73P PET and neck US for the detection of cervical lymphadenopathy in patients with lung cancer and mediastinal lymphadenopathy

Abstract

Background: Cervical lymph nodes are frequently involved in patients with lung cancer and indicate inoperability. Some guidelines recommend neck ultrasound (NUS) in patients with bulky mediastinal lymphadenopathy. Positron emission tomography (PET) is indicated for patients with potentially curable disease. We aimed to assess the diagnostic yield of NUS and the diagnostic accuracy of PET for cervical lymphadenopathy among patients with suspected lung cancer and mediastinal lymphadenopathy. Methods: Records of all patients with lung cancer who underwent a NUS over a consecutive 5-year period were reviewed. Only patients with mediastinal lymphadenopathy on CT were included. The diagnostic accuracy of PET was assessed with NUS-guided fine needle aspiration cytology used as the reference test. Results: During the study period 123 patients met the inclusion criteria. Malignant cervical lymphadenopathy was confirmed in 39.8% (95% CI 31.1–49.1%). PET-CT had a specificity of 81.1%, sensitivity of 87.5%, negative predictive value of 96.8% and positive predictive value of 50% for the detection of cervical lymphadenopathy, and it contributed no additional staging information in the neck area. Overall, PET led to changes in management in only 2.2% of cases. Conclusions: A significant proportion of patients with lung cancer and mediastinal lymphadenopathy have cervical lymphadenopathy detected by NUS. In this group of patients PET offers minimal additional value in staging and management. Legal entity responsible for the study: Galway University Hospital Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest.