Curr Oncol. 2014 Dec;21(6):e768-74. doi: 10.3747/co.21.2125.

Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review.

Current oncology (Toronto, Ont.)

M Smoragiewicz, J Laskin, D Wilson, K Ramsden, J Yee, S Lam, T Shaipanich, Y Zhai, C Ho

PMID: 25489265 PMCID: PMC4257121 DOI: 10.3747/co.21.2125

Abstract

BACKGROUND: Combined positron-emission tomography and computed tomography (pet-ct) reduces futile thoracotomy (ft) rates in patients with non-small-cell lung cancer (nsclc). We sought to identify preoperative risk factors for ft in patients staged with pet-ct.

METHODS: We retrospectively reviewed all patients referred to the BC Cancer Agency during 2009-2010 who underwent pet-ct and thoracotomy for nsclc. Patients with clinical N2 disease were excluded. An ft was defined as any of a benign lesion; an exploratory thoracotomy; pathologic N2 or N3, stage iiib or iv, or inoperable T3 or T4 disease; and recurrence or death within 1 year of surgery.

RESULTS: Of the 108 patients who met the inclusion criteria, ft occurred in 27. The main reason for ft was recurrence within 1 year (14 patients) and pathologic N2 disease (10 patients). On multivariate analysis, an Eastern Cooperative Oncology Group performance status greater than 1, a pet-ct positive N1 status, a primary tumour larger than 3 cm, and a period of more than 16 weeks from pet-ct to surgery were associated with ft. N2 disease that had been negative on pet-ct occurred in 21% of patients with a pet-ct positive N1 status and in 20% of patients with tumours larger than 3 cm and non-biopsy mediastinal staging only. The combination of pet-ct positive N1 status and a primary larger than 3 cm had 85% specificity, and the presence of either risk factor had 100% sensitivity, for ft attributable to N2 disease.

CONCLUSIONS: To reduce ft attributable to N2 disease, tissue biopsy for mediastinal staging should be considered for patients with pet-ct positive N1 status and with tumours larger than 3 cm even with a pet-ct negative mediastinum.

Keywords: Non-small-cell lung cancer; endobronchial ultrasonography; endoscopic ultrasonography; lymphatic metastasis or pathology; mediastinal staging; mediastinoscopy; positron-emission tomography–computed tomography; thoracotomy

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