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Right arrow Lung - cancer

Ann Thorac Surg 2002;73:259-266
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

An initial experience with FDG-PET in the imaging of residual disease after induction therapy for lung cancer

Tim Akhurst, MD*a, Robert J. Downey, MDb, Michelle S. Ginsberg, MDc, Mithat Gonen, PhDd, Manjit Bains, MDb, Robert Korst, MDb, Robert J. Ginsberg, MDb,e, Valerie W. Rusch, MDb, Steven M. Larson, MDa

a Nuclear Medicine Service, Department of Radiology, New York, NY, USA
b Thoracic Surgery Service, Department of Surgery, New York, NY, USA
c Department of Radiology, New York, NY, USA
d Biostatistics Service, Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
e Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada

* Address reprint requests to Dr Akhurst, Nuclear Medicine Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA
e-mail: akhurstt{at}mskcc.org

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

Background. The 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) imaging is an advance over computed tomography alone in the staging of untreated nonsmall cell lung cancer (NSCLC). Aside from one 9-patient study, there are no data comparing FDG-PET imaging with surgical staging of NSCLC after induction therapy.

Methods. We reviewed our institutional experience with FDG-PET imaging followed by surgical staging of nonsmall cell lung cancer after induction therapy. A nuclear physician blinded to surgical findings reviewed the FDG-PET scans and assigned a clinical TNM stage. A thoracic surgeon assigned a pathologic TNM stage. Then the clinical TNM stage and the pathologic TNM stage were compared.

Results. Fifty-six patients (30 males and 26 females; median, age 60) with nonsmall cell lung cancer underwent chemotherapy (40 patients), chemoradiation (11 patients), or radiation alone (5 patients) followed by PET and operations. PET had a positive predictive value of 98% for detecting residual viable disease in the primary tumor. PET over-staged nodal status in 33% of patients, under staged nodal status in 15%, and was correct in 52%. PET correctly classified all patients with M1 disease.

Conclusions. Positron emission tomography after induction therapy accurately detects residual viable primary tumor, but not the involvement of mediastinal lymph nodes.




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