Efficacy of helical dynamic CT versus integrated PET/CT for detection of mediastinal nodal metastasis in non-small cell lung cancer.
OBJECTIVE
The purpose of our study was to compare the diagnostic efficacies of helical dynamic CT and integrated PET/CT for the prediction of mediastinal nodal metastasis in stage T1 non-small cell lung cancer (NSCLC).


METHODS
One hundred forty-three patients with stage T1 NSCLC underwent both helical dynamic CT and integrated PET/CT followed by surgical nodal staging. In helical dynamic CT, patients were regarded to have stage N2 disease when a nodule showed a peak enhancement > or = 110 H or a net enhancement > or = 60 H. In integrated PET/CT, nodes were regarded as positive for malignancy when they showed > or = 3.5 in maximum standardized uptake value with a discrete margin and more 18F-FDG uptake than mediastinal structures. Sensitivities, specificities, and accuracies for mediastinal nodal metastasis detection were compared for helical dynamic CT and integrated PET/CT using the McNemar test.


RESULTS
Of the 143 patients, 34 (24%) had positive mediastinal nodes. The sensitivity, specificity, and accuracy for mediastinal nodal metastasis prediction on helical dynamic CT were 65% (22 of 34 patients), 89% (97 of 109), and 83% (119 of 143), respectively, whereas those on integrated PET/CT were 56% (19 of 34), 100% (109 of 109), and 90% (128 of 143). The p values were 0.664, < 0.001, and 0.015.


CONCLUSIONS
In stage T1 NSCLC, contrast-enhanced helical dynamic CT better predicts, but not significantly so, mediastinal nodal metastasis than PET/CT, whereas PET/CT shows perfect specificity and higher accuracy than helical dynamic CT.
Yi
Chin A
CA
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
Lee
Kyung Soo
KS
Kim
Byung-Tae
BT
Shim
Sung Shine
SS
Chung
Myung Jin
MJ
Sung
Yon Mi
YM
Jeong
Sun Young
SY
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000556:secondary*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008175:Lung Neoplasms / Q000175:diagnosis*; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D018511:Systems Integration; D036542:Tomography, Spiral Computed / Q000379:methods*