Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial

Barbara M Fischer; Jann Mortensen; Hanne Hansen; Peter Vilmann; Søren Larsen; Annika Loft; Anne-Katrine Bertelsen; Jesper Ravn; Paul Clementsen; Asbjørn Høegholm; Klaus Richter Larsen; Asger Dirksen; Birgit G Skov; Mark Krasnik; Liselotte Højgaard; Ulrik Lassen; Søren Schytt Larsen; Annika Loft Jakobsen; Anne Kiil Berthelsen

doi:10.1136/thx.2010.154476

Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial

Barbara M Fischer, Jann Mortensen, Hanne Hansen, Peter Vilmann, Søren Larsen, Annika Loft, Anne-Katrine Bertelsen, Jesper Ravn, Paul Clementsen, Asbjørn Høegholm, Klaus Richter Larsen, Asger Dirksen, Birgit G Skov, Mark Krasnik, Liselotte Højgaard, Ulrik Lassen, Søren Schytt Larsen, Annika Loft Jakobsen, Anne Kiil Berthelsen

53 Citations (Scopus)

Abstract

Background: Correct mediastinal staging is a cornerstone in the treatment of patients with non-small cell lung cancer. A large range of methods is available for this purpose, making the process of adequate staging complex. The objective of this study was to describe faults and benefits of positron emission tomography (PET)-CT in multimodality mediastinal staging. Methods: A randomised clinical trial was conducted including patients with a verified diagnosis of non-small cell lung cancer, who were considered operable. Patients were assigned to staging with PET-CT (PET-CT group) followed by invasive staging (mediastinoscopy and/or endoscopic ultrasound with fine needle aspiration (EUS-FNA)) or invasive staging without prior PET-CT (conventional work up (CWU) group). Mediastinal involvement (dichotomising N stage into N0-1 versus N2-3) was described according to CT, PET-CT, mediastinoscopy, EUS-FNA and consensus (based on all available information), and compared with the final N stage as verified by thoracotomy or a conclusive invasive diagnostic procedure. Results: A total of 189 patients were recruited, 98 in the PET-CT group and 91 in the CWU group. In an intention-to-treat analysis the overall accuracy of the consensus N stage was not significantly higher in the PET-CT group than in the CWU group (90% (95% confidence interval 82% to 95%) vs 85% (95% CI 77% to 91%)). Excluding the patients in whom PET-CT was not performed (n=14) the difference was significant (95% (95% CI 88% to 98%) vs 85% (95% CI 77% to 91%), p=0.034). This was mainly based on a higher sensitivity of the staging approach including PET-CT. Conclusion: An approach to lung cancer staging with PET-CT improves discrimination between N0-1 and N2-3. In those without enlarged lymph nodes and a PET-negative mediastinum the patient may proceed directly to surgery. However, enlarged lymph nodes on CT needs confirmation independent of PET findings and a positive finding on PET-CT needs confirmation before a decision on surgery is made. Clinical trial number NCT00867412.

Original language	English
Journal	Thorax
Volume	66
Issue number	4
Pages (from-to)	294-300
Number of pages	7
ISSN	0040-6376
DOIs	https://doi.org/10.1136/thx.2010.154476
Publication status	Published - 1 Apr 2011

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10.1136/thx.2010.154476

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Fischer, B. M., Mortensen, J., Hansen, H., Vilmann, P., Larsen, S., Loft, A., Bertelsen, A.-K., Ravn, J., Clementsen, P., Høegholm, A., Larsen, K. R., Dirksen, A., Skov, B. G., Krasnik, M., Højgaard, L., Lassen, U., Larsen, S. S., Jakobsen, A. L., & Berthelsen, A. K. (2011). Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial. Thorax, 66(4), 294-300. https://doi.org/10.1136/thx.2010.154476

