title: Mediastinal staging in Non-Small-Cell Lung Carcinoma: computed tomography versus F-18-fluorodeoxyglucose positron-emission tomography and computed tomography.
abstract: BACKGROUND
  After the diagnosis Non-Small-Cell Lung Carcinoma (NSCLC) has been established, consideration must turn toward the stage of disease, because this will impact directly on management and prognosis. Staging is used to predict survival and to guide the patient toward the most appropriate treatment regimen or clinical trial. Distinguishing malignant involvement of the mediastinal lymph nodes (N2 or N3) from the hilar lymph nodes, or no lymph nodes (N0 or N1) is critical, because malignant involvement of N2 or N3 lymph nodes usually indicates non-surgically resectable disease. The purpose of this study was to examine and compare CT versus integrated F18-FDG PET/low dose CT (FDG PET/CT) for mediastinal staging in NSCLC, and the desire was to safely distinguish between malignant and benign lesions without the need for invasive procedures. All results were controlled for reproducibility.
  
  
  METHODS
  114 participants with NSCLC were included in a prospective cohort study. Blinded CT and FDG PET/CT images were reviewed. The participants' mediastinums were staged based on lymph node sizes (CT), or on FDG uptake (FDG PET/CT). Reference standard was tissue sampling.
  
  
  RESULTS
  We found that there was no measureable difference between CT and FDG PET/CT mediastinal staging results; overall two-thirds of the participants in the study were correctly staged, and almost one-third of the participants were falsely staged.
  
  
  CONCLUSIONS
  Neither CT nor FDG PET/CT could obviate the need for further invasive staging prior to thoracotomy in patients with NSCLC; for that purpose, the results of both modalities were too meagre. Therefore, these patients still depend on invasive staging methods. In our study, invasive staging was accomplished by mediastinoscopy. However, today this is increasingly replaced by EBUS or EUS.
authors.forename: Stefan Walbom
authors.initials: SW
authors.lastname: Harders
authors.forename: Hans Henrik
authors.initials: HH
authors.lastname: Madsen
authors.forename: Karin
authors.initials: K
authors.lastname: Hjorthaug
authors.forename: Anne Kirstine
authors.initials: AK
authors.lastname: Arveschoug
authors.forename: Torben Riis
authors.initials: TR
authors.lastname: Rasmussen
authors.forename: Peter
authors.initials: P
authors.lastname: Meldgaard
authors.forename: Johanne Andersen
authors.initials: JA
authors.lastname: Hoejbjerg
authors.forename: Hans Kristian
authors.initials: HK
authors.lastname: Pilegaard
authors.forename: Henrik
authors.initials: H
authors.lastname: Hager
authors.forename: Michael
authors.initials: M
authors.lastname: Rehling
authors.forename: Finn
authors.initials: F
authors.lastname: Rasmussen
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008482:Mediastinum / Q000473:pathology*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18