Original article: general thoracic
The role of FDG-PET scan in staging patients with nonsmall cell carcinoma

Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
https://doi.org/10.1016/S0003-4975(03)00888-9Get rights and content

Abstract

Background

To assess the role of flourodeoxyglucose–positron-emission tomography (FDG-PET) scan in staging patients with nonsmall cell lung cancer (NSCLC).

Methods

We prospectively studied 400 patients with NSCLC. Each patient underwent a computed tomography (CT) scan of the chest and upper abdomen, other conventional staging studies and had a FDG-PET scan within 1 month before surgery. All suspicious N2 lymph nodes by either chest CT or by FDG-PET scan were biopsied. Patients that were N2 and M1 negative underwent pulmonary resection and complete thoracic lymphadenectomy.

Results

The FDG-PET had a higher sensitivity (71% vs 43%, p < 0.001), positive predictive value (44% vs 31%, p < 0.001), negative predictive value (91% vs 84%, p = 0.006), and accuracy (76% vs 68%, p = 0.037) than CT scan for N2 lymph nodes. Similarly, FDG-PET had a higher sensitivity (67% vs 41%, p < 0.001), but lower specificity (78% vs 88%, p = 0.009) than CT scan for N1 lymph nodes. FDG-PET led to unnecessary mediastinoscopy in 38 patients. FDG-PET was most commonly falsely negative in the subcarinal (#7) station and the aortopulmonary window lymph node (#5, #6) stations. It accurately upstaged 28 patients (7%) with unsuspected metastasis and it accurately downstaged 23 patients (6%).

Conclusions

The FDG-PET scan allows for improved patient selection. It more accurately stages the mediastinum, however there are many false positives lymph nodes and it may be more likely to miss N2 disease in the #5, #6, and #7 stations. A positive FDG-PET scan means a tissue biopsy is indicated in that location.

Section snippets

Material and methods

From May 2000 through July 2002 all patients who had an indeterminate pulmonary nodule or who had biopsy proven nonsmall lung cancer (NSCLC) were sent to a newly opened positron-emission tomography (PET) center in Birmingham, Alabama. This center features a dedicated ECAT EXACT PET scanner (CTI, Knoxville, TN). The scans were performed 60 minutes after injection of approximately 370 MBq of F-18 (FDG) intravenously. The PET scans were correlated with chest CT scans. The patients were advised not

Results

There were 400 patients (258 men and 142 women) with a median age of 66 years old (range 27 to 88 years old). The sensitivity, specificity, PPV, NPV, and accuracy for FDG-PET scans and CT scan for the N2 and N1 lymph nodes are depicted in Table 3. As illustrated in Table 3, FDG-PET has a significantly higher sensitivity, PPV, NPV, and accuracy than CT for the N2 lymph nodes. The p values for this difference are indicated in the table. Similarly, FDG-PET has a higher sensitivity, but lower

Comment

The exact role and cost effectiveness of FDG-PET scanning for patients with apparent resectable nonsmall cell carcinoma is still controversial. Recent reports using FDG-PET for patients with bronchogenic malignancy 3, 4, 5, 6, 7 have called it accurate [3], useful [4], and reliable [5]. Some conclude that it is has “better efficiency than CT scanning” [4] and “improves the rate of detection of local and distant metastases” [5]. It has also been reported to be “cost effective” [7]. However, the

References (24)

  • Depierre A, Milleron B, Moro-Sibilot, D, et al. Preoperatie chemotherapy followed by surgery compared with primary...
  • C.F. Mountain

    Revisions in the international systems for staging lung cancer

    Chest

    (1997)
  • M.K. Gould et al.

    Accuracy of positron emission tomography for diagnosis of pulmonary nodules, and mass lesions

    JAMA

    (2001)
  • T.W. McCain et al.

    The usefulness of positron emission tomography in evaluating patients for pulmonary malignancies

    Chest

    (2000)
  • N.C. Gupta et al.

    Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small, intermediate, and large lymph node lesions

    Chest

    (2000)
  • R.M. Pieterman et al.

    Preoperative staging of non-small cell lung cancer with positron emission tomography

    N Engl J Med

    (2000)
  • M. Dietlein et al.

    Cost-effectiveness of FDG-PET for the management of potentially operable non-small lung cancer. Priority for a PET-based strategy after nodal negative CT results

    Eur J Nucl Med

    (2000)
  • P.F. Roberts et al.

    Factors associated with false-positive staging of lung cancer by positron emission tomography

    Ann Thor Surg

    (2000)
  • R.J. Hagge et al.

    Positron emission tomographybrain tumors and lung cancer

    Radiol Clin North Am

    (2001)
  • G. Savelli et al.

    Bone scintigraphy and the added value of SPECT in detecting skeletal lesions

    Q J Nuclear Med

    (2001)
  • L.G. Strauss

    Sensitivity and specificity of positron emission tomography for the diagnosis of lymph node metasases

    Cancer Res

    (2000)
  • P.M. Boiselle

    MR imaging of thoracic lymph nodes. A comparison of computed tomography and positron emission tomography

    Magn Reson Imaging Clin N Am

    (2000)

    • Cited by (0)

    View full text
    Copyright © 2003 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.