title: Positron-emission tomography for lung cancer in a tuberculosis-endemic region.
abstract: A potential limitation of integrated positron-emission tomography and computed tomography in non-small-cell lung cancer may be false-positive results due to granulomatous disease. This retrospective study examined the accuracy of this imaging modality for mediastinal nodal staging of non-small-cell lung cancer in Hong Kong where tuberculosis remains endemic. There were 249 lymph node stations evaluated in 107 patients, of whom 38 (36%) had active tuberculosis or evidence of previous tuberculosis. Imaging results were compared with histological findings. The sensitivity, specificity, and accuracy of integrated imaging for mediastinal nodal staging were 52%, 86%, and 80%, respectively; the overall positive-predictive value for mediastinal nodal metastasis was 46%, and the overall negative-predictive value was 89%. The positive-predictive value for mediastinal nodal metastasis was 39% in patients with tuberculosis and 50% in controls; the negative-predictive value was high in both groups (92% and 87%). The likelihood ratio for true positives was 6.47 in patients with tuberculosis vs. 10.97 in controls. This suggests that the reliability of positron-emission/computed tomography may be substantially poorer in patients with tuberculosis. Histological confirmation should be considered mandatory in patients with suspected metastasis on integrated imaging.
authors.affiliation: Division of Cardiothoracic Surgery Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China. alvasit@doctor.com
authors.forename: Alva K Y
authors.initials: AK
authors.lastname: Sit
authors.forename: Alan D L
authors.initials: AD
authors.lastname: Sihoe
authors.forename: Wai Sing
authors.initials: WS
authors.lastname: Suen
authors.forename: Lik Cheung
authors.initials: LC
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D015331:Cohort Studies; D015897:Comorbidity; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000453:epidemiology*