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

Department of Surgery, VU University Amsterdam, Amsterdamo, North Holland, Netherlands
European Journal of Cardio-Thoracic Surgery (Impact Factor: 3.3). 02/2006; 29(1):26-9. DOI: 10.1016/j.ejcts.2005.10.002
Source: PubMed


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 > or =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.

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Available from: Otto S Hoekstra, Oct 04, 2015
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    • "The microscopic disease in normal sized nodes and LN enlargement caused by benign conditions, limit the diagnostic accuracy of CT for nodal enlargement caused by EC. According to a meta-analysis, the sensitivity and specificity of CT for regional lymph node metastases were 0.50 and 0.83 in thoracic tumor, respectively [20]. In the future study, if the IFI was used, the more accurate diagnostic technique should be performed to avoid the missing of involved node. "
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    ABSTRACT: Since there is high local failure and poor survival for unresectable esophageal squamous cell carcinoma (ESCC), the necessity of elective node irradiation is controversial. The purpose of this study was to investigate the failure patterns and survival in patients with locally advanced ESCC receiving involved-field irradiation (IFI). A retrospective study was preformed on the clinical records of patients with locally advanced ESCC, who have received IFI with concurrent chemotherapy between January 2003 and January 2009. Comparing the target volume and first sites of failure, patterns of failure were defined as in-field, out-of-field regional lymph node and distant failure. The survivals were analyzed by different patterns of failure. Eighty patients were included in our study. With a median follow-up of 52.6 months, failures were observed in 76 patients. In-field recurrence, distant metastasis, and out-of-field regional failure were seen in 53.75%, 41.25%, 30% patients, respectively. There were significant differences in OS for patients with and without in-field (median OS 14.2 vs.17.4 m, P = 0.01)or distant failure(13.2 vs.15.9 m, P <= 0.0001), but not for out-of-field regional lymph node failure(both 14.5 m, P = 0.665). The solitary regional nodal failure of out-of-field was acceptable in advanced ESCC patients treated with IFI. In-field and distant failures remained the predominant patterns and negatively impacted survival more significantly. Further investigation is needed to establish the optimal radiotherapy field for these patients at advanced stage.
    Radiation Oncology 02/2014; 9(1):64. DOI:10.1186/1748-717X-9-64 · 2.55 Impact Factor
    • "They showed that it is better for all of these patients to undergo FDG-PET after CT scan and divided the patients into three groups: group I: 10-15 mm, group II: 16-20 mm, group III: >20 mm. They found that the patients with tumor size: 10-15 mm with negative PET (the possibility of lymph metastasis is < 5%) were not candidates for other methods for obtaining tissue samples; other patients with either positive or negative PET scans were candidates for mediastinoscopy.[5] Another study by Billé, et al. in 2009 showed that lymph node size and the results of negative PET were not accurate for evaluation of the patients in terms of N2 stage involvement and they recommended routinely performing of mediastinoscopy for all patients.[6] "
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    ABSTRACT: Since determining of prognosis and treatment method is related to accurate evaluation of TNM staging of non small cell lung cancer (NSCLC), we aimed to evaluate the role of Video-assisted thoracic surgery (VATS) in staging of NSCLC. This study was performed on 40 patients with NSCLC who had undergone preoperative staging and were candidate for curative surgery between 2008-2010. They underwent VATS immediately before the surgery. After performing VATS, the patients underwent thoracotomy by posterolateral incision unless any criteria of inoperability were present. Diagnostic accuracy of VATS for confirmation or modification of preoperative staging was evaluated. M/F ratio was 21/19. Mean age of the patients was 57.2 ± 16.64 yrs. The most common symptom was coughing in 90% of patients. 72.5% of the patients had endobronchial mass and only for 27.5% tissue sample was obtained by transthoracic needle biopsy (TTNB) method. After performing VATS, 6 patients were excluded from surgery (3 cases (7.5%) due to seeding plural metastasis, 2 cases (5%) due to N2 involvement and one case (2.5%) due to satellite lesion in other lobes). Other 34 patients underwent surgery. Surgical resection was performed successfully in 31 cases (77.5%), but in 3 cases (7.5%) due to adhesion to hillum of the lung tumor was not resectable. According to the above results, VATS diagnosing accuracy was 92.5%. VATS can help to determine TNM staging and prevent unnecessary thoracotomy in some patients and we recommend this method for accurate staging of NSCLC.
    Lung India 03/2013; 30(1):12-5. DOI:10.4103/0970-2113.106120
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    ABSTRACT: Lymph nodes have high clinical relevance and routinely need to be considered in clinical practice. Automatic detection is, however, challenging due to clutter and low contrast. In this paper, a method is presented that fully automatically detects and segments lymph nodes in 3-D computed tomography images of the chest. Lymph nodes can easily be confused with other structures, it is therefore vital to incorporate as much anatomical prior knowledge as possible in order to achieve a good detection performance. Here, a learned prior of the spatial distribution is used to model this knowledge. Different prior types with increasing complexity are proposed and compared to each other. This is combined with a powerful discriminative model that detects lymph nodes from their appearance. It first generates a number of candidates of possible lymph node center positions. Then, a segmentation method is initialized with a detected candidate. The graph cuts method is adapted to the problem of lymph nodes segmentation. We propose a setting that requires only a single positive seed and at the same time solves the small cut problem of graph cuts. Furthermore, we propose a feature set that is extracted from the segmentation. A classifier is trained on this feature set and used to reject false alarms. Cross-validation on 54 CT datasets showed that for a fixed number of four false alarms per volume image, the detection rate is well more than doubled when using the spatial prior. In total, our proposed method detects mediastinal lymph nodes with a true positive rate of 52.0% at the cost of only 3.1 false alarms per volume image and a true positive rate of 60.9% with 6.1 false alarms per volume image, which compares favorably to prior work on mediastinal lymph node detection.
    Medical image analysis 11/2012; 17(2). DOI:10.1016/ · 3.65 Impact Factor
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