PET-CT has low specificity for mediastinal staging of non-small-cell lung cancer in an endemic area for tuberculosis: a diagnostic test study (LACOG 0114)

Gustavo Werutsky, Bruno Hochhegger, José Antônio Lopes de Figueiredo Pinto, Jeovany Martínez-Mesa, Mara Lise Zanini, Eduardo Herz Berdichevski, Eduardo Vilas, Vinícius Duval da Silva, Maria Teresa Ruiz Tsukazan, Arthur Vieira, Leandro Genehr Fritscher, Louise Hartmann, Marcos Alba, Guilherme Sartori, Cristina Matushita, Vanessa Bortolotto, Rayssa Ruszkowski do Amaral, Luís Carlos Anflor Junior, Facundo Zaffaroni, Carlos H Barrios, Márcio Debiasi, Carlos Cezar Frietscher, Gustavo Werutsky, Bruno Hochhegger, José Antônio Lopes de Figueiredo Pinto, Jeovany Martínez-Mesa, Mara Lise Zanini, Eduardo Herz Berdichevski, Eduardo Vilas, Vinícius Duval da Silva, Maria Teresa Ruiz Tsukazan, Arthur Vieira, Leandro Genehr Fritscher, Louise Hartmann, Marcos Alba, Guilherme Sartori, Cristina Matushita, Vanessa Bortolotto, Rayssa Ruszkowski do Amaral, Luís Carlos Anflor Junior, Facundo Zaffaroni, Carlos H Barrios, Márcio Debiasi, Carlos Cezar Frietscher

Abstract

Background: The present study aims to assess the performance of 18F-FDG PET-CT on mediastinal staging of non-small cell lung cancer (NSCLC) in a location with endemic granulomatous infectious disease.

Methods: Diagnostic test study including patients aged 18 years or older with operable stage I-III NSCLC and indication for a mediastinal lymph node biopsy. All patients underwent a 18F-FDG PET-scan before invasive mediastinal staging, either through mediastinoscopy or thoracotomy, which was considered the gold-standard. Surgeons and pathologists were blinded for scan results. Primary endpoint was to evaluate sensitivity, specificity and positive and negative predictive values of PET-CT with images acquired in the 1st hour of the exam protocol, using predefined cutoffs of maximal SUV, on per-patient basis.

Results: Overall, 85 patients with operable NSCLC underwent PET-CT scan followed by invasive mediastinal staging. Mean age was 65 years, 49 patients were male and 68 were white. One patient presented with active tuberculosis and none had HIV infection. Using any SUV_max > 0 as qualitative criteria for positivity, sensitivity and specificity were 0.87 and 0.45, respectively. Nevertheless, even when the highest SUV cut-off was used (SUV_max ≥5), specificity remained low (0.79), with an estimated positive predictive value of 54%.

Conclusions: Our findings are in line with the most recent publications and guidelines, which recommend that PET-CT must not be solely used as a tool to mediastinal staging, even in a region with high burden of tuberculosis.

Trial registration: The LACOG 0114 study was registered at ClinicalTrials.gov , before study initiation, under identifier NCT02664792.

Keywords: Granulomatous infectious diseases; Mediastinal staging; Non-small cell lung cancer; PET-CT.

Conflict of interest statement

Ethics approval and consent to participate

The study was conducted in compliance with all national and international ethical standards for research with humans and for research using radiopharmaceuticals. All study procedures were approved by the Pontifícia Universidade Católica do Rio Grande do Sul Institutional Ethics Committee (approval number 641.287) and patients gave written informed consent before being enrolled.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
STARD flow diagram for the evaluation of 18F-FDG PET-CT on mediastinal staging of non-small cell lung cancer
Fig. 2
Fig. 2
ROC curve comparing PET-CT performance for images acquired in hour 1 and 2
Fig. 3
Fig. 3
Correlation between maximum SUV and anatomopathological finding for the mediastinal lymphnodes

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