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Tha role of FDG-PET for Mediastinal Staging in Primary Lung Cancer

Tha role of FDG-PET for Mediastinal Staging in Primary Lung Cancer. Osman Eroğlu, Sedat Ziyade, Alper Toker, Serhan Tanju , Sukru Dilege, Goksel Kalayc ı Istanbul Universty Istanbul Medical School Department of Thoracic Surgery. Mediastinal Evaluation in Lung Cancer. Non-invasive CT

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Tha role of FDG-PET for Mediastinal Staging in Primary Lung Cancer

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  1. Tha role of FDG-PET for Mediastinal Staging in Primary Lung Cancer Osman Eroğlu, Sedat Ziyade, Alper Toker, Serhan Tanju, Sukru Dilege, Goksel Kalaycı Istanbul Universty Istanbul Medical School Department of Thoracic Surgery

  2. Mediastinal Evaluation in Lung Cancer • Non-invasive • CT • FDG-PET • Invasive • FOB-TTFNA • Mediastinoscopy/tomy • VATS • EUS FNA tt/te

  3. Patients & Methods“November 2001-January 2005” • Patients who had cytologicaly prooved lung cancer without a distant metastases. • Technicaly resectable lung cancer patients. • Physiologicaly operable patients in terms of cadiopulmonary evaluations. • Patients with chest CT not longer than 45 days. • The duration between chest CT and PET not longer than 1 month. • Patients without a neoadjuvant chemotherapy nor radiotherapy • Patients who did not have PET after a kind of induction treatment. • Patients without a diagnosis of Diabetes Mellitus. • Patients without a history of tuberculosis. • 53 patients • Age, gender,histology,localisation of tumor, PET, CT, surgery, pathology

  4. Method • Stations were detected with PET-scan in case of suv max was graeter than 2,5 • Diameter of mediastinal lymph node in same station was evaluated with CT, • Lymph nodes which were sampled from same region, were recorded.

  5. Method • Mediastinoscopy, superior mediastinal suvmax >2.5 • Cervical and/or extented • VATS, inferior mediastinal suvmax >2.5 • Thoracotomy- sudmax <2.5 all mediastinal stations, lymph nodes not in pathological diameter • Mountain Staging

  6. Method • The patients who had positive lymph nodes with mediastinoscopy and VATS were exculuded from study • Thoracotomy was performed to patients who had negative mediastinoscopy or uptake value lower than suv max 2,5 in PET • Systematic lymph node sampling was performed during thoracotomy. • Statisticaly analyzed spesifically to patient / lymph node station.

  7. Results • 53 patients • 45 M / 8 F • Mean age 63.9 (49-75)

  8. Mediastinal Evaluation in Patients “PET”

  9. Lymph Node Based Mediastinal Evaluation

  10. Histopathological type/PET • Squamous ca Adenocarcinoma • p>0.05

  11. Lymph node station/PET • 2R 2L • 4R 4L

  12. Lymph node station/PET • 5 6 • 7

  13. Mediastinal EvaluationPET vs CT

  14. Result • Kernstine (1999) • Sensitivity %70, specificity %86 • Cerfolio (2003) • Sensitivity %71, specificity %77, PPD %44, NPD %91 • Gonzales (2003) • Sensitivity %64, specificity %77, PPD 44, NPD %88 • Kelly (2004) • Sensitivity %62, specificity %98, PPD %89, NPD %92 • İstanbul Tıp Fakültesi (2005) • Sensitivity %65, specificity %86, PPD %52, NPD %91

  15. Result • Specitivity %86 • Same as CT • Sensitivity %65 • Higher than CT p<0.05 • PPD %52 • NPD %91 • False positivity % 47,5 • Antrocosis • False negativity % 8,3 • Subcapsular micrometases

  16. Result • Squamous vs adeno • p>0.05 • Lymph node station • p>0.05 • PET (+) mediastinoscopy (%47,5) • PET (-), BT (-) thoracotomy (%8,3)

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