title: Prospective comparative study of integrated positron emission tomography-computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 Non-small-cell lung cancer: a Leuven Lung Cancer Group Study.
abstract: OBJECTIVE
  Mediastinal restaging after induction therapy for non-small-cell lung cancer remains a difficult and controversial issue. The goal of this prospective study was to compare the performance of integrated positron emission tomography (PET)--computed tomography (CT) and remediastinoscopy in the evaluation of mediastinal lymph node metastasis after induction chemotherapy.
  
  
  METHODS
  Thirty consecutive stage IIIA-N2 non-small-cell lung cancer patients surgically treated at our institution were entered onto this prospective study. N2 disease was proven by cervical mediastinoscopy, at which a mean number of 3.8 lymph node levels were biopsied. After completion of induction chemotherapy, the mediastinum was reassessed by integrated PET-CT and remediastinoscopy. All patients underwent thoracotomy with attempted complete resection and systematic nodal dissection.
  
  
  RESULTS
  PET-CT showed no evidence of nodal disease (N0) in 13 patients, Hilar nodal disease (N1) disease in three patients, and residual mediastinal disease (N2) in 14 patients. Remediastinoscopy was positive in only five patients. The preinduction involved lymph node level could be accurately re-evaluated in 18 patients. This was not the case in the other 12 because of extensive fibrosis and adhesions. In 17 patients, persistent N2 disease was found at thoracotomy. The sensitivity, specificity, and accuracy of PET-CT were 77%, 92%, and 83%, respectively. These parameters for remediastinoscopy were 29%, 100%, and 60%, respectively. Sensitivity (P < .0001) and accuracy (P = .012) were significantly better for PET-CT.
  
  
  CONCLUSIONS
  After a thorough staging mediastinoscopy, postinduction remediastinoscopy had a disappointing sensitivity because of adhesions and fibrosis. Integrated PET-CT yielded a better result than that obtained in previous studies with side-by-side PET and CT images.
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Paul.Deleyn@uz.kuleuven.ac.be
authors.forename: Paul
authors.initials: P
authors.lastname: De Leyn
authors.forename: Sigrid
authors.initials: S
authors.lastname: Stroobants
authors.forename: Walter
authors.initials: W
authors.lastname: De Wever
authors.forename: Toni
authors.initials: T
authors.lastname: Lerut
authors.forename: Willy
authors.initials: W
authors.lastname: Coosemans
authors.forename: Georges
authors.initials: G
authors.lastname: Decker
authors.forename: Philippe
authors.initials: P
authors.lastname: Nafteux
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Raemdonck
authors.forename: Luc
authors.initials: L
authors.lastname: Mortelmans
authors.forename: Kristiaan
authors.initials: K
authors.lastname: Nackaerts
authors.forename: Johan
authors.initials: J
authors.lastname: Vansteenkiste
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012074:Remission Induction; D012680:Sensitivity and Specificity; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed