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Predictors of mediastinal staging and usefulness of PET in patients with stage IIIA (N2) or IIIB (N3) lung cancer

The Clinical Respiratory Journal Sep 11, 2020

Gullón JA, Villanueva MA, Sánchez‐Antuña AA, et al. - By analyzing data from patients with non‐small cell lung cancer (NSCLC) who underwent EBUS‐TBNA, researchers investigated the factors that could predict mediastinal N2/N3 lymph node staging as well as if PET and CT have the diagnostic accuracy to determine it. This study involved 134 patients. Of these, definitive lymph node staging was N2 or N3 in 88 (65.6%). Univariate analysis revealed the association of following factors with N2/N3: primary tumor of central location, lymph node size, maximum standardized uptake value of lymph node and radiographic N stage by CT or PET. However, in logistic regression model, N2/N3 was shown to be only independently associated with N stage by CT or PET. CT had a negative predictive value of 0.81 and a positive predictive value of 0.74, and these values were 0.78 and 0.68 for PET, respectively. Overall, findings revealed that the existence of N2/N3 mediastinal disease in NSCLC was predicted by radiographic staging by CT or PET in locoregional disease, but the inadequacy of negative and positive predictive values of both imaging methods was also evident. Experts recommended obtaining EBUS‐TBNA samples in all lymph nodes with a diameter greater than 5 mm, irrespective of PET findings.

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