Staging of the mediastinum: value of positron emission tomography imaging in non-small cell lung cancer

Abstract

S St ta ag gi in ng g o of f t th he e m me ed di ia as st ti in nu um m: : v va al lu ue e o of f p po os si it tr ro on n e em mi is ss si io on n t to om mo og gr ra a--p ph hy y i im ma ag gi in ng g i in n n no on n--s sm ma al ll l c ce el ll l l lu un ng g c ca an nc ce er r We have performed a prospective study comparing FDG-PET and CT of the thorax in the presurgical assessment of the mediastinum in 50 patients with newly diagnosed non-small cell lung cancer (NSCLC). CT and PET scans were interpreted separately, and results were compared to pathological staging obtained during thoracotomy.Hilar or mediastinal lymph node involvement was present in 58%. In staging for lymph node involvement, CT had a sensitivity of 72% and specificity of 81%, whereas PET had a sensitivity and specificity of 90% and 86%, respectively. When the PET study was compared to histological results, there were four cases showing more advanced mediastinal involvement with PET and four cases showing less involvement with PET.From our preliminary results, we conclude that positron emission tomography with 18-fluorodeoxyglucose is significantly more accurate than computed tomography in the mediastinal staging of non-small cell lung cancer.

Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer

“…Several studies have evaluated the role of FDG PET for staging lung carcinoma. Most investigators have used focal techniques and concentrated on mediastinal lymph node staging [5][6][7][8][9]. Concerning the detection of distant metastases by whole-body FDG PET, three studies have already been published showing that the technique has excellent accuracy [10][11][12].…”

“…With patients in a fasting state, about 200-250 MBq FDG has been injected via an antecubital vein [8]. The whole-body mode acquires multiple overlapping steps at 64-mm intervals.…”

“…This uptake can be used in PET studies to visualize the tumour with high contrast compared with the surrounding tissue [2][3][4]. Considerable experience is now available on the diagnostic value of FDG PET in the mediastinal staging of lung cancer [5][6][7][8][9] but analysis of the efficiency of FDG PET for the detection of distant metastasis remains fragmentary [10][11][12]. This paper reports our current clinical experience in 110 patients with nonsmall cell lung cancer (NSCLC).…”

Imaging in lung cancer: positron emission tomography scan

“…Because of this very moderate level of accuracy of CT, invasive staging by mediastinoscopy until recently remained the only reliable tool for mediastinal LN staging. The use of FDG-PET as a noninvasive tool for the determination of LN spread has thus been examined in several well-designed prospective studies [27,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72]. FDG-PET proved to be significantly more accurate than CT in locoregional LN staging.…”

Prognostic value of FDG-PET scans at diagnosis in small cell lung cancer

“…The role of FDG-PET in non-small cell lung cancer (NSCLC) has been widely studied, with a trend to upstaging compared to conventional CT scans along with [10][11][12][13][14][15][16][17][18][19] a change in clinical management [20][21][22][23][24][25] . In fact, the intensity of FDG uptake in NSCLC, as measured by highest standard uptake value [SUV max ] has also been shown to correlate with prognosis [26] .…”