title: Test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours.
abstract: Positron emission tomography-CT (PET-CT) is one of the initial mediastinal staging modality for non-small cell lung cancer; however, the clinical utility in carcinoid tumours is uncertain. We sought to determine the test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours. We collated data from seven institutions, performing a retrospective search on pathological databases for a consecutive series of patients who underwent thoracic surgery (with lymph nodal dissection) for carcinoid tumours with preoperative PET-CT staging. PET-CT results were compared with the reference standard of pathologic results obtained from lymph node dissection and test performance reported using sensitivity and specificity. From November 1999 to January 2013, 247 patients from seven institutions underwent surgery for carcinoid tumours with a corresponding preoperative PET-CT scan. The mean age of the patients was 61 (SD 15, range 73) and 84 were male patients (34%). The pathologic subtype was typical carcinoid in 217 patients (88%) and atypical carcinoid in 30 patients (12%). Results from lymph node dissection were obtained in 207 patients. The calculated sensitivity and specificity of PET-CT to identify mediastinal lymph node disease was 33% (95% CI 4% to 78%) and 94% (95% CI 89% to 97%), respectively. Our results indicate that PET-CT has a poor sensitivity but good specificity to detect the presence of mediastinal lymph node metastases in pulmonary carcinoid tumours. Mediastinal lymph node metastases cannot be ruled out with negative PET-CT uptake, and if the absence of mediastinal lymph node disease is a prerequisite for directing management, tissue sampling should be undertaken.
authors.affiliation: Department of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Holly A
authors.initials: HA
authors.lastname: Pattenden
authors.affiliation: Department of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Leung
authors.affiliation: Department of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Beddow
authors.affiliation: Department of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Dusmet
authors.affiliation: Department of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK National Heart and Lung Division, Imperial College, London, UK.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Nicholson
authors.affiliation: Department of Thoracic Surgery, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Shackcloth
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Saifullah
authors.initials: S
authors.lastname: Mohamed
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Adnan
authors.initials: A
authors.lastname: Darr
authors.affiliation: Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Babu
authors.initials: B
authors.lastname: Naidu
authors.affiliation: Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK.
authors.forename: Swetha
authors.initials: S
authors.lastname: Iyer
authors.affiliation: Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Marchbank
authors.affiliation: Department of Cardiothoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Greenwood
authors.affiliation: Department of Cardiothoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: Doug
authors.initials: D
authors.lastname: West
authors.affiliation: West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Felice
authors.initials: F
authors.lastname: Granato
authors.affiliation: West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Kirk
authors.affiliation: Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK.
authors.forename: Priyadharshanan
authors.initials: P
authors.lastname: Ariyaratnam
authors.affiliation: Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Loubani
authors.affiliation: Department of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK National Heart and Lung Division, Imperial College, London, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
mesh_terms: D000368:Aged; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Imaging/CT MRI etc; Non-Small Cell Lung Cancer; Thoracic Surgery