The size of mediastinal lymph nodes and its relation with metastatic involvement: A meta-analysis

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) seems to be superior to computed tomography (CT) in staging the mediastinum in patients with non-small-cell lung cancer (NSCLC). However, recent results suggest that FDG-PET performance characteristics are conditional for nodal size as shown by CT: FDG-PET is more sensitive but less specific with lymph node enlargement on CT. The association between size and the probability of malignancy needs to be known to predict the post-test probabilities after PET, and finally, stratify patients for mediastinoscopy or thoracotomy depending on the PET and CT results. Therefore, we performed a meta-analysis of available studies reporting on the prevalence of metastatic involvement for different size categories of enlarged lymph nodes in patients with NSCLC and were able to include 14 studies. The prevalence of metastatic involvement and conditional test performance of CT and FDG-PET were calculated for lymph nodes measuring 10-15 mm, 16-20 mm and >20 mm. We found a post-test probability for N2 disease of 5% for lymph nodes measuring 10-15 mm on CT in patients with a negative FDG-PET result, suggesting that these patients should be planned for thoracotomy because the yield of mediastinoscopy will be extremely low. For patients with lymph nodes measuring ≥16 mm on CT and a negative FDG-PET result a post-test probability for N2 disease of 21% was found, suggesting that these patients should be planned for mediastinoscopy prior to possible thoracotomy to prevent too many unnecessary thoracotomies in this subset.

Original languageEnglish
Pages (from-to)26-29
Number of pages4
JournalEuropean Journal of Cardio-thoracic Surgery
Volume29
Issue number1
DOIs
Publication statusPublished - 1 Jan 2006

Cite this

@article{8839beb1bb8d494590cef7f1efbea54f,
title = "The size of mediastinal lymph nodes and its relation with metastatic involvement: A meta-analysis",
abstract = "Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) seems to be superior to computed tomography (CT) in staging the mediastinum in patients with non-small-cell lung cancer (NSCLC). However, recent results suggest that FDG-PET performance characteristics are conditional for nodal size as shown by CT: FDG-PET is more sensitive but less specific with lymph node enlargement on CT. The association between size and the probability of malignancy needs to be known to predict the post-test probabilities after PET, and finally, stratify patients for mediastinoscopy or thoracotomy depending on the PET and CT results. Therefore, we performed a meta-analysis of available studies reporting on the prevalence of metastatic involvement for different size categories of enlarged lymph nodes in patients with NSCLC and were able to include 14 studies. The prevalence of metastatic involvement and conditional test performance of CT and FDG-PET were calculated for lymph nodes measuring 10-15 mm, 16-20 mm and >20 mm. We found a post-test probability for N2 disease of 5{\%} for lymph nodes measuring 10-15 mm on CT in patients with a negative FDG-PET result, suggesting that these patients should be planned for thoracotomy because the yield of mediastinoscopy will be extremely low. For patients with lymph nodes measuring ≥16 mm on CT and a negative FDG-PET result a post-test probability for N2 disease of 21{\%} was found, suggesting that these patients should be planned for mediastinoscopy prior to possible thoracotomy to prevent too many unnecessary thoracotomies in this subset.",
keywords = "Carcinoma, non-small-cell lung, Fluorodeoxyglucose F18, Lymphatic metastasis, Sensitivity and specificity, Tomography, X-ray computed, FDG PET, Mediastinoscopy, thoracic surgery, cancer diagnostics, Lymph node metastasis, Computed tomography (CT), Mediastinum/pathology",
author = "{De Langen}, {Adrianus J.} and Pieter Raijmakers and Ingrid Riphagen and Paul, {Marinus A.} and Hoekstra, {Otto S.}",
year = "2006",
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language = "English",
volume = "29",
pages = "26--29",
journal = "European Journal of Cardio-thoracic Surgery",
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The size of mediastinal lymph nodes and its relation with metastatic involvement : A meta-analysis. / De Langen, Adrianus J.; Raijmakers, Pieter; Riphagen, Ingrid; Paul, Marinus A.; Hoekstra, Otto S.

