Imaging with F‐18 FDG PET is superior to Tl‐201 SPECT in the staging of non‐small cell lung cancer for radical radiation therapy*

Abstract

Thallium-201 (Tl-201) single photon emission computed tomography (SPECT) is funded for evaluation of malignancy in Australia and may have utility for staging of non-small cell lung cancer (NSCLC) if CT results are equivocal. Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET) is superior to CT for staging NSCLC but is more expensive and less widely available than Tl-201 SPECT. Therefore, these techniques were prospectively compared in 27 radical radiation therapy candidates. Patients were allocated a conventional, PET and Tl-201 stage. Tumour to background ratios (TBR) were recorded for the primary on both techniques. Metastatic disease was confirmed by surgical pathology, serial imaging or clinical follow up. Tumour to background ratios were consistently higher for FDG PET than Tl-201 SPECT (P < 0.0001). Positron emission tomography detected all known primary tumours but Tl-201 failed to image four primary tumours (15%). In 10 of 18 cases of discordance between PET and Tl-201 SPECT regarding stage, corroboration was available from pathology or disease progression. Positron emission tomography was shown to have a 100% positive predictive value, including all three patients with PET-detected distant metastases (P=0.002). Results indicate that PET is superior to Tl-201 SPECT scanning in the staging of NSCLC for radical radiation therapy, and that the low sensitivity for detection of local and metastatic disease is likely to limit the clinical impact and cost-effectiveness of this technique despite its lower cost.

Impact of FDG-labelled positron emission tomography imaging on the management of non-small-cell lung cancer

“…Before the advent of PET to assist with the noninvasive determination of the extent of lung cancer, imaging with TI-201 single-photon emission computed tomography (SPECT) was available. FDG-PET has, however, proved far superior to TI-201 SPECT in staging of NSCLC, and tumour to background ratio is consistently higher with PET compared with SPECT (P c 0.0001) (37).…”

Advances in Clinical Oncology Research on 99mTc-3PRGD2 SPECT Imaging

“…Moreover, it is superior to 18 F-FDG PET/CT in that it can be used to judge metastatic lymph nodes with higher specificity. Nevertheless, PET is a relatively expensive technology, and PET scanners are not widely available ( 20 ). These limitations can interfere with clinical use.…”

“…18 F-FDG PET/CT plays a very important role in the diagnosis and treatment of breast cancer ( 36 , 37 ). Nevertheless, 18 F-FDG PET/CT application is significantly restricted owing to high cost and low availability, as PET is a relatively expensive technology and neither PET scanners nor the cyclotrons required to produce isotopes for PET are widely available ( 20 ). Therefore, 99m Tc-3PRGD 2 SPECT imaging could be an excellent alternative.…”

Cancer imaging - making the most of your gamma camera

“…Alveolar cell carcinomas showed greater uptake of 201 Tl-thallous chloride than 18 FDG whilst PET was more sensitive to malignant nodules less than 2 cm in diameter. For mediastinal staging, 99m Tc-MIBI and 201 Tl-thallous demonstrate superior diagnostic performance over CT but have not proved as effective as 18 FDG-PET [ 2 , 3 ]. However, the relative cost-effectiveness of 18 FDG-PET compared to gamma camera techniques for staging lung cancer has not been evaluated.…”