Fischer, BM, Mortensen, J, Hansen, H, Vilmann, P, Larsen, S, Loft, A, Bertelsen, A-K, Ravn, J, Clementsen, P, Høegholm, A, Larsen, KR, Dirksen, A, Skov, BG, Krasnik, M, Højgaard, L , Lassen, U, Larsen, SS, Jakobsen, AL & Berthelsen, AK 2011, 'Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial', Thorax, vol. 66, no. 4, pp. 294-300. https://doi.org/10.1136/thx.2010.154476

@article{70d1af231e1e475a9fde8b94b03a8fe7,

title = "Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial",

abstract = "Background: Correct mediastinal staging is a cornerstone in the treatment of patients with non-small cell lung cancer. A large range of methods is available for this purpose, making the process of adequate staging complex. The objective of this study was to describe faults and benefits of positron emission tomography (PET)-CT in multimodality mediastinal staging. Methods: A randomised clinical trial was conducted including patients with a verified diagnosis of non-small cell lung cancer, who were considered operable. Patients were assigned to staging with PET-CT (PET-CT group) followed by invasive staging (mediastinoscopy and/or endoscopic ultrasound with fine needle aspiration (EUS-FNA)) or invasive staging without prior PET-CT (conventional work up (CWU) group). Mediastinal involvement (dichotomising N stage into N0-1 versus N2-3) was described according to CT, PET-CT, mediastinoscopy, EUS-FNA and consensus (based on all available information), and compared with the final N stage as verified by thoracotomy or a conclusive invasive diagnostic procedure. Results: A total of 189 patients were recruited, 98 in the PET-CT group and 91 in the CWU group. In an intention-to-treat analysis the overall accuracy of the consensus N stage was not significantly higher in the PET-CT group than in the CWU group (90% (95% confidence interval 82% to 95%) vs 85% (95% CI 77% to 91%)). Excluding the patients in whom PET-CT was not performed (n=14) the difference was significant (95% (95% CI 88% to 98%) vs 85% (95% CI 77% to 91%), p=0.034). This was mainly based on a higher sensitivity of the staging approach including PET-CT. Conclusion: An approach to lung cancer staging with PET-CT improves discrimination between N0-1 and N2-3. In those without enlarged lymph nodes and a PET-negative mediastinum the patient may proceed directly to surgery. However, enlarged lymph nodes on CT needs confirmation independent of PET findings and a positive finding on PET-CT needs confirmation before a decision on surgery is made. Clinical trial number NCT00867412.",

author = "Fischer, {Barbara M} and Jann Mortensen and Hanne Hansen and Peter Vilmann and S{\o}ren Larsen and Annika Loft and Anne-Katrine Bertelsen and Jesper Ravn and Paul Clementsen and Asbj{\o}rn H{\o}egholm and Larsen, {Klaus Richter} and Asger Dirksen and Skov, {Birgit G} and Mark Krasnik and Liselotte H{\o}jgaard and Ulrik Lassen and Larsen, {S{\o}ren Schytt} and Jakobsen, {Annika Loft} and Berthelsen, {Anne Kiil}",

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doi = "10.1136/thx.2010.154476",

language = "English",

volume = "66",

pages = "294--300",

journal = "Thorax",

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T1 - Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial

