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Staging of non-small cell lung cancer: clinical value of positron emission tomography and mediastinoscopy

Department of Cardiothoracic Surgery, University Hospital Wuerzburg, Germany

*Corresponding author. Klinik und Poliklinik für Herz- und Thoraxchirurgie der Universität Würzburg, Josef-Schneider-Str. 6, 97080 Würzburg, Germany. Tel.: +49-931-2010; fax: +49-931-201-33447.

E-mail address: Schimmer_C{at}klinik.uni-wuerzburg.de (C. Schimmer).

We report about a MEDLINE research from 2000 to 2005 with the key words ‘positron emission tomography AND/OR mediastinoscopy’. The search identified 448 potential studies. Out of the published data sensitivity, specificity, positive and negative predictive value, and accuracy for mediastinal lymph node staging by FDG-PET ranged from 58%–94%, 76%–96%, 43%–95%, 56%–98% to 74%–91%, respectively. With corresponding values of 80%–96%, 100%, 100%, 92%–97%, and 94%, respectively, for mediastinoscopy. FDG-PET improved the rate of detection of local and distant metastases in 12% to 62% and changed the management of treatment in 8% to 60% of patients with NSCLC. Our study shows that in the diagnostic strategy of patients with NSCLC, additional FDG-PET can prevent non-therapeutic thoracotomy in a significant number of cases. If FDG-PET imaging and CT scan is negative for mediastinal lymph node involvement routinely mediastinoscopy can be omitted and thoracotomy can immediately be performed. In patients with negative FDG-PET scan, but positive CT scan, histologic verification by invasive methods can individually be considered. Patients with positive FDG-PET scan mediastinoscopy still remain a reliable standard for exact lymph node staging. By incorporating FDG-PET in clinical staging unnecessary exploratory thoracotomies, and mediastinoscopy, can be omitted.

Key Words: Non-small cell lung cancer; [¹⁸F]Fluoro-2-deoxy-D-glucose positron emission tomography; Mediastinoscopy; Staging