FDG-PET scan in potentially operable non-small cell lung cancer: do anatometabolic PET-CT fusion images improve the localisation of regional lymph node metastases?

Abstract Exact localisation of thoracic lymph nodes (LNs) on fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) can be hampered by the paucity of anatomical landmarks. In non-small cell lung cancer (NSCLC) patients referred for locoregional LN staging, we prospectively examined to what extent localisation of LNs at PET reading could be improved by visual correlation with computed tomography (CT), or by anatometabolic PET+CT fusion images. Fifty-six patients with potentially operable NSCLC underwent CT, PET and surgical staging. Prospective reading was performed for CT, PET without CT, PET+CT visual correlation and PET+CT fusion. Reading was blinded to surgical pathology data and noted on a standard LN map. Surgical staging was available for 493 LN stations. In the evaluation per individual LN station, CT was accurate in 87%, PET in 91% and visual correlation and fusion in 93%. In the identification of the nodal stage, CT was correct in 28/56 patients (50%), PET in 37/56 (66%), visual correlation in 40/56 (71%), and fusion in 41/56 (73%). It is concluded that in the exact localisation of metastatic thoracic LNs, the accuracy of reading of PET is increased if the PET images can be visually correlated with CT images. PET+CT anatometabolic fusion images add only a marginal benefit compared with visual correlation.

[1]  J. Cooper,et al.  Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. , 1982, The Journal of thoracic and cardiovascular surgery.

[2]  M. Decramer,et al.  Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small cell lung cancer. A study of 569 patients. , 1994, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[3]  U. Pastorino,et al.  Pretreatment minimal staging for non-small cell lung cancers: a consensus report , 1991 .

[4]  Guy Marchal,et al.  Multimodality image registration by maximization of mutual information , 1997, IEEE Transactions on Medical Imaging.

[5]  A. Dowlati,et al.  Evaluation of the solitary pulmonary nodule by positron emission tomography imaging. , 1996, The European respiratory journal.

[6]  B J McNeil,et al.  CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. , 1991, Radiology.

[7]  J Bogaert,et al.  Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  P. Valk,et al.  Staging non-small cell lung cancer by whole-body positron emission tomographic imaging. , 1995, The Annals of thoracic surgery.

[9]  N. Martini,et al.  The role of surgery in N2 lung cancer. , 1987, The Surgical clinics of North America.

[10]  N. Gupta,et al.  Positron emission tomography of lung tumors and mediastinal lymph nodes using [18F]fluorodeoxyglucose. The Members of the PET-Lung Tumor Study Group. , 1994, The Annals of thoracic surgery.

[11]  G. V. von Schulthess,et al.  Non-small cell lung cancer: nodal staging with FDG PET versus CT with correlative lymph node mapping and sampling. , 1997, Radiology.

[12]  I. Leav,et al.  The interaction among glucose transport, hexokinase, and glucose-6-phosphatase with respect to 3H-2-deoxyglucose retention in murine tumor models. , 1996, Nuclear medicine and biology.

[13]  J. Reed,et al.  Mediastinal staging of non-small-cell lung cancer with positron emission tomography. , 1995, American journal of respiratory and critical care medicine.

[14]  R. Wahl,et al.  Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluation. , 1994, Radiology.

[15]  V. Lowe,et al.  Thoracic nodal staging with PET imaging with 18FDG in patients with bronchogenic carcinoma. , 1995, Chest.

[16]  T. Naruke,et al.  Lymph node mapping and curability at various levels of metastasis in resected lung cancer. , 1978, The Journal of thoracic and cardiovascular surgery.

[17]  M. Mandelkern,et al.  Fluorodeoxyglucose-positron emission tomography in the detection and staging of lung cancer. , 1996, American journal of respiratory and critical care medicine.

[18]  L. Shepp,et al.  Maximum Likelihood Reconstruction for Emission Tomography , 1983, IEEE Transactions on Medical Imaging.

[19]  P. Goldstraw.  The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer. , 1992, Thorax.

[20]  P. Goldstraw,et al.  Surgical management of non-small-cell lung cancer with ipsilateral mediastinal node metastasis (N2 disease). , 1994, The Journal of thoracic and cardiovascular surgery.

[21]  Young Hi Choi,et al.  CT and MR Imaging in Staging Non-Small Cell Bronchogenic Carcinoma , 1995 .

[22]  K. Nackaerts,et al.  Mediastinal lymph node staging with FDG-PET scan in patients with potentially operable non-small cell lung cancer - A prospective analysis of 50 cases , 1997 .

[23]  J. Sunderland,et al.  Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography. , 1996, The Journal of thoracic and cardiovascular surgery.

[24]  R. Mirimanoff,et al.  Induction therapy for NSCLC: a consensus report , 1991 .

[25]  Guy Marchal,et al.  Multi-modality image registration by maximization of mutual information , 1996, Proceedings of the Workshop on Mathematical Methods in Biomedical Image Analysis.

[26]  D. Sugarbaker,et al.  Patterns of disease failure after trimodality therapy of nonsmall cell lung carcinoma pathologic stage IIIA (N2): Analysis of Cancer and Leukemia Group B Protocol 8935 , 1996, Cancer.

[27]  K. Nackaerts,et al.  Survival and prognostic factors in resected N2 non-small cell lung cancer: A study of 140 cases , 1997 .

[28]  E H Moore,et al.  Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. , 1992, Radiology.

[29]  T Jones,et al.  Glucose utilization in vivo by human pulmonary neoplasms , 1987, Cancer.