Accuracy of Fluorodeoxyglucose-Positron Emission Tomography Within the Clinical Practice of the American College of Surgeons Oncology Group Z4031 Trial to Diagnose Clinical Stage I Non-Small Cell Lung Cancer

Abstract

Background Fluoro-deoxyglucose positron emission tomography (FDG-PET) is recommended for diagnosis and staging of NSCLC. Meta-analyses of FDG-PET diagnostic accuracy demonstrated sensitivity and specificity of 96% and 78%, respectively but were performed in select centers introducing potential bias. This study evaluates the accuracy of FDG-PET to diagnose NSCLC and examines differences across enrolling sites in the national ACOSOG Z4031 trial. Methods 959 eligible patients with clinical stage I (cT1-2N0M0) known or suspected NSCLC were enrolled between 2004 and 2006 in the Z4031 trial and 682 had a baseline FDG-PET. Final diagnosis was determined by pathological examination. FDG-PET avidity was categorized into four levels based on radiologist description or reported maximum standard uptake value (SUV). FDG-PET diagnostic accuracy was calculated for the entire cohort. Accuracy differences based on preoperative size and by enrolling site were examined. Results Preoperative FDG-PET results were available for 682 participants enrolled at 51 sites in 39 cities. Lung cancer prevalence was 83%. FDG-PET sensitivity was 82% (95% CI: 79–85) and specificity was 31% (95% CI: 23%–40%). Positive and negative predictive values were 85% and 26%, respectively. Accuracy improved with lesion size. Of 80 false positive scans, 69% were granulomas. False negative scans occurred in 101 patients with adenocarcinoma being the most frequent (64%) and eleven were ≤10mm. The sensitivity varied from 68% to 91% (p=0.03) and the specificity ranged from 15% to 44% (p=0.72) across cities with > 25 participants. Conclusions In a national surgical population with clinical stage I NSCLC, FDG-PET to diagnose lung cancer performed poorly compared to published studies.

Noninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index

“…6) The secondary analysis of American College of Surgeons Oncology Group (ACOSOG) Z4031 trial showed the result of diagnostic accuracy of PNs. 20) Unfortunately, the study did not require a standard PET/CT protocol and an SUV cut-off value of 2.5 was the one of the diagnostic indications. These papers suggested that the use of a cut-off point for FDG accumulation or for SUV is controversial.…”

“…9) Grogan, et al revealed that PET accuracy improved with increasing sizes of lesions, from 67% for 1-2-cm lesions (sensitivity, 76%; specificity, 35%) to 84% for 3-5-cm lesions (sensitivity, 90%; specificity, 18%; P <0.001). 20) Our study included 30 patients with nodules ≤1 cm. Among them, 12 patients had malignant nodules with SUV indices ≥1.2; that is, there were no patients with false-positive results.…”

Cone-beam computed tomography in lung stereotactic ablative radiation therapy: predictive parameters of early response

“…23 Moreover, PET/CT after SABR for lung malignancies may be utilized as a surrogate of tumour response, according to available literature data. [24][25][26] On-board CBCT has been recently implemented in clinical practice for precise treatments. Another potential application of CBCT could be the ability to assess tumour volume changes during RT.…”

Sublobar Resection, Radiofrequency Ablation or Radiotherapy in Stage I Non-Small Cell Lung Cancer

“…Primary tumor histologies are attained in all surgical cases, whereas the diagnoses rely on positron emission tomography/CT morphological criteria in a significant number of RT patients. The sensitivity of positron emission tomography/CT ranges between 68 and 100%, but it only has a moderate positive predictive value [9]. …”