The high sensitivity of PET-CT may safe scarce financial resources in developing countries: The LACOG-0114 Study

Introduction: Mediastinal evaluation is critical for therapeutic decision in operable non-small cell lung cancer (NSCLC). This analysis aims to evaluate the sensibility and the negative predictive value (NPV) of PET-CT in mediastinal staging NSCLC patients in Brazil. Methods: Patients with stages I-III NSCLC underwent PET-CT before invasive mediastinal staging. Exams showing mediastinal uptake = 0 (zero) SUV were considered negative. This abstract shows the sensitivity and the NPV associated with PET-CT when this extremely sensitive cut-of is considered. Results: From Aug/2014 to Aug/2016, 85 patients who were submitted to mediastinoscopy after PET-CT were enrolled in this study. Median age was 65 years (range 47-80). At baseline, 49 (58%) patients were male, 68 (80%) white and 80 (94%) current or former smokers. Mediastinal involvement was 27% (23/85) confirmed by histopathological evaluation. PET-CT demonstrated sensitivity of 87% (95% CI 66%–97%) and NPV of 90% (95% CI 76%–97%). Conclusion: These findings demonstrate that PET-CT shows a high sensitivity and NPV when SUV > 0 is used as cut of for positivity. This real world data creates an opportunity for health care professionals and policy makers to consider not performing invasive mediastinal staging when facing a negative PET-CT. However, caution must be taken in the clinical decision of foregoing mediastinoscopy before surgery with a negative PET-CT because other factors such as the expected local prevalence of mediastinal involvement (pretest probability of mediastinal metastasis) must also be considered. * This study was supported by CNPq (Brazilian National Council of Scientific and Technological Development)