title: Stage T1 non-small cell lung cancer: preoperative mediastinal nodal staging with integrated FDG PET/CT--a prospective study.
abstract: OBJECTIVE
  To prospectively evaluate the sensitivity and specificity of integrated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) (PET/CT) for the preoperative diagnosis of mediastinal nodal metastasis in stage T1 non-small cell lung cancer (NSCLC), with surgical and histologic results as reference standards.
  
  
  METHODS
  Institutional review board approval and informed consent were obtained. From June 2003 to February 2005, 150 patients (89 men and 61 women; mean age, 59 years) with stage T1 NSCLC at stand-alone CT underwent integrated PET/CT and surgical staging. Two observers (one radiologist and one nuclear medicine physician) evaluated prospectively and in consensus the mediastinal nodes by analyzing both PET (functional) and CT (anatomic) images. Nodal stages were determined by using the American Joint Committee on Cancer staging system and surgical and histologic findings as the reference standard. Statistical evaluation of malignant lymph nodes was performed on per-nodal-station and per-person bases.
  
  
  RESULTS
  A total of 568 mediastinal nodal stations were evaluated. Nodes were positive for malignancy in 34 (23%) of 150 patients and 55 (10%) of 568 nodal stations. For depiction of malignant nodes, the respective sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of integrated PET/CT were 42% (23 of 55), 100% (513 of 513), 100% (23 of 23), 94% (513 of 545), and 94% (536 of 568) on per-nodal-station basis and 47% (16 of 34), 100% (116 of 116), 100% (16 of 16), 87% (116 of 134), and 88% (132 of 150) on a per-patient basis.
  
  
  CONCLUSIONS
  Integrated FDG PET/CT provides high specificity and positive predictive value of mediastinal nodal staging in stage T1 NSCLC, although the sensitivity is low.
authors.affiliation: Department of Nuclear Medicine, Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Byung-Tae
authors.initials: BT
authors.lastname: Kim
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
authors.forename: Sung Shine
authors.initials: SS
authors.lastname: Shim
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Choi
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
authors.forename: Hojoong
authors.initials: H
authors.lastname: Kim
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.forename: Jhingook
authors.initials: J
authors.lastname: Kim
authors.forename: Seonwoo
authors.initials: S
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18