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Mediastinal Lymph Node Staging by Means of Positron Emission Tomography Is Less Sensitive in Elderly Patients with Non-Small-Cell Lung Cancer

2008; Elsevier BV; Volume: 9; Issue: 1 Linguagem: Inglês

10.3816/clc.2008.n.007

1938-0690

Nael Al-Sarraf, Kathy Gately, Julie Lucey, Lorraine Wilson, Eillish McGovern, Vincent Young,

Medical Imaging Techniques and Applications

Abstract PURPOSE We sought to identify the impact of age on the sensitivity and specificity of integrated positron emission tomography/computed tomography (PET-CT; CT) on mediastinal lymph node staging of patients with non–small-cell lung cancer (NSCLC). PATIENTS AND METHODS We conducted a retrospective review of 206 consecutive patients with histologically proven NSCLC who underwent resection and/or mediastinoscopy in our center between September 2004 and January 2007. All of these patients had preoperative staging with integrated PET-CT as an adjunct to chest CT before resection and/or mediastinoscopy. Diabetic patients and patients who received neoadjuvant chemotherapy were excluded. The pathologic results of all of these cases were reviewed and correlated with those on CT and integrated PET-CT. RESULTS The sensitivity and positive predictive values (PPV) of PET-CT in mediastinal nodal staging were significantly lower in elderly patients (age ≥ 65 years; sensitivity, 42%; PPV, 66%) than in younger patients (age < 65 years; sensitivity, 52%; PPV, 74%). Specificity and negative predictive values were similar in both groups. CONCLUSION PET-CT staging of the mediastinum is less sensitive in elderly patients with NSCLC who have a lower PPV. Positive mediastinal uptake on PET-CT should be verified by mediastinoscopy, irrespective of age. Elderly patients with positive mediastinal uptake should not be refuted a curative intent surgical resection on the basis of positive mediastinal uptake alone.