Originally published as JCO Early Release 10.1200/JCO.2004.00.6361 on October 11 2005

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Accuracy of Helical Computed Tomography and [¹⁸F] Fluorodeoxyglucose Positron Emission Tomography for Identifying Lymph Node Mediastinal Metastases in Potentially Resectable Non–Small-Cell Lung Cancer

From the Clinical Epidemiology Unit, Department of Pulmonology, Department of Thoracic Surgery, Department of Radiology, Hospital Universitario 12 de Octubre, and the Centro PET Complutense, Madrid, Spain

Address reprint requests to Francisco Pozo-Rodríguez, Servicio de Neumología, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain; e-mail: fpozo{at}h12o.es

PURPOSE: Computed tomography (CT) and [¹⁸F] Fluorodeoxyglucose positron emission tomography (FDG-PET) are considered suitable methods for the noninvasive staging of the mediastinum. Our study was intended to estimate the efficacy of contrast-enhanced helical CT (hCT) and FDG-PET, alone and combined, in the diagnosis of lymph node mediastinal metastases.

METHODS: This study was a prospective and blind comparison of the efficacy of hCT and FDG-PET with two alternative reference standards, mediastinoscopy, and mediastinoscopy plus thoracotomy plus a 6-month follow-up to diagnose lymph node mediastinal metastases in 132 consecutive patients with potentially resectable non–small-cell lung cancer (NSCLC). The metastatic disease was assessed histopathologically. Further clinical information was obtained postoperatively after a median follow-up of 42 months.

RESULTS: The prevalence of cN2,3 is 0.28. For hCT the sensitivity and specificity are 0.86 (95% CI, 0.70 to 0.93) and 0.67 (95% CI, 0.56 to 0.75), for PET 0.94 (95% CI, 0.81 to 0.98) and 0.59 (95% CI, 0.49 to 0.68), and for hCT and PET combined in-parallel 0.97 (95% CI, 0.84 to 0.99) and 0.44 (95% CI, 0.34 to 0.53), which translate into a negative predicted probability of 0.98 (95% CI, 0.88 to 1.00). The crude diagnostic odds ratio of PET in the total sample studied is 13.1, in the subgroup hCT+ 11.04 (3.0 to 40 0.1), and in the hCT- 3.5 (0.5 to 21.5). Similar results were obtained for hCT stratified by PET.

CONCLUSION: hCT and PET perform similarly in the mediastinal staging of NSCLC, both tests are conditionally dependent and provide complementary information, and their diagnostic value mainly resides on the negative results.

Supported by a research grant (FIS 98/0702) from the Fund for Health Research and Red Respira (RTIC 03/11), Ministry of Health, Spain. The Centro PET Complutense was paid for all PET scans by the Hospital Universitario 12 de Octubre.

Presented in part at the IX Annual Meeting of the Society of Pneumology and Thoracic Surgery of Madrid, Madrid, Spain, April 2004; XXXVII Annual Meeting of the Spanish Society of Pneumology and Thoracic Surgery, Madrid, Spain, June 2004; 25th Annual Meeting of the Spanish Society of Nuclear Medicine, Barcelona, Spain, June 2004; 51st Annual Meeting of the Society of Nuclear Medicine, Philadelphia, PA, June 2004; XIV Annual Conference of the European Respiratory Society, Glasgow, UK, September 2004.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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