Impact of 18F-FDG PET/CT on the Treatment of Patients With Non-Small Cell Lung Cancer

Abstract

IntroductionDisease 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 the treatment of early stage non-small cell lung cancer (NSCLC), but there is still insufficient data to define its role in other stages. HypothesisInformation provided by FDG-PET/CT has an impact on the therapeutic management of patients with NSCLC. MethodsA 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. ResultsOf the 522 patients diagnosed of NSCLC, FDG-PET/CT was performed in 246 patients (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%). Of 90 patients (36.5%) evaluated as stage iii by CT staging, FDG-PET/CT modified the therapeutic approach in 36 (40%). For 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. DiscussionOur 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.