To determine the sensitivity, specificity, and accuracy of staging mediastinal nodal disease in potentially resectable lung cancer using fluorodeoxyglucose-positron emission tomography (FDG-PET), computed tomography (CT), or both and compare these results to surgical staging. We also assessed whether PET scanning results changed clinical management. From 1992 to 1997, 50 patients underwent CT, and PET scanning before or close to the time of surgical staging. Sensitivity, specificity, accuracy, and predictive values were then calculated based on pathology results. A retrospective review of the records was performed to determine how PET results affected clinical treatment decisions. Forty-seven of 50 patients had non-small-cell lung cancer. The prevalence of pathologically confirmed mediastinal and hilar involvement was 38%. The sensitivity, specificity, and accuracy of mediastinal disease staging were as follows: CT alone = 73%, 77%, 76%; PET alone = 73%, 94%, 87%; PET + CT = 82%, 96%, 91%, respectively. PET was more specific and accurate than CT (p = 0.025). The results of PET changed management decisions in 12 of 50 cases (24%). Using FDG-PET in conjunction with CT scanning provides the most accurate staging of mediastinal disease in lung cancer by contributing complementary information. Furthermore, PET can affect clinical decision-making and allow some patients considered unresectable a chance for resection.
From the Department of Radiation Oncology (E.W., S.R., A.S., G.J., R.M.), University of California Los Angeles; Radiation Therapy, Pulmonary Medicine, and Nuclear Medicine Services (A.S., S.S., C.B., M.M., L.T.), West Los Angeles Veterans Hospital, Los Angeles, California, U.S.A.
Accepted for oral presentation at RSNA meeting in Chicago, November 29, 1998.
Accepted for poster presentation at ASTRO in Phoenix, October 1998.
Address correspondence and reprint requests to Dr. Elaine Weng, UCLA/Radiation Oncology, 200 Medical Plaza, B265, Los Angeles, CA 90095-8347, U.S.A.
|P^deceased
