A Systematic Review of Restaging After Induction Therapy for Stage IIIa Lung Cancer Prediction of Pathologic Stage

Background: Many clinicians use restaging after induction therapy as a way to select patients for surgery. Methods: A systematic review was conducted to define the reliability of restaging tests after induction therapy for stage III(N2) lung cancer, when compared with pathologic findings at surgery. Results: A complete response at all sites carries a false-negative (FN) rate of 50% for computed tomography and 30% for positron emission tomography. Mediastinal node involvement has FN and false-positive rates of 33% and 33% by computed tomography, and 25% and 33% by positron emission tomography. The FN rate of invasive restaging is 22% by repeat mediastinoscopy, 14% by esophageal ultrasound and needle aspiration in expert hands (reliable results are not yet available for endobronchial ultrasound), and 9% by primary mediastinoscopy done with optimal thoroughness. These results are not significantly affected by the type of induction therapy or the timing of restaging. Conclusion: The ability to identify patients who have achieved mediastinal downstaging other than by a careful primary mediastinoscopy is poor.