Mediastinal staging of non-small-cell lung cancer with positron emission tomography.

Abstract

To determine the usefulness of positron emission tomography with fluoro-2-deoxyglucose (PET-FDG) in assessing mediastinal disease in patients with non-small-cell lung cancer (NSCLC) and to compare its yield to that of computed tomography (CT), we performed a prospective consecutive sample investigation in a university hospital and its related clinics. In 30 patients with NSCLC with clinical stage I (T1-2, NO, MO) disease, we compared the results of chest CT and PET-FDG with the findings at surgical exploration of the mediastinum. Seven (77%) of nine patients with surgically proven mediastinal metastasis were identified by the PET-FDG results, with four false-positives in 21 patients with negative lymph node dissections (p = 0.004). Using the results of pathologic examination of mediastinal lymph nodes as the criterion standard, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for PET-FDG imaging of mediastinal metastases were 78%, 81%, 80%, 64%, and 89%, respectively. The sensitivity, specificity, accuracy, PPV, and NPV for chest CT in the detection of mediastinal metastasis were 56%, 86%, 77%, 63%, and 87%, respectively. CT and PET-FDG results agreed in 21 patients. The diagnostic accuracy of the combined imaging modalities was 90%. We concluded that mediastinal uptake of FDG correlates with the extent of mediastinal involvement of NSCLC and may contribute to preoperative staging. PET-FDG imaging complements chest CT in the noninvasive evaluation of NSCLC, and strategies for its use merit further investigation.

Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer

“…Several studies have evaluated the role of FDG PET for staging lung carcinoma. Most investigators have used focal techniques and concentrated on mediastinal lymph node staging [5][6][7][8][9]. Concerning the detection of distant metastases by whole-body FDG PET, three studies have already been published showing that the technique has excellent accuracy [10][11][12].…”

“…This uptake can be used in PET studies to visualize the tumour with high contrast compared with the surrounding tissue [2][3][4]. Considerable experience is now available on the diagnostic value of FDG PET in the mediastinal staging of lung cancer [5][6][7][8][9] but analysis of the efficiency of FDG PET for the detection of distant metastasis remains fragmentary [10][11][12]. This paper reports our current clinical experience in 110 patients with nonsmall cell lung cancer (NSCLC).…”

Whole-body 18FDG positron emission tomography in the staging of non-small cell lung cancer

“…In the other patients, PET modified the therapeutic strategy by allowing us to adopt either a more curative approach or a more palliative approach than initially planned. Recent studies have shown that mediastinal 18 FDG uptake correlates well with the extent of mediastinal involvement in NSCLC [13,[16][17][18][19][20][21]. In particular, STEINERT et al [21] showed that 18 FDG-PET is superior to CT for nodal staging of NSCLC and help in surgical planning by enabling correct differentiation of N0 or N1 disease from N2 or N3 disease.…”

Oncological applications of positron emission tomography with fluorine-18 fluorodeoxyglucose

“…These studies must be separated into two groups, Some investigators have used focal techniques and have concentrated on hilar and mediastinal lymph node staging, while others have used whole-body techniques and have evaluated extrathoracic (Table 2) [49,[110][111][112][113][114][115][116][117][118][119]. The reported sensitivity for lymph node staging in non-small cell lung cancer varies from 82% to 100% and the specificity from 73% to 100%.…”