title: Is there a role for traditional nuclear medicine imaging in the management of pulmonary carcinoid tumours?
abstract: OBJECTIVE
  The clinical utility of fluorodeoxyglucose-positron emission tomography (FDG-PET) and somatostatin receptor scintigraphy (SRS) in pulmonary carcinoids staging is unclear. This study aims to determine the role of FDG-PET and SRS in detecting hilar-mediastinal lymph node metastasis from these tumours.
  
  
  METHODS
  We retrospectively collected the data of 380 patients who underwent lung resection for primary pulmonary carcinoid in seven centres between 2000 and 2015. Patients without nodal sampling ( n  = 78) were excluded. In 302 patients [35% men, median age 58 (interquartile range 47-68) years] the results of preoperative computed tomography (CT) scan, FDG-PET and SRS were analysed and compared to the pathological findings after resection to determine the respective utility of these two nuclear tests.
  
  
  RESULTS
  The sensitivity, specificity and negative predictive value in detecting N1 and N2 disease were respectively 33% and 46%, 93% and 90%, 88% and 95% for computed-tomography-scan, 38% and 60%, 93% and 95%, 88% and 95% for FDG-PET, 22% and 33%, 95% and 98%, 84% and 87% for SRS. The diagnostic accuracy for N1 and N2 disease of CT scan was not significantly different from that of FDG-PET ( P  =   1.0 and P  =   0.37 for N1 and N2 disease respectively) and of SRS ( P  =   0.47 and P  =   0.35 for N1 and N2 disease respectively). The sensitivity and specificity of these imaging tests were also similar when analysed by typical vs atypical histology.
  
  
  CONCLUSIONS
  CT scan, FDG-PET and SRS showed similar performance in terms of nodal staging for pulmonary carcinoid. These findings suggest that additional nuclear imaging beyond CT scan is not required as long as a lymphadenectomy or nodal sampling is completed at resection.
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Cattoni
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Vallières
authors.affiliation: Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Brown
authors.affiliation: Section of General Thoracic Surgery, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Sarkeshik
authors.affiliation: Unit of Thoracic Surgery, Catholic University 'Sacred Heart', Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.affiliation: Unit of Thoracic Surgery, Catholic University 'Sacred Heart', Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Siciliani
authors.affiliation: Center of Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Imperatori
authors.affiliation: Center of Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rotolo
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: Wandell
authors.affiliation: Division of Thoracic Surgery, Providence Regional Medical Center, Everett, WA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Costas
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mann
authors.affiliation: Division of Thoracic Surgery, Virginia Mason Hospital & Seattle Medical Center, Seattle, WA, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Hubka
authors.affiliation: Division of Thoracic Surgery, Virginia Mason Hospital & Seattle Medical Center, Seattle, WA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kaplan
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farivar
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
authors.affiliation: Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
mesh_terms: D000368:Aged; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Computed tomography scan; Fluorodeoxyglucose positron emission tomography ; Mediastinal staging; Pulmonary carcinoid tumours; Somatostatin receptor scintigraphy