Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review

  • M. Smoragiewicz British Columbia Cancer Agency
  • J. Laskin British Columbia Cancer Agency
  • D. Wilson British Columbia Cancer Agency
  • K. Ramsden British Columbia Cancer Agency
  • J. Yee Vancouver General Hospital
  • S. Lam British Columbia Cancer Agency
  • T. Shaipanich British Columbia Cancer Agency
  • Y. Zhai University of British Columbia
  • C. Ho British Columbia Cancer Agency
Keywords: non-small-cell lung cancer, positron-emission tomography–computed tomography, thoracotomy, lymphatic metastasis or pathology, mediastinal staging, endobronchial ultrasonography, mediastinoscopy, endoscopic ultrasonography



Combined positron-emission tomography and computed tomography (pet-ct) reduces futile thoracotomy (ft) rates in patients with non-small-cell lung cancer (nsclc). We sought to identify preoperative risk factors for ft in patients staged with pet-ct.


We retrospectively reviewed all patients referred to the BC Cancer Agency during 2009–2010 who underwent pet-ct and thoracotomy for nsclc. Patients with clinical N2 disease were excluded. An ft was defined as any of a benign lesion; an exploratory thoracotomy; pathologic N2 or N3, stage iiib or iv, or inoperable T3 or T4 disease; and recurrence or death within 1 year of surgery.


Of the 108 patients who met the inclusion criteria, ft occurred in 27. The main reason for ft was recurrence within 1 year (14 patients) and pathologic N2 disease (10 patients). On multivariate analysis, an Eastern Cooperative Oncology Group performance status greater than 1, a pet-ct positive N1 status, a primary tumour larger than 3 cm, and a period of more than 16 weeks from pet-ct to surgery were associated with ft. N2 disease that had been negative on pet-ct occurred in 21% of patients with a pet-ct positive N1 status and in 20% of patients with tumours larger than 3 cm and non-biopsy mediastinal staging only. The combination of pet-ct positive N1 status and a primary larger than 3 cm had 85% specificity, and the presence of either risk factor had 100% sensitivity, for ft attributable to N2 disease.


To reduce ft attributable to N2 disease, tissue biopsy for mediastinal staging should be considered for patients with pet-ct positive N1 status and with tumours larger than 3 cm even with a pet-ct negative mediastinum.

Author Biography

M. Smoragiewicz, British Columbia Cancer Agency
Medical Oncology Resident
How to Cite
Smoragiewicz, M., Laskin, J., Wilson, D., Ramsden, K., Yee, J., Lam, S., Shaipanich, T., Zhai, Y., & Ho, C. (2014). Using pet-ct to reduce futile thoracotomy rates in non-small-cell lung cancer: a population-based review. Current Oncology, 21(6), e768-e774.
Surgical Oncology