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Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?

Publication ,  Journal Article
Tandberg, DJ; Gee, NG; Chino, JP; D'Amico, TA; Ready, NE; Coleman, RE; Kelsey, CR
Published in: J Thorac Cardiovasc Surg
October 2013

OBJECTIVE: Many patients with non-small cell lung cancer have positive mediastinal lymph nodes on preoperative positron emission tomography (PET) but do not have mediastinal involvement after surgery. The prognostic significance of this discordance was assessed. METHODS: This Institutional Review Board-approved study evaluated patients treated with upfront surgery at Duke Cancer Institute (Durham, NC) for non-small cell lung cancer from 1995 to 2008. Those staged with PET with pN0-1 disease after negative invasive mediastinal assessment were included. Mediastinal lymph nodes were scored as positive or negative based on visual analysis of the preoperative PET. Clinical outcomes of the PET-positive and PET-negative cohorts were estimated using the Kaplan-Meier method and compared using a log-rank test. Prognostic factors were assessed using a multivariate analysis. RESULTS: A total of 547 patients were assessed, of whom 105 (19%) were PET positive in the mediastinum. The median number of mediastinal lymph node stations sampled was 4 (range, 1-9). The 5-year risk of local recurrence was 26% in PET-positive versus 21% in PET-negative patients (P = .50). Patterns of local failure were similar between the 2 groups. Distant recurrence (35% vs 29%; P = .63) and overall survival (44% vs 54%; P = .52) were comparable for PET-positive and PET-negative patients. On multivariate analysis, a positive PET was not significant for local recurrence (hazard ratio [HR], 1; P = 1), distant recurrence (HR, 0.82; P = .42), or overall survival (HR, 1.08; P = .62). CONCLUSIONS: Patients with positive mediastinal lymph nodes on preoperative PET, but negative on histologic analysis, are not at increased risk of disease recurrence. Pathologic staging remains the standard.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

October 2013

Volume

146

Issue

4

Start / End Page

796 / 801

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Proportional Hazards Models
  • Predictive Value of Tests
  • Positron-Emission Tomography
  • Pneumonectomy
  • North Carolina
 

Citation

APA
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ICMJE
MLA
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Tandberg, D. J., Gee, N. G., Chino, J. P., D’Amico, T. A., Ready, N. E., Coleman, R. E., & Kelsey, C. R. (2013). Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant? J Thorac Cardiovasc Surg, 146(4), 796–801. https://doi.org/10.1016/j.jtcvs.2013.05.027
Tandberg, Daniel J., Nathan G. Gee, Junzo P. Chino, Thomas A. D’Amico, Neal E. Ready, R Edward Coleman, and Chris R. Kelsey. “Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?J Thorac Cardiovasc Surg 146, no. 4 (October 2013): 796–801. https://doi.org/10.1016/j.jtcvs.2013.05.027.
Tandberg DJ, Gee NG, Chino JP, D’Amico TA, Ready NE, Coleman RE, et al. Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant? J Thorac Cardiovasc Surg. 2013 Oct;146(4):796–801.
Tandberg, Daniel J., et al. “Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant?J Thorac Cardiovasc Surg, vol. 146, no. 4, Oct. 2013, pp. 796–801. Pubmed, doi:10.1016/j.jtcvs.2013.05.027.
Tandberg DJ, Gee NG, Chino JP, D’Amico TA, Ready NE, Coleman RE, Kelsey CR. Are discordant positron emission tomography and pathological assessments of the mediastinum in non-small cell lung cancer significant? J Thorac Cardiovasc Surg. 2013 Oct;146(4):796–801.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

October 2013

Volume

146

Issue

4

Start / End Page

796 / 801

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Proportional Hazards Models
  • Predictive Value of Tests
  • Positron-Emission Tomography
  • Pneumonectomy
  • North Carolina