Abstract
Simple SummaryNon-small cell lung cancer (NSCLC) patients are at considerable risk of recurrence or second primary cancer (SPC) after curative therapy. The utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) surveillance to detect recurrent lesions in NSCLC patients without suspicion of recurrence has not been established. The aim of our retrospective study was to evaluate the diagnostic value of surveillance FDG PET/CT for detecting clinically unsuspected recurrence or SPC in patients with NSCLC after curative therapy. In a cohort of 2684 NSCLC patients after curative therapy, surveillance FDG PET/CT showed good diagnostic efficacy for detecting clinically unexpected recurrence or SPC. Furthermore, the diagnostic performance was 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. Surveillance PET/CT 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.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.
Highlights
Lung cancer is one of the most common cancers and the first leading cause of cancerrelated death worldwide [1]
Non-small cell lung cancer (NSCLC) patients who had no evidence of disease recurrence within 6 months following curative treatment and underwent at least one surveillance FDG positron emission tomography (PET)/CT from 6 months to 5 years after their first curative treatment
The present study focused on the diagnostic performance of surveillance FDG positron emission tomography/computed tomography (PET/CT)
Summary
Lung cancer is one of the most common cancers and the first leading cause of cancerrelated death worldwide [1]. Non-small cell lung cancer (NSCLC) represents the majority of lung cancer cases, comprising about 85% of newly diagnosed lung cancer [2]. NSCLC patients remain at considerable risk of recurrence [3,4]. Recent studies reported that NSCLC patients with limited recurrent lesions at the time of detection might have the potential for overall survival benefit with local ablative therapy [5,6]. Early detection using routine image-based surveillance might lead to better clinical outcomes in NSCLC patients. On the basis of this concept, the National Comprehensive
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