR imaging data.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Rankin S. The role of imaging in screening, diagnosis and staging of Non-Small Cell Lung Cancer (NSCLC). EJC Suppl 2004. [DOI: 10.1016/j.ejcsup.2003.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kahn D, Menda Y, Kernstine K, Bushnell D, McLaughlin K, Miller S, Berbaum K. The Utility of 99m Tc Depreotide Compared With F-18 Fluorodeoxyglucose Positron Emission Tomography and Surgical Staging in Patients With Suspected Non-small Cell Lung Cancer. Chest 2004; 125:494-501. [PMID: 14769730 DOI: 10.1378/chest.125.2.494] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The findings from conventional imaging modalities, such as chest CT, are frequently unreliable in patients with lung cancer. This study was designed to compare the relative diagnostic accuracies and utility of the two most widely used functional imaging examinations, F-18-2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) and (99m)Tc depreotide scintigraphy, for the diagnosis and staging of lung cancer. DESIGN Prospective, experimental investigation. SETTING Academic medical center. PATIENTS One hundred sixty-six subjects with suspected lung cancer were enrolled in the study. INTERVENTIONS Whole-body and single-photon emission CT imaging of the chest was performed after IV administration of (99m)Tc depreotide. Attenuation-corrected FDG PET imaging was performed after IV administration of FDG. Image findings were compared with the biopsy results or clinical follow-up. MEASUREMENTS AND RESULTS In 157 subjects with evaluable lung lesions, the sensitivities and specificities for detecting malignant disease (95% confidence intervals) of FDG PET are 96% (90 to 98%) and 71% (54 to 85%), and of (99m)Tc depreotide are 94% (88 to 98%) and 51% (34 to 68%). In the 139 subjects with available complete staging data, FDG PET correctly staged 76 of 139 patients (55%), and (99m)Tc depreotide correctly staged 63 of 139 patients (45%). CONCLUSIONS The sensitivity for detection of lung cancer in the primary lesion is equally high for FDG PET and (99m)Tc depreotide. The specificity is superior for FDG PET. The staging accuracy of FDG PET and (99m)Tc depreotide is similar, but when read with the chest CT neither scintigraphic examination is sufficiently accurate to stage patients with non-small cell lung cancer.
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Affiliation(s)
- Daniel Kahn
- Nuclear Medicine Section 115, Iowa City VA Medical Center, Iowa City, IA 52246, USA.
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