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Current Oncology
Volume 21
Issue 6
10.3747/co.21.2125
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

Using pet-ct to Reduce Futile Thoracotomy Rates in Non-Small-Cell Lung Cancer: A Population-Based Review

by
M. Smoragiewicz
1,*,
J. Laskin
1,
D. Wilson
1,
K. Ramsden
1,
J. Yee
2,
S. Lam
1,
T. Shaipanich
1,
Y. Zhai
3 and
C. Ho
1
1
British Columbia Cancer Agency, Vancouver, BC, Canada
2
Vancouver General Hospital, Vancouver, BC, Canada
3
Department of Statistics, University of British Columbia, Vancouver, BC, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2014, 21(6), 768-774; https://doi.org/10.3747/co.21.2125
Submission received: 3 September 2014 / Revised: 10 October 2014 / Accepted: 11 November 2014 / Published: 1 December 2014

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

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MDPI and ACS Style

Smoragiewicz, M.; Laskin, J.; Wilson, D.; Ramsden, K.; Yee, J.; Lam, S.; Shaipanich, T.; Zhai, Y.; Ho, C. Using pet-ct to Reduce Futile Thoracotomy Rates in Non-Small-Cell Lung Cancer: A Population-Based Review. Curr. Oncol. 2014, 21, 768-774. https://doi.org/10.3747/co.21.2125

AMA Style

Smoragiewicz M, Laskin J, Wilson D, Ramsden K, Yee J, Lam S, Shaipanich T, Zhai Y, Ho C. Using pet-ct to Reduce Futile Thoracotomy Rates in Non-Small-Cell Lung Cancer: A Population-Based Review. Current Oncology. 2014; 21(6):768-774. https://doi.org/10.3747/co.21.2125

Chicago/Turabian Style

Smoragiewicz, M., J. Laskin, D. Wilson, K. Ramsden, J. Yee, S. Lam, T. Shaipanich, Y. Zhai, and C. Ho. 2014. "Using pet-ct to Reduce Futile Thoracotomy Rates in Non-Small-Cell Lung Cancer: A Population-Based Review" Current Oncology 21, no. 6: 768-774. https://doi.org/10.3747/co.21.2125

APA Style

Smoragiewicz, M., Laskin, J., Wilson, D., Ramsden, K., Yee, J., Lam, S., Shaipanich, T., Zhai, Y., & Ho, C. (2014). Using pet-ct to Reduce Futile Thoracotomy Rates in Non-Small-Cell Lung Cancer: A Population-Based Review. Current Oncology, 21(6), 768-774. https://doi.org/10.3747/co.21.2125

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