Lung-Cancer Staging with PET–CT

Abstract

To the Editor: In their assessment of the usefulness of combined positron-emission tomography and computed tomography (PET–CT) in the preoperative staging of lung cancer, Fischer et al. (July 2 issue)1 provide no information on the interval between baseline staging and thoracotomy, nor on the use of neoadjuvant therapy. A prolonged delay between PET–CT and surgery may negate the diagnostic value of PET–CT and may be due to coexisting conditions that would themselves have a negative effect on survival. Although the PET–CT scans in the study were read by an experienced radiologist and a nuclear medicine specialist, it is unclear who interpreted the diagnostic CT scans and whether the final tumor–node–metastasis (TNM) stage was determined by the same investigators in all patients or whether the stage was decided locally. These factors are important for assessing the influence of observer bias on the study results.