Mediastinal lymph nodes staging by 18F-FDG PET/CT for early stage non-small cell lung cancer: a multicenter study

Accurate staging of mediastinal lymph nodes metastases is critical for determining the application of stereotactic body radiation therapy (SBRT) for patients with early stage non-small cell lung cancer (NSCLC). In this multicenter study the accuracy of (18)F-FDG PET/CT to detect lymph node metastases was evaluated for early stage NSCLC.

The data from the patients with stage1 NSCLC who received preoperative (18)F-FDG PET/CT staging and radical surgery was retrospectively reviewed of five centers from February 2004 to August 2010. The lymph node metastases were confirmed histopathologically after radical surgery. And the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for PET/CT staging.

Two hundred patients were enrolled. The sensitivity, specificity, accuracy, PPV and NPV for lymph node metastases on PET/CT were 44%, 83%, 78%, 29% and 91%, respectively. There were eight and 19 cases positive for lymph node metastases with central (n=62) and peripheral (n=138) NSCLC (P>0.05), respectively.

(18)F-FDG PET/CT was specific in N(0) staging for T(1-2) NSCLC. The NPV was about 91% in clinical N(0) patients, suggested that (18)F-FDG PET/CT may help to accurately stage N(0) patients and thus identify patients for SBRT.