In: European Journal of Cardio-thoracic Surgery, Vol. 29, No. 1, 01.01.2006, p. 26-29.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - The size of mediastinal lymph nodes and its relation with metastatic involvement

T2 - A meta-analysis

AU - De Langen, Adrianus J.

AU - Raijmakers, Pieter

AU - Riphagen, Ingrid

AU - Paul, Marinus A.

AU - Hoekstra, Otto S.

PY - 2006/1/1

Y1 - 2006/1/1

N2 - Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) seems to be superior to computed tomography (CT) in staging the mediastinum in patients with non-small-cell lung cancer (NSCLC). However, recent results suggest that FDG-PET performance characteristics are conditional for nodal size as shown by CT: FDG-PET is more sensitive but less specific with lymph node enlargement on CT. The association between size and the probability of malignancy needs to be known to predict the post-test probabilities after PET, and finally, stratify patients for mediastinoscopy or thoracotomy depending on the PET and CT results. Therefore, we performed a meta-analysis of available studies reporting on the prevalence of metastatic involvement for different size categories of enlarged lymph nodes in patients with NSCLC and were able to include 14 studies. The prevalence of metastatic involvement and conditional test performance of CT and FDG-PET were calculated for lymph nodes measuring 10-15 mm, 16-20 mm and >20 mm. We found a post-test probability for N2 disease of 5% for lymph nodes measuring 10-15 mm on CT in patients with a negative FDG-PET result, suggesting that these patients should be planned for thoracotomy because the yield of mediastinoscopy will be extremely low. For patients with lymph nodes measuring ≥16 mm on CT and a negative FDG-PET result a post-test probability for N2 disease of 21% was found, suggesting that these patients should be planned for mediastinoscopy prior to possible thoracotomy to prevent too many unnecessary thoracotomies in this subset.

AB - Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) seems to be superior to computed tomography (CT) in staging the mediastinum in patients with non-small-cell lung cancer (NSCLC). However, recent results suggest that FDG-PET performance characteristics are conditional for nodal size as shown by CT: FDG-PET is more sensitive but less specific with lymph node enlargement on CT. The association between size and the probability of malignancy needs to be known to predict the post-test probabilities after PET, and finally, stratify patients for mediastinoscopy or thoracotomy depending on the PET and CT results. Therefore, we performed a meta-analysis of available studies reporting on the prevalence of metastatic involvement for different size categories of enlarged lymph nodes in patients with NSCLC and were able to include 14 studies. The prevalence of metastatic involvement and conditional test performance of CT and FDG-PET were calculated for lymph nodes measuring 10-15 mm, 16-20 mm and >20 mm. We found a post-test probability for N2 disease of 5% for lymph nodes measuring 10-15 mm on CT in patients with a negative FDG-PET result, suggesting that these patients should be planned for thoracotomy because the yield of mediastinoscopy will be extremely low. For patients with lymph nodes measuring ≥16 mm on CT and a negative FDG-PET result a post-test probability for N2 disease of 21% was found, suggesting that these patients should be planned for mediastinoscopy prior to possible thoracotomy to prevent too many unnecessary thoracotomies in this subset.

KW - Carcinoma, non-small-cell lung

KW - Fluorodeoxyglucose F18

KW - Lymphatic metastasis

KW - Sensitivity and specificity

KW - Tomography, X-ray computed

KW - FDG PET

KW - Mediastinoscopy

KW - thoracic surgery

KW - cancer diagnostics

KW - Lymph node metastasis

KW - Computed tomography (CT)

KW - Mediastinum/pathology

UR - http://www.scopus.com/inward/record.url?scp=29244476223&partnerID=8YFLogxK

U2 - 10.1016/j.ejcts.2005.10.002

DO - 10.1016/j.ejcts.2005.10.002

M3 - Review article

VL - 29

SP - 26

EP - 29

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 1

ER -