HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Simon R Knight C Peter Clarke Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berlangieri, S. U Articles by John McKay, W Search for Related Content PubMed PubMed Citation Articles by Berlangieri, S. U Articles by John McKay, W

Eur J Cardiothorac Surg 1999;16:S25-S30
© 1999 Elsevier Science NL

F-18 fluorodeoxyglucose positron emission tomography in the non-invasive staging of non-small cell lung cancer

^a Department of Nuclear Medicine and Centre for Positron Emission Tomography, Austin and Repatriation Medical Centre, Studley Road, Heidelberg VIC 3084, Australia
^b Ludwig Institute of Cancer Research, Austin and Repatriation Medical Centre, Studley Road, Heidelberg VIC 3084, Australia
^c Department of Thoracic Surgery, Austin and Repatriation Medical Centre, Studley Road, Heidelberg VIC 3084, Australia
^d Department of Radiology, Austin and Repatriation Medical Centre, Studley Road, Heidelberg VIC 3084, Australia
^e Department of Radiology, St Vincent's Hospital, Victoria Parade, Fitzroy VIC 3141, Australia

^* Corresponding author. Tel.: +61-613-9496-5669; fax: +61-613-9457-6605 (Email: sub{at}austin.unimelb.edu.au).

Objective: Positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG), a glucose analogue, as a metabolic tumour marker, has been proposed for the non-invasive staging of oncological disease. Tumours demonstrate increased glycolytic activity and thereby, FDG PET can differentiate benign from malignant lesions. To determine its role in the mediastinal staging of patients with suspected non-small cell lung cancer, a prospective study of FDG PET and computed tomography (CT) compared to surgery and pathology was performed. The analysis group consists of 50 patients, 37 men and 13 women, mean age 64 years (range, 41–78 years). Methods: A nuclear physician, blind to the clinical and CT data, graded the FDG PET studies qualitatively on a five-point scale, based on the intensity of glucose uptake, for the presence of mediastinal nodal tumour involvement. Scores of four or greater were considered positive for tumour. An experienced radiologist interpreted the patients' CT scans blind to the other data. The CT criterion for tumour involvement was a nodal long axis diameter of 10 mm or greater. All patients underwent either thoracotomy or mediastinoscopy to obtain surgical specimens. The PET, CT, surgery and pathology were mapped according to the American Thoracic Society nodal classification resulting in 201 nodal stations evaluated. The imaging studies were analysed for N2 or N3 tumour involvement compared to histology or dissection of nodal stations. Results: All patients had proven non-small cell lung carcinoma. PET excluded tumour in 175 of 181 nodal stations (specificity 97%) compared to 162 of 181 (specificity 90%) by CT. PET correctly identified 16 of 20 (sensitivity 80%) nodal stations with tumour compared to 13 of 20 by CT (sensitivity 65%). Overall, PET correctly staged 191 of 201 nodal stations (accuracy 95%) compared to 175 of 201 by CT (accuracy 87%). By the McNemar test, PET was significantly more specific than CT in excluding nodal tumour involvement ( ²=5.5, P<0.05). Conclusions: FDG PET is more specific than computed tomography in the non-invasive mediastinal staging of non-small cell lung cancer and has an important clinical role in the pre-operative staging of lung cancer patients.

Key Words: Lung cancer staging • Fluorodