Impact of 18F-FDG PET/CT in the treatment of patients with non-small cell lung cancer

Arch Bronconeumol. 2014 Mar;50(3):99-104. doi: 10.1016/j.arbres.2013.09.017. Epub 2013 Dec 19.
[Article in English, Spanish]

Abstract

Introduction: Disease stage is the most important prognostic factor in lung cancer, and optimal staging is important to determine the best therapeutic option. FDG-PET/CT has demonstrated its value in early stage non-small cell lung cancer (NSCLC) but there is still insufficient data to define its role in other stages.

Hypothesis: Information provided by FDG-PET/CT has an impact on the therapeutic management of patients with NSCLC.

Methods: A retrospective review was made of patients who underwent FDG-PET/CT between January 2008 and December 2010 for the diagnosis of NSCLC. Clinical stage before and after FDG-PET/CT and information about any change in therapeutic decision due to information provided by FDG-PET/CT were collected. Using pathologic evaluation as the gold standard, sensitivity, specificity, and positive and negative predictive values for CT and FDG-PET/CT were calculated.

Results: Of the 522 patients diagnosed of NSCLC, FDG-PET/CT was performed in 246 (47.1%). In 85 cases (34.6%) FDG-PET/CT led to stage migration. Treatment was modified in 60 patients (24.4% of all FDG-PET/CT performed), avoiding a futile thoracotomy in 13 cases (5.2%), and allowing treatment with curative intent in 26 (10.5%). Out of 90 patients (36.5%) evaluated as stage iii by CT staging, FDG-PET/CT modified the therapeutic approach in 36 (40%). For the 133 cases (54%) with pathological assessment of the mediastinal lymph nodes, sensitivity, specificity, positive predictive value and negative predictive value were 0.57, 0.64, 0.48 and 0.72 for CT, and 0.68, 0.86, 0.75 and 0.81 for FDG-PET/CT.

Discussion: Our data support previous reports that FDG-PET/CT is essential in the staging process not only for patients with potentially operable NSCLC but also for stage iii patients, as demonstrated by our data.

Keywords: 18F-FDG PET/CT; Computed tomography scan; Cáncer de pulmón no microcítico; Estadificación; FDG PET/TC; Non-small cell lung cancer; Staging; Tomografía computarizada.

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Decision Making
  • Female
  • Fluorine Radioisotopes
  • Fluorodeoxyglucose F18
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery
  • Lymph Node Excision
  • Lymphatic Metastasis / diagnostic imaging
  • Male
  • Mediastinum / diagnostic imaging
  • Multimodal Imaging*
  • Neoplasm Staging / methods*
  • Pneumonectomy / methods
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Radiopharmaceuticals
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed*

Substances

  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18