title: Accuracy of positron emission tomography in identifying hilar (N1) lymph node involvement in non-small cell lung cancer: Implications for stereotactic body radiation therapy.
abstract: OBJECTIVE
  To assess the efficacy of preoperative positron emission tomography (PET) to stage the ipsilateral hilum in resected non-small cell lung cancer (NSCLC).
  
  
  METHODS
  All patients who underwent surgery for NSCLC between 1995 and 2008 were evaluated. Patients who underwent preoperative PET imaging at our institution and had hilar nodal sampling were included. Those whose primary tumors extended to the hilum or who received preoperative chemotherapy or radiation therapy were excluded. All PET studies were interpreted by an attending nuclear medicine radiologist and were scored as positive or negative in the hilum or peribronchial area based on visual analysis alone. A 2-sided Fisher exact test compared patient subgroups.
  
  
  RESULTS
  During the time interval, 1558 patients underwent surgery for NSCLC, of whom 484 were eligible for this analysis. The ipsilateral hilum was positive on preoperative PET in 107 patients. The median number of N1 lymph nodes sampled was 4 (range, 1-31). Positive ipsilateral N1 lymph nodes were identified pathologically in 91 patients (19%). Among the 91 patients with involved N1 lymph nodes, 40 were PET positive resulting in a sensitivity of 44%. Among 393 patients without pathologic involvement of hilar lymph nodes, 326 were PET negative resulting in a specificity of 83%. The positive predictive and negative predictive values were 37% and 86%, respectively.
  
  
  CONCLUSIONS
  Positron emission tomography appears to have limitations in staging the ipsilateral hilar lymph nodes. Invasive sampling is appropriate if treatment would differ based on the nodal status.
authors.affiliation: Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pepek
authors.affiliation: Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.affiliation: Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Neal E
authors.initials: NE
authors.lastname: Ready
authors.affiliation: Department of Radiology, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Nathan G
authors.initials: NG
authors.lastname: Gee
authors.affiliation: Department of Radiology, Division of Nuclear Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: R Edward
authors.initials: RE
authors.lastname: Coleman
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.affiliation: Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina. Electronic address: christopher.kelsey@duke.edu.
authors.forename: Chris R
authors.initials: CR
authors.lastname: Kelsey
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; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods