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Alva KY Sit
Alan DL Sihoe
Lik Cheung Cheng
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ORIGINAL ARTICLE

Positron-Emission Tomography for Lung Cancer in a Tuberculosis-Endemic Region

Alva KY Sit, MRCS, Alan DL Sihoe, FRCS, Wai Sing Suen, FRCS, Lik Cheung Cheng, FRCS

Division of Cardiothoracic Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China

Alva KY Sit, MRCS, Tel: +852 2855 3973, Fax: +852 2819 4819, Email: alvasit{at}doctor.com, Division of Cardiothoracic Surgery Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China.

ABSTRACT

A potential limitation of integrated positron-emission tomography and computed tomography in non-small-cell lung cancer may be false-positive results due to granulomatous disease. This retrospective study examined the accuracy of this imaging modality for mediastinal nodal staging of non-small-cell lung cancer in Hong Kong where tuberculosis remains endemic. There were 249 lymph node stations evaluated in 107 patients, of whom 38 (36%) had active tuberculosis or evidence of previous tuberculosis. Imaging results were compared with histological findings. The sensitivity, specificity, and accuracy of integrated imaging for mediastinal nodal staging were 52%, 86%, and 80%, respectively; the overall positive-predictive value for mediastinal nodal metastasis was 46%, and the overall negative-predictive value was 89%. The positive-predictive value for mediastinal nodal metastasis was 39% in patients with tuberculosis and 50% in controls; the negative-predictive value was high in both groups (92% and 87%). The likelihood ratio for true positives was 6.47 in patients with tuberculosis vs. 10.97 in controls. This suggests that the reliability of positron-emission/computed tomography may be substantially poorer in patients with tuberculosis. Histological confirmation should be considered mandatory in patients with suspected metastasis on integrated imaging.

Key Words: Lung Neoplasms • Neoplasm Staging • Tomography • Emission-Computed • Tomography • X-Ray Computed • Tuberculosis

Asian Cardiovasc Thorac Ann 2010; 18:33-38
© 2010 by SAGE Publications
DOI: 10.1177/0218492309352119




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