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A. Kır*, İ. İskender*, H.B. Takır**, M. Halaç***, S.Z. Kadıoğlu*,

Mediastinal Lymph Node Staging in Nonsmall Cell Lung Cancer: Comparison of Positron Emission Tomography and Mediastinoscopy. A. Kır*, İ. İskender*, H.B. Takır**, M. Halaç***, S.Z. Kadıoğlu*, O. Kapıcıbaşı*, A. Yılmaz**, A. Atasalihi*

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A. Kır*, İ. İskender*, H.B. Takır**, M. Halaç***, S.Z. Kadıoğlu*,

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  1. Mediastinal Lymph Node Staging in Nonsmall Cell Lung Cancer: Comparison of Positron Emission Tomography and Mediastinoscopy A. Kır*, İ. İskender*, H.B. Takır**, M. Halaç***, S.Z. Kadıoğlu*, O. Kapıcıbaşı*, A. Yılmaz**, A. Atasalihi* Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Investigation Hospital *II. Thoracic Surgery Department **X. Pulmonology Department ***İ.Ü. Cerrahpaşa Medical Faculty, Department of Nuclear Medicine

  2. In this study, the results of PET and Mediastinoscopy are comparatively analysed on patients withNSCLC, for mediastinal staging.

  3. Materials and Methods • September 2005 – December 2006 • Known or suspicious for NSCLC • Results of PET/CT and mediastinoscopy are recorded

  4. Complete history and physical examination • Blood analyses • Chest radiography • Spirometry • Cardiac investigation • Thorax CT • PET/CT • Cranial MRI

  5. PET Imaging: • 90 patients (%85) Siemens Biograph LSO HI-REZ integrated PET/CT; two centers • Serum glucose concentration <150 mg/dl • Imaging from neck to hip • 90-150 minute after intravenous injection of FDG-18 • Fusion of PET and CT images

  6. FDG uptake was considered to be positive in mediastinum if tracer activity was significantly higher than mediastinal background activity. *Gonzalez-Stawinski GV, Lemaire A, Merchant F, O’Halloran E, Coleman RE, Harpole DH, D’Amico TA. A comparative analysis of positron emission tomography and mediastinoscopy in staging non-small cell lung cancer. J Thorac Cardiovasc Surg. 2003 Dec;126(6):1900-5.

  7. Surgical staging • Cervical mediastinoscopy • Extended cervical mediastinoscopy • Naruke classification • paratracheal (2R-2L), • tracheobronchial (4R-4L) • subcarinal (7) • Subaortic (5), paraaortic (6) • Thoracotomy

  8. Patients excluded from the study: • Mediastinoscopy; not performed • Stage IV • Time interval between PET and mediastinoscopy > 6 weeks • Neoadjuvant therapy • Mediastinoscopy; not able to be done (tracheostomy, kyphosis, bleeding etc.) • PET Imaging performed after mediastinoscopy

  9. Results • A total of 425 mediastinal lymph node samplings were done from 106 patients, among 138 investigated patients, having above criteria (4.01 stations/patient) • 100 male, 6 female • Mean age: 58.9 years (39-80 ) • PET scan – Mediastinoscopy: 14.1 days (2-37 ) • The diagnosis was put in 85 (%80.2) patients preoperatively

  10. Cell types

  11. Type of the Operations

  12. Pathological staging

  13. PET/CT and Mediastinoscopy

  14. PET/CT and Mediastinoscopy

  15. PET/CT and Mediastinoscopy

  16. PET/CT and Mediastinoscopy

  17. Evaluation PET negative 11 lymph nodes • 1 patient N0N2 ( single station) • 2 patient N2N2 (two stations) • 2 patient N2N3 (three stations) • 3 patient N3N3 (five stations)

  18. Mediastinoscopy is still gold standart on the assessment of the mediastinal lymph nodes. • Sensitivity %80, spesificity %100 • %0.5 complication risk *Graeter TP, Hellwig D, Hoffmann K, Ukena D, Kirsch CM, Schafers HJ. A Mediastinal lymph node staging in suspected lung cancer: comparison of positron emission tomography with F-18-fluorodeoxyglucose and mediastinoscopy. Ann Thorac Surg. 2003 Jan;75(1):231-5

  19. PET; helps the surgeon to sample more lymph nodes, precisely during mediastinoscopy, avoiding unnecessary thoracotomies.

  20. How many mediastinoscopies can be avoided in all PET negatif cases? • N:55/106 %51.9 • 54/55 %98.2 Negative predictive value

  21. Mediastinoscopy is necessary for exact lymph node staging in PET positive patients • Mediastinoscopy can be omitted in patients with negative PET scan.

  22. Calculations of SUV • Mean of mass SUV: 15.7 (4.0-36.4) • For the mediastinum cut off value 2.5; sensitivity %94, spesificity %93 * • PET true positive 57 stations • Mean SUV: 8.6 (3.3 – 22.3) • PET false positive 45 stations • 3 stations SUV< 2.5 *Duhaylongsod FG, Lowe VJ, Patz E, Vaughn AL, Coleman RE, Wolfe W. Detection of primary and recurrent lung cancer by means of F-18 fluorodeoxyglucose positron emission tomography (FDG PET). J. Thorac Cardiovasc Surg 1995;110:130-40

  23. PET/CT and Mediastinoscopy

  24. PET/CT and Mediastinoscopy

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