FDG-PET/CT for pretherapeutic lymph node staging in non-small cell lung cancer: A tailored approach to the ESTS/ESMO guideline workflow.
Aged
Female
Humans
Male
Carcinoma, Non-Small-Cell Lung
/ diagnostic imaging
Expressed Sequence Tags
Fluorodeoxyglucose F18
Lung Neoplasms
/ diagnostic imaging
Lymph Nodes
/ diagnostic imaging
Mediastinum
/ diagnostic imaging
Neoplasm Staging
Positron Emission Tomography Computed Tomography
Prospective Studies
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed
Workflow
Practice Guidelines as Topic
Accuracy
FDG-PET/CT
Guideline
Mediastinal lymph nodes
Non-small cell lung cancer
Journal
Lung cancer (Amsterdam, Netherlands)
ISSN: 1872-8332
Titre abrégé: Lung Cancer
Pays: Ireland
ID NLM: 8800805
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
16
12
2020
revised:
23
04
2021
accepted:
01
05
2021
pubmed:
18
5
2021
medline:
25
6
2021
entrez:
17
5
2021
Statut:
ppublish
Résumé
In patients with NSCLC, current ESTS and ESMO guidelines recommend invasive lymph node (LN) staging with EBUS-TBNA even if FDG-PET/CT is negative for mediastinal LNs if at least one of three risk factors is present (cN1, non-peripheral primary or primary >3 cm). Modified workflows to avoid unnecessary invasive procedures were evaluated. Monocentric retrospective analysis of pretherapeutic FDG-PET/CT in 247 patients with NSCLC (62 % male; age, 68 [43-88] years) using an analog or digital PET/CT scanner. PET windowing was standardized. LNs were positive if 'LN uptake > mediastinal blood pool' or short axis >10 mm. Surgery or EBUS-TBNA served as reference for diagnostic accuracy per LN station. In all patients with negative mediastinal LNs by PET/CT, LN histology from surgery was available. Among 700 L N stations analyzed, 180 were malignant. Sensitivity and specificity of PET/CT per LN station were 93 % and 71 %. Following current guidelines, 76 patients with mediastinal negative PET/CT required confirmatory invasive staging. Only 5/76 patients had unexpected pN2 (all had adenocarcinoma). In a modified approach, confirmatory invasive staging was confined to patients with mediastinal negative PET/CT who showed all three risk factors. Using this modification, EBUS-TBNA could have been omitted in 62 (82 %) of the 76 patients who required EBUS-TBNA based on current recommendation. Among these 62 patients, only one patient had unsuspected pN2 (single-level) while the remaining 61 of 62 omitted EBUS-TBNA were deemed unnecessary because mediastinal LNs were confirmed to be negative. No multi-level pN2 would have been missed. In the current analysis, 82 % of EBUS-TBNA procedures in patients with mediastinal negative PET/CT could have been omitted by modifying the current guideline workflow as proposed (i.e., restricting EBUS-TBNA in patients with cN0/1 to those with all three risk factors). This was consistent with different PET/CT scanners. Prospective confirmation is required.
Identifiants
pubmed: 33994197
pii: S0169-5002(21)00171-9
doi: 10.1016/j.lungcan.2021.05.003
pii:
doi:
Substances chimiques
Fluorodeoxyglucose F18
0Z5B2CJX4D
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
66-74Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.