| Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). | |
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MedLine Citation:
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PMID: 17873168 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Correctly staging lung cancer is important because the treatment options and the prognosis differ significantly by stage. Several noninvasive imaging studies including chest CT scanning and positron emission tomography (PET) scanning are available. Understanding the test characteristics of these noninvasive staging studies is critical to decision making. METHODS: Test characteristics for the noninvasive staging studies were updated from the first iteration of the lung cancer guidelines using systematic searches of the MEDLINE, HealthStar, and Cochrane Library databases up to May 2006, including selected metaanalyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables. RESULTS: The pooled sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were 51% (95% confidence interval [CI], 47 to 54%) and 85% (95% CI, 84 to 88%), respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, the pooled estimates of sensitivity and specificity for identifying mediastinal metastasis were 74% (95% CI, 69 to 79%) and 85% (95% CI, 82 to 88%), respectively. These findings demonstrate that PET scanning is more accurate than CT scanning. If the clinical evaluation in search of metastatic disease is negative, the likelihood of finding metastasis is low. CONCLUSIONS: CT scanning of the chest is useful in providing anatomic detail, but the accuracy of chest CT scanning in differentiating benign from malignant lymph nodes in the mediastinum is poor. PET scanning has much better sensitivity and specificity than chest CT scanning for staging lung cancer in the mediastinum, and distant metastatic disease can be detected by PET scanning. With either test, abnormal findings must be confirmed by tissue biopsy to ensure accurate staging. |
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Authors:
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Gerard A Silvestri; Michael K Gould; Mitchell L Margolis; Lynn T Tanoue; Douglas McCrory; Eric Toloza; Frank Detterbeck; |
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Publication Detail:
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Type: Journal Article; Practice Guideline |
Journal Detail:
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Title: Chest Volume: 132 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 2007 Sep |
Date Detail:
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Created Date: 2007-09-17 Completed Date: 2007-10-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 178S-201S Citation Subset: AIM; IM |
Affiliation:
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Medical University of South Carolina, Department of Pulmonary and Critical Care Medicine, 171 Ashley Ave, Room 812-CSB, Charleston, SC 29425-2220, USA. silvestri@musc.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Carcinoma, Non-Small-Cell Lung
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pathology* Clinical Trials as Topic Diagnosis, Differential Evidence-Based Medicine Humans Lung Neoplasms / pathology* Lymphatic Metastasis Neoplasm Staging Positron-Emission Tomography Sensitivity and Specificity Tomography, X-Ray Computed |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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