The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with nonsmall cell lung cancer.

BACKGROUND The treatment of patients with nonsmall cell lung cancer (NSCLC) is determined by the stage. We evaluated the accuracy of staging using integrated positron emission tomography (PET) and computed tomography (CT) and compared it with dedicated PET visually correlated with CT scan. METHODS A prospective blinded trial was performed on a consecutive series of patients with NSCLC. Patients underwent integrated PET-CT scanning with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG-18). A radiologist assigned the T, N and M status. No sooner than 2 weeks the same radiologist read the dedicated PET alone, without the integrated CT images and a T, N and M status was assigned again. The most recent CT scan was available and visually correlated with both studies. All patients underwent biopsies of suspicious N2 or N3 lymph node or distant metastases and if negative, pulmonary resection with lymphadenectomy was performed. RESULTS There were 129 patients. Integrated PET-CT is a better predictor than PET for all stages of cancer and achieved statistical significance for stage I (52% versus 33%, p = 0.03) and for stage II (70% versus 36%, p = 0.04). It also is a better overall predictor for T status (70% versus 47%, p = 0.001) and the N status (78% versus 56%, p = 0.008). Nodal analysis shows that integrated PET-CT was more accurate for the total N2 nodes (96% versus 93%, p = 0.01) and for the total N1 nodes (90% versus 80%, p = 0.001). It was also more sensitive, specific, and had a higher positive predictive value for both N2 and N1 nodes (p < 0.05 for all). Integrated PET-CT is significantly more sensitive at the 4R, 5, 7, 10 L and 11 stations and more accurate at the 7 and 11 lymph nodes stations than dedicated PET. CONCLUSIONS Integrated PET-CT using FDG-18 better predicts stage I and II disease as well as the T and N status of patients with NSCLC when compared with dedicated PET alone. It is more accurate at some nodal stations but still only achieves an accuracy of 96% and 90% for the N2 and N1 nodes, respectively.

[1]  H. Schäfers,et al.  Mediastinal lymph node staging in suspected lung cancer: comparison of positron emission tomography with F-18-fluorodeoxyglucose and mediastinoscopy. , 2003, The Annals of thoracic surgery.

[2]  G. V. von Schulthess,et al.  Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. , 2003, The New England journal of medicine.

[3]  J. Padilla,et al.  Preresectional chemotherapy in stage IIIA non-small-cell lung cancer: a 7-year assessment of a randomized controlled trial. , 1999, Lung cancer.

[4]  J. Roth,et al.  A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. , 1994, Journal of the National Cancer Institute.

[5]  Thomas Beyer,et al.  Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. , 2003, Radiology.

[6]  N. Gupta,et al.  Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small ( 3 cm) lymph node lesions. , 2000 .

[7]  J. Mate,et al.  A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. , 1994, The New England journal of medicine.

[8]  Improved Radiologic Staging of Lung Cancer with 2-[18F]-Fluoro-2-Deoxy-d-Glucose–Positron Emission Tomography and Computed Tomography Registration , 2003, Journal of computer assisted tomography.

[9]  C. Mountain,et al.  Revisions in the International System for Staging Lung Cancer. , 1997, Chest.

[10]  H. Groen,et al.  Preoperative staging of non-small-cell lung cancer with positron-emission tomography. , 2000, The New England journal of medicine.

[11]  J. Roth,et al.  Long-term follow-up of patients enrolled in a randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. , 1998, Lung cancer.

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

[13]  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.

[14]  Quynh-Thu Le,et al.  Non-small cell lung cancer: Clinical practice guidelines in oncology , 2006 .

[15]  J. Mountz,et al.  The role of FDG-PET scan in staging patients with nonsmall cell carcinoma. , 2003, The Annals of thoracic surgery.

[16]  J. Correia,et al.  Registration of nuclear medicine images. , 1990, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[17]  P. Valk,et al.  Factors associated with false-positive staging of lung cancer by positron emission tomography. , 2000, The Annals of thoracic surgery.

[18]  D. Wood,et al.  The impact of fluorodeoxyglucose F 18 positron-emission tomography on the surgical staging of non-small cell lung cancer. , 2002, The Journal of thoracic and cardiovascular surgery.

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

[20]  D W. Townsend,et al.  Combined PET/CT Imaging in Oncology. Impact on Patient Management. , 2000, Clinical positron imaging : official journal of the Institute for Clinical P.E.T.

[21]  E. Lemarié,et al.  Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II, and IIIa non-small-cell lung cancer. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.