1. Tha role of FDG-PET for Mediastinal Staging in Primary Lung Cancer
Osman Eroğlu, Sedat Ziyade, Alper Toker,
Serhan Tanju, Sukru Dilege, Goksel Kalaycı
Istanbul Universty
Istanbul Medical School
Department of Thoracic Surgery

2. Mediastinal Evaluation in Lung Cancer
Non-invasive CT
FDG-PET
Invasive
FOB-TTFNA
Mediastinoscopy/tomy
VATS
EUS FNA tt/te

3. Patients & Methods “November 2001-January 2005”
Patients who had cytologicaly prooved lung cancer without a distant metastases.
Technicaly resectable lung cancer patients.
Physiologicaly operable patients in terms of cadiopulmonary evaluations.
Patients with chest CT not longer than 45 days.
The duration between chest CT and PET not longer than 1 month.
Patients without a neoadjuvant chemotherapy nor radiotherapy
Patients who did not have PET after a kind of induction treatment.
Patients without a diagnosis of Diabetes Mellitus.
Patients without a history of tuberculosis.
53 patients
Age, gender,histology,localisation of tumor, PET, CT, surgery, pathology

4. Method
Stations were detected with PET-scan in case of suv max was graeter than 2,5
Diameter of mediastinal lymph node in same station was evaluated with CT,
Lymph nodes which were sampled from same region, were recorded.

5. Method Mediastinoscopy, superior mediastinal suvmax >2.5
Cervical and/or extented
VATS, inferior mediastinal suvmax >2.5
Thoracotomy- sudmax <2.5 all mediastinal stations, lymph nodes not in pathological diameter
Mountain Staging

6. Method
The patients who had positive lymph nodes with mediastinoscopy and VATS were exculuded from study
Thoracotomy was performed to patients who had negative mediastinoscopy or uptake value lower than suv max 2,5 in PET
Systematic lymph node sampling was performed during thoracotomy.
Statisticaly analyzed spesifically to patient / lymph node station.

7. Results
53 patients
45 M / 8 F
Mean age 63.9 (49-75)

9. Mediastinal Evaluation in Patients “PET”

10. Lymph Node Based Mediastinal Evaluation

11. Histopathological type/PET
Squamous ca Adenocarcinoma
p>0.05

12. Lymph node station/PET
2R 2L
4R 4L

13. Lymph node station/PET 7

14. Mediastinal Evaluation PET vs CT

15. Result Kernstine (1999) Cerfolio (2003) Gonzales (2003) Kelly (2004)
Sensitivity %70, specificity %86
Cerfolio (2003)
Sensitivity %71, specificity %77, PPD %44, NPD %91
Gonzales (2003)
Sensitivity %64, specificity %77, PPD 44, NPD %88
Kelly (2004)
Sensitivity %62, specificity %98, PPD %89, NPD %92
İstanbul Tıp Fakültesi (2005)
Sensitivity %65, specificity %86, PPD %52, NPD %91

16. Result Specitivity %86 Sensitivity %65 PPD %52 NPD %91
Same as CT
Sensitivity %65
Higher than CT p<0.05
PPD %52
NPD %91
False positivity % 47,5
Antrocosis
False negativity % 8,3
Subcapsular micrometases

17. Result Squamous vs adeno Lymph node station
PET (+) mediastinoscopy (%47,5)
PET (-), BT (-) thoracotomy (%8,3)