Clinical Value of Surveillance 18F-fluorodeoxyglucose PET/CT for Detecting Unsuspected Recurrence or Second Primary Cancer in Non-Small Cell Lung Cancer after Curative Therapy

Abstract

We evaluated the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT surveillance for detecting clinically unsuspected recurrence or second primary cancer (SPC) in patients with non-small cell lung cancer (NSCLC) after curative therapy. A total of 4478 surveillance FDG PET/CT scans from 2864 NSCLC patients without suspicion of recurrence after curative therapy were reviewed retrospectively. In 274 of 2864 (9.6%) patients, recurrent NSCLC or SPC was found by surveillance PET/CT during clinical follow-up. Surveillance PET/CT scans showed sensitivity of 98.9% (274/277), specificity of 98.1% (4122/4201), accuracy of 98.2% (4396/4478), positive predictive value (PPV) of 77.6% (274/353), and negative predictive value of 99.9% (4122/4125). The specificity and accuracy in the curative surgery group were significantly higher than those in the curative radiotherapy group. PPV was significantly improved in subgroups of patients with advanced stage prior to curative therapy, PET/CT scans performed within 3 years after curative-intent therapy, and curative surgery. FDG PET/CT surveillance showed good diagnostic efficacy for detecting clinically unexpected recurrence or SPC in NSCLC patients after curative therapy. It can be more useful when performed soon after therapy in curative surgery recipients and those with an advanced disease stage considering its diagnostic efficacy and yield.

PET/CT in Staging and Treatment Evaluation of Non-Small Cell Lung Cancer

“…There is a study on the evaluation of the metabolic parameters of PET-CT (total tumor volume, SUVmax, total glycolysis of the lesion) in determining whether a patient has second primary synchronous or metachronous tumors following non-small cell lung cancer, which is relatively common [21] . Zhu et al [22] mentioned that these parameters can be used to predict the overall survival of the patient with acceptable accuracy regardless of age, type of treatment, tumor histology and TNM stage.…”

PET/CT en estadiaje y evaluación del tratamiento en cáncer de pulmón de células no pequeñas

“…Existe en la literatura la evaluación de los parámetros metabólicos de PET-CT (volumen tumoral total, SUVmax, glicólisis total de la lesión), como un reto a asumir en pacientes que tienen un segundo primario sincrónico o metacrónico al cáncer de pulmón de células no pequeñas; situación que no es infrecuente (22) . Zhu y colaboradores (23) mencionan que los parámetros citados permiten predecir la supervivencia global del paciente con un grado de exactitud aceptable, independientemente de la edad, tipo de tratamiento que se instaure, histología del tumor y estadio TNM.…”

Use of [18F]Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography after Curative Treatment of Non-Small-Cell Lung Cancer Patients: A Nationwide Cohort Study

“…Compared to conventional staging methods, [¹ 8 F]FDG PET/CT improves the detection of mediastinal and distant metastasis, establishing it as an essential tool for determining which patients would benefit from surgical resection [6]. Further, [¹ 8 F]FDG PET/CT has an excellent diagnostic performance for recurrence detection after curative-intent therapy, especially in patients with a high risk of recurrence [7]. In addition, [¹ 8 F]FDG PET/CT may benefit a subset of patients with suspicious findings that are difficult to characterize on CT during post-treatment surveillance [8].…”