PURPOSE/OBJECTIVES: @entity1 receiving stereotactic body radiotherapy for stage I @entity1149 are typically staged clinically with positron emission tomography-computed tomography. Currently, limited data exist for the detection of occult hilar/peribronchial (N1) disease. We hypothesize that positron emission tomography-computed tomography underestimates spread of @entity5 to N1 lymph nodes and that future stereotactic body radiotherapy @entity1 may benefit from increased pathologic evaluation of N1 nodal stations in addition to N2 nodes. MATERIALS/METHODS: A retrospective study was performed of all @entity1 with clinical stage I (T1-2aN0) @entity1149 (American Joint Committee on Cancer, 7th edition) by positron emission tomography-computed tomography at our institution from 2003 to 2011, with subsequent surgical resection and lymph node staging. Findings on positron emission tomography-computed tomography were compared to pathologic nodal involvement to determine the negative predictive value of positron emission tomography-computed tomography for the detection of N1 nodal disease. An analysis was conducted to identify predictors of occult spread. RESULTS: A total of 105 @entity1 with clinical stage I @entity1149 were included in this study, of which 8 (7.6%) @entity1 were found to have occult N1 @entity3 on pathologic review yielding a negative predictive value for N1 disease of 92.4%. No @entity1 had occult mediastinal nodes. The negative predictive value for positron emission tomography-computed tomography in @entity1 with clinical stage T1 versus T2 @entity5 was 72 (96%) of 75 versus 25 (83%) of 30, respectively (P = .03), and for peripheral versus central @entity5 location was 77 (98%) of 78 versus 20 (74%) of 27, respectively (P = .0001). The negative predictive values for peripheral T1 and T2 @entity5 were 98% and 100%, respectively; while for central T1 and T2 @entity5 , the rates were 85% and 64%, respectively. Occult lymph node involvement was not associated with @entity5 maximum standard uptake value, histology, grade, or interval between positron emission tomography-computed tomography and surgery. CONCLUSION: Our results support pathologic assessment of N1 lymph nodes in @entity1 with stage @entity151 considered for stereotactic body radiotherapy, with the greatest benefit in @entity1 with central and T2 @entity5 . Diagnostic evaluation with endoscopic bronchial ultrasound should be considered in the evaluation of stereotactic body radiotherapy candidates.

Limitations of PET/CT in the Detection of Occult N1 Metastasis in Clinical Stage I(T1-2aN0) XXXX for Staging Prior to Stereotactic Body Radiotherapy.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'cancer', 'primary tumor', 'tumors'] @entity1149 :: ('MESH:D002289', 'Disease') :: ['non-small cell lung cancer'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastasis'] @entity151 :: ('MESH:D055752', 'Disease') :: ['Inon-small cell lung cancer']
@entity1149 :: (MESH:D002289,Disease) :: ['Non-Small Cell Lung Cancer']
