. Step 3 of 41
Clinical Stem 3
A patient with right upper lobe adenocarcinoma progressing on biomarker-directed therapy

Answer D
Accurate staging is essential for managing patients with lung cancer because treatment options and prognosis differ significantly according to tumor stage. For this reason, patient findings are presented for discussion at multidisciplinary lung cancer meetings. If limited stage lung cancer is confirmed, treatment depends on patient operability. Systematic reviews conclude that CT scans have limited ability to rule in or exclude mediastinal metastasis. CT has a pooled sensitivity of 51% and specificity of 85% for identifying mediastinal lymph node metastasis. PET is more accurate that CT. Pooled estimates of sensitivity and specificity for identifying mediastinal metastasis by PET are 74% and 85% respectively.
ACCP guidelines recommend PET scanning to investigate potential mediastinal and extra-thoracic metastatic disease. PET should be considered in patients with clinical stage 1A lung cancer treated with curative intent (Grade of recommendation, 2C).

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References:
  1. Silvestri GA, Gould MK, Margolis ML, et al. American College of Chest Physicians. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007;Sep;132(3 Suppl):178S-201S.
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