PURPOSE: Objectives: Survival for patients with lung cancer is strongly affected by metastasis to lymph nodes. Patients with N2 disease have a poor prognosis so most surgeons would offer surgery for stages Ia to IIb only, whether de-novo or post neo-adjuvant treatment. Early, appropriate identification of N2 disease is thus crucial. In England, funding for routine PET scan before radical treatment has become a government driven target. We analysed our results since introducing routine PET-CT.
METHODS: Methods: Since January 2004, all patients having curative surgery treated in a single institution had a CT-PET scan with histological confirmation of positive mediastinal nodes only (Group A). During the two years prior to this date, histological confirmation was only obtained when the CT short-axis diameter nodal was greater than 1 cm (Group B). All patients with occult N2 disease had adjuvant chemotherapy.
RESULTS: Results: Nodal stage in Group A was N0 69 (67.0%), N1 23 (23.3%), N2 11 (10.7%) and in Group B N0 41 (56.9%), N1 39 (22.2%) and N2 15 (20.8%) respectively. There significantly more occult N2 patients in Group B, p=0.08 for trend. One patient in Group B was down-staged with neo-adjuvant chemotherapy. Median survival (days) with occult N2 disease was 569 for Group A and 566 for Group B, p=0.98. In Group A survival for N1 was not different to N2 survival (570, p=0.99).
CONCLUSION: Conclusions: Routine CT-PET scanning with selective mediastinoscopy halves occult N2 disease compared to CT and selective mediastinoscopy. In this context false negative PET does not affect survival. Furthermore, routine mediastinoscopy or intra-operative nodal sampling is not justified.
CLINICAL IMPLICATIONS: Routine PET scanning is sufficient preoperative staging for lung cancer. Pre-operative mediastinoscopy or secondary intra-operative nodal sampling is not justified. Survival with limited N2 disease warrants radical/curative treatment with surgical resection.
DISCLOSURE: Edward Black, None.