WHEN IS TISSUE STAGING NECESSARY ?

Tissue staging of the mediastinum is clearly required if there
is pet activity in mediastinal nodes ( unless there's extensive
mediastinal infiltration ). this is often as a result of the fp rate of pet in
the mediastinum could be approximately 15% to twenty%, five, 25 although
the massivest and most recent metaanalysis found an average fp
rate of 27% ( on a per patient basis, excluding studies with a
prevalence of 10% ). six these recommendations are summarized
in table 29. three.
tissue staging is an elementicularly vital with increasing
wide variability within the quality of pet scans. furthermore,
the accuracy of the scan interpretation is increasingly a difficulty
with the movement to bring pet scanners out into smaller
communities ( particularly mobile scanners ), that hampers
communication between the reader of the pet scan and a physician
experienced in treating lung cancer. there are knowledge that
the interpretation of a ct scan is far more correct when it
is done with input from the treating clinician, 44 and also there are
multiple reasons that would recommend that this is often even a lot of true
with pet ima ging. vital aspects during this regard include
a mechanism on behalf of meaningful interaction between a dedicated
pet radiologist and a clinician with expertise in lung cancer
( enabling collective judgment ) still as a mechanism for
feedback of final results to the radiologist. 45, forty six very little formal
study of those problems has been done, other then they recommend that one
ought to be cautious concerning merely accepting pet interpretation
while not tissue confirmation, particularly when the pet is done
in a very smaller center.
tissue staging of the mediastinum could be also required within the
face of a negative pet within the mediastinum in patients with
discrete mediastinal node involvement ( radiographic cluster b )
and that in patients with central tumors or n1 node enlargement
( radiographic cluster c, fig. 29. one ). five the premise for this statement
is that the finding of an fn rate of pet of approximately
25% within these things. five, 25, 47–49 ct alone could be also notoriously
inaccurate within these patient cohorts ( an fp rate of 40% with
discrete mediastinal node involvement and an fn rate of 25%
in patients with central tumors of n1 node enlargement ). 11
so, tissue staging is necessary in such patients whether
or not a pet is performed.
it's worth noting that correct mediastinal staging is
vital whenever treatment with curative intent is being
planned, not just when the treatment involves operation. the
principles of correct staging are specific to the disease and
to not the modality used. so, a similar knowledge and, so,
a similar rules concerning the want for tissue staging of the mediastinum
apply if the curative treatment being thought-about is
chemoradiation alone, radiofrequency ablation, or stereotactic
radiosurgery