Evaluation of efficacy and clinical impact of FDG-PET on patients with potentially resectable non-small cell lung cancer

Abstract

Aims We have evaluated the efficacy and clinical impact of FDG-PET for staging patients with potentially resectable non-small cell lung cancer (NSCL) in CT. Materials and methods We have prospectively studied 115 patients (104 M/11 F and mean age: 59 years old) with diagnosis of potentially resectable NSCL, (resectable criteria: Stage < IIIB in CT), including cases with equivocal lesions in mediastinum or in extrathoracic sites. In all patients we have done a whole body scan with FDG-PET, after intravenous injection of 370-440 MBq of 18F-FDG, in normoglucemia conditions. A qualitative and semiquantitative (SUV) analysis of images was carried out. Results Prevalence of mediastine lymphatic metastasis was 46.6 %, and CT was false negative (FN) in 21 cases and FDGPET only in 9. Overall sensitivity, specificity, negative predictive value, positive predictive value and accuracy were of 83.3, 73.7, 75, 81.8 % and 78.3 % in FDG-PET, and 61.1, 68.8, 64.7, 65.6 % and 65.2 % in CT, respectively. All contralateral or supraclavicular lymph metastasis (N3) were detected in FDG-PET, whereas CT had 7 FN cases. In distant metastasis, FDG-PET had 1 FN and 4 FP, whereas CT had 6 cases FN and 10 FP. Clinical Impact of FDG-PET was 26 % of patients, avoiding surgery in 11 cases, allowing in 8, indicating neoadjuvant chemotherapy in 8 and surgery of synchronic incidentaloma in 3 cases. Conclusion PET-FDG had better efficacy than CT in resectable NSCL, and should be incorporated in diagnosis protocols of NSCL before surgery decision making.