AU - Fischer, Barbara M

AU - Mortensen, Jann

AU - Hansen, Hanne

AU - Vilmann, Peter

AU - Larsen, Søren

AU - Loft, Annika

AU - Bertelsen, Anne-Katrine

AU - Ravn, Jesper

AU - Clementsen, Paul

AU - Høegholm, Asbjørn

AU - Larsen, Klaus Richter

AU - Dirksen, Asger

AU - Skov, Birgit G

AU - Krasnik, Mark

AU - Højgaard, Liselotte

AU - Lassen, Ulrik

AU - Larsen, Søren Schytt

AU - Jakobsen, Annika Loft

AU - Berthelsen, Anne Kiil

PY - 2011/4/1

Y1 - 2011/4/1

N2 - Background: Correct mediastinal staging is a cornerstone in the treatment of patients with non-small cell lung cancer. A large range of methods is available for this purpose, making the process of adequate staging complex. The objective of this study was to describe faults and benefits of positron emission tomography (PET)-CT in multimodality mediastinal staging. Methods: A randomised clinical trial was conducted including patients with a verified diagnosis of non-small cell lung cancer, who were considered operable. Patients were assigned to staging with PET-CT (PET-CT group) followed by invasive staging (mediastinoscopy and/or endoscopic ultrasound with fine needle aspiration (EUS-FNA)) or invasive staging without prior PET-CT (conventional work up (CWU) group). Mediastinal involvement (dichotomising N stage into N0-1 versus N2-3) was described according to CT, PET-CT, mediastinoscopy, EUS-FNA and consensus (based on all available information), and compared with the final N stage as verified by thoracotomy or a conclusive invasive diagnostic procedure. Results: A total of 189 patients were recruited, 98 in the PET-CT group and 91 in the CWU group. In an intention-to-treat analysis the overall accuracy of the consensus N stage was not significantly higher in the PET-CT group than in the CWU group (90% (95% confidence interval 82% to 95%) vs 85% (95% CI 77% to 91%)). Excluding the patients in whom PET-CT was not performed (n=14) the difference was significant (95% (95% CI 88% to 98%) vs 85% (95% CI 77% to 91%), p=0.034). This was mainly based on a higher sensitivity of the staging approach including PET-CT. Conclusion: An approach to lung cancer staging with PET-CT improves discrimination between N0-1 and N2-3. In those without enlarged lymph nodes and a PET-negative mediastinum the patient may proceed directly to surgery. However, enlarged lymph nodes on CT needs confirmation independent of PET findings and a positive finding on PET-CT needs confirmation before a decision on surgery is made. Clinical trial number NCT00867412.

AB - Background: Correct mediastinal staging is a cornerstone in the treatment of patients with non-small cell lung cancer. A large range of methods is available for this purpose, making the process of adequate staging complex. The objective of this study was to describe faults and benefits of positron emission tomography (PET)-CT in multimodality mediastinal staging. Methods: A randomised clinical trial was conducted including patients with a verified diagnosis of non-small cell lung cancer, who were considered operable. Patients were assigned to staging with PET-CT (PET-CT group) followed by invasive staging (mediastinoscopy and/or endoscopic ultrasound with fine needle aspiration (EUS-FNA)) or invasive staging without prior PET-CT (conventional work up (CWU) group). Mediastinal involvement (dichotomising N stage into N0-1 versus N2-3) was described according to CT, PET-CT, mediastinoscopy, EUS-FNA and consensus (based on all available information), and compared with the final N stage as verified by thoracotomy or a conclusive invasive diagnostic procedure. Results: A total of 189 patients were recruited, 98 in the PET-CT group and 91 in the CWU group. In an intention-to-treat analysis the overall accuracy of the consensus N stage was not significantly higher in the PET-CT group than in the CWU group (90% (95% confidence interval 82% to 95%) vs 85% (95% CI 77% to 91%)). Excluding the patients in whom PET-CT was not performed (n=14) the difference was significant (95% (95% CI 88% to 98%) vs 85% (95% CI 77% to 91%), p=0.034). This was mainly based on a higher sensitivity of the staging approach including PET-CT. Conclusion: An approach to lung cancer staging with PET-CT improves discrimination between N0-1 and N2-3. In those without enlarged lymph nodes and a PET-negative mediastinum the patient may proceed directly to surgery. However, enlarged lymph nodes on CT needs confirmation independent of PET findings and a positive finding on PET-CT needs confirmation before a decision on surgery is made. Clinical trial number NCT00867412.

U2 - 10.1136/thx.2010.154476

DO - 10.1136/thx.2010.154476

M3 - Journal article

C2 - 21169287

SN - 0040-6376

VL - 66

SP - 294

EP - 300

JO - Thorax

JF - Thorax

IS - 4

ER -

Multimodality approach to mediastinal staging in non-small cell lung cancer. Faults and benefits of PET-CT: a randomised trial

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