Search

Objectives In this study, we aimed to define the efficacy of F-18 FDG PET/CT for the detection of mediastinal lymph node metastases by comparing the mediastinal findings of F-18 FDG PET/CT with the histopathological results obtained either by mediastinoscopy or thoracotomy in patients with clinically operable non-small cell lung cancer (NSCLC).Material and Methods This is a prospective, single-institution study of 68 consecutive patients with suspected or pathologically proven, localized, clinically resectable NSCLC (8 females and 60 males; mean age: 60.36 ± 1.01 years, range: 43-78 years). The patients underwent integrated PET/CT scanning at the same PET center. Standard cervical mediastinoscopy and extended mediastinoscopy were performed to sample the lymph nodes. During thoracotomy, complete mediastinal lymph node dissection was routinely performed.Results Mediastinoscopy gave true positive results in 9 patients and true negative results in 57 patients. There were two false negative results. Mediastinoscopy had a sensitivity of 81.8% (95% CI: 63-82), a specificity of 100% (95% CI: 96-100), a PPV of 100% (95% CI: 77-100), a NPV of 96.6% (95% CI: 93-96), and an accuracy of 97% for the detection of mediastinal lymph node metastases. When PET/CT results were compared with postoperative pathological examination results, PET/CT correctly identified 48 out of 50 patients (96%) who did not have metastatic lymph node involvement. N2/N3 disease was correctly determined by PET/CT in 8 of 11 patients (72.7%) who had positive results on histological analysis. When only N2 and N3 nodal diseases were included in the calculation with the aim of making a comparison with mediastinoscopy (for mediastinal nodes), integrated PET/CT had a sensitivity of 72.7% (95% CI: 51-80), a specificity of 97.7% (95% CI: 92-99), a PPV of 88.9% (95% CI: 62-97), a NPV of 93.3% (95% CI: 88-95) and an accuracy of 92.6% (95% 83-95) for the detection of intrathoracic N2 and N3 nodal metastases.Conclusion Our data shows that due to its high sensitivity and accuracy, mediastinoscopy is still the most reliable method to evaluate mediastinal lymph nodes in patients with NSCLC. [ABSTRACT FROM AUTHOR]

Background: The most widely accepted approach nowadays in nodal staging of non-small cell lung cancer (NSCLC) is the combined use of 18-Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). However, this approach may not be sufficient, especially for early stages., Aims: Our aim was to assess whether more satisfactory results can be obtained with standardized uptake value maximum lymph node/standardized uptake value mean mediastinal blood pool (SUVmax LN/SUVmean MBP), SUVmax LN/Primary tumor, or a novel cut-off value to SUVmax in this special group., Subjects and Methods: Patients with diagnosed NSCLC and underwent FDG-PET/CT were reviewed retrospectively. 168 LNs of 52 early stage NSCLC patients were evaluated. The LNs identified in surgery/pathology reports were found in the FDG-PET/CT images. Anatomic and metabolic parameters were measured. Statistical analysis was performed by using of MedCalc Statistical Software., Results: Regardless of LNs size; sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SUVmax >2.5 were 91.5%, 65.9%, 58.2%, and 95.1%, respectively. Optimum cut-off value of SUVmax was >4.0. Sensitivity, specificity, PPV, and NPV were found as 81.0%, 90.0%, 81.0%, and 90.0% respectively. Optimum cut-off value of SUVmax LN/SUVmean MBP was >1.71. Sensitivity, specificity, PPV, and NPV were found as 94.7%, 80.0%, 71.1%, and 96.7%, respectively. Optimum cut-off value of SUVmax LN/Primary tumor was >0.28. Sensitivity, specificity, PPV, and NPV were found as 81.1%, 85.1%, 72.9% and 90.1%, respectively., Conclusion: SUVmax LN/SUVmean MBP >1.71 has higher PPV than currently used, with similar NPV and sensitivity. This can provide increase in the accuracy of combined approach. In this way, faster nodal staging/treatment decisions, cost savings for healthcare system and time saving of medical professionals can be obtained., Competing Interests: None

Introduction: It's difficult to make a scientific, evidence-based approach about the timing of radioiodine remnant ablation (RRA) in patients with differentiated thyroid carcinomas (DTCs). Primary aim of the study was to reveal whether timing of RRA relates to achievement of non- structurally incomplete response (non-SIR) in low/intermediate and high-risk patients. Another aim was to reveal the correlation of timing with non-SIR status in reproductive-age women., Materials and Methods: Records of 279 low, intermediate, and high-risk patients were analysed, retrospectively. Number of days between surgery and RRA is referred to as timing. Low/intermediate-risk patients, high-risk patients, and low/intermediate-risk reproductive-age women were divided into non-SIR and SIR groups, according to 2015 American Thyroid Association guidelines for therapy response. The relationship between timing and therapy response was analysed statistically., Results: We could not find any significant relationship in patients with low/intermediate risk between timing and non-SIR, including women between 18-49 years of age (p >0.1). For high-risk patients, we found a statistically significant relationship between timing and non-SIR response. According to ROC analysis, RRA ≤58 days was found as a cut-off value. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated as 83.3%, 70.0%, 2.78, and 0.24, respectively., Conclusion: RRA must be initiated within 58 days after surgery in patients with high-risk DTCs. Under this approach, risk of SIR and associated mortality risk may be reduced. RRA timing for women in reproductive ages with low/intermediate risk groups may be planned according to their pregnancy/breastfeeding intent. For other low/intermediate risk groups, they can safely proceed according to the capacity of the medical facility and related logistical considerations., (Copyright © 2019 Sociedad Española de Medicina Nuclear e Imagen Molecular. All rights reserved.)