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Audit, research and guideline update
Test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours
  1. Holly A Pattenden1,
  2. Maria Leung1,
  3. Emma Beddow1,
  4. Michael Dusmet1,
  5. Andrew G Nicholson1,2,
  6. Michael Shackcloth3,
  7. Saifullah Mohamed4,
  8. Adnan Darr4,
  9. Babu Naidu4,
  10. Swetha Iyer5,
  11. Adrian Marchbank5,
  12. Amy Greenwood6,
  13. Doug West6,
  14. Felice Granato7,
  15. Alan Kirk7,
  16. Priyadharshanan Ariyaratnam8,
  17. Mahmoud Loubani8,
  18. Eric Lim1,2,
  19. on behalf of the UK Thoracic Surgery Collaborative
  1. 1Department of Thoracic Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK
  2. 2National Heart and Lung Division, Imperial College, London, UK
  3. 3Department of Thoracic Surgery, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK
  4. 4Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK
  5. 5Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK
  6. 6Department of Cardiothoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
  7. 7West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
  8. 8Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, UK
  1. Correspondence to Eric Lim, Academic Division of Thoracic Surgery, The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; e.lim{at}rbht.nhs.uk

Abstract

Positron emission tomography-CT (PET-CT) is one of the initial mediastinal staging modality for non-small cell lung cancer; however, the clinical utility in carcinoid tumours is uncertain. We sought to determine the test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours. We collated data from seven institutions, performing a retrospective search on pathological databases for a consecutive series of patients who underwent thoracic surgery (with lymph nodal dissection) for carcinoid tumours with preoperative PET-CT staging. PET-CT results were compared with the reference standard of pathologic results obtained from lymph node dissection and test performance reported using sensitivity and specificity. From November 1999 to January 2013, 247 patients from seven institutions underwent surgery for carcinoid tumours with a corresponding preoperative PET-CT scan. The mean age of the patients was 61 (SD 15, range 73) and 84 were male patients (34%). The pathologic subtype was typical carcinoid in 217 patients (88%) and atypical carcinoid in 30 patients (12%). Results from lymph node dissection were obtained in 207 patients. The calculated sensitivity and specificity of PET-CT to identify mediastinal lymph node disease was 33% (95% CI 4% to 78%) and 94% (95% CI 89% to 97%), respectively. Our results indicate that PET-CT has a poor sensitivity but good specificity to detect the presence of mediastinal lymph node metastases in pulmonary carcinoid tumours. Mediastinal lymph node metastases cannot be ruled out with negative PET-CT uptake, and if the absence of mediastinal lymph node disease is a prerequisite for directing management, tissue sampling should be undertaken.

  • Imaging/CT MRI etc
  • Thoracic Surgery
  • Non-Small Cell Lung Cancer

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