Original Articles
Evaluation of fluorine-18-fluorodeoxyglucose whole body positron emission tomography imaging in the staging of lung cancer

https://doi.org/10.1016/S0003-4975(98)01257-0Get rights and content

Abstract

Background. Surgical resection of lung cancer remains the treatment of choice in appropriately staged disease, but conventional imaging techniques have limitations. Positron emission tomography (PET) may improve staging accuracy.

Methods. We studied whole body and localized thoracic PET in staging lung cancer. Standardized uptake value was calculated for the primary lesion. Ninety-seven patients under consideration for surgical resection were included. PET, computed tomography, and clinical staging were compared to stage at operation, biopsy, or final outcome. Mean follow up was 17.5 months.

Results. PET detected all primary lung cancers with two false-positive primary sites. Sensitivity and specificity for N2 and N3 mediastinal disease was 20% and 89.9% for computed tomography and 70.6% and 97% for PET. PET correctly altered stage in 26.8%, nodal stage in 13.4%, and detected distant metastases in 16.5%. PET missed 7 of 10 cerebral metastases. PET altered management in 37% of patients. PET staging (p < 0.0001) and standardized uptake value (p < 0.001) were the best predictors of time to death apart from operative staging.

Conclusions. PET provides significant staging and prognostic information in lung cancer patients considered operable by standard criteria. Routine use of PET will prevent unnecessary operation and may be cost effective.

Section snippets

Patients and methods

All patients referred to one surgeon for the consideration of resection for lung cancer in the period were studied. Ninety-seven patients were studied from November 1992 to July 1995. Follow-up continued to July 1996.

Entry criteria included (1) biopsy proved lung cancer (n = 84) or strong suspicion of cancer on clinical and CT criteria (n = 13); and (2) operability by clinical and CT staging with TNM stage 3a or less or equivocal evidence on other imaging of metastatic disease.

Results

Ninety-seven patients (64 men) were included in the study. The mean age was 63.3 years (range, 36 to 77 years). There was histologically proved malignancy in 84 patients before PET imaging, whereas 13 had suspicion of cancer, which was subsequently proved in 11. Histologic subtypes are summarized in Table 1.

Comment

A recent consensus statement from the American Thoracic Society and European Respiratory Society [17] on the pretreatment evaluation of non-small cell carcinoma of the lung suggests that PET is in its early stages of development and not readily available outside academic centers and therefore, at present, has little role to play in the management of this group of patients. This contrasts heavily with the suggestion by Gambhir and colleagues [14] that incorporation of PET into an assessment of

Acknowledgements

We thank Paul Seed for assistance with statistical analysis and the staff of The Clinical PET Centre for their expertise and the staff of the South East Thames Cancer Registry Office. Dr Catherine Saunders was assisted by the Bernie Amos Travelling Fellowship, Westmead Hospital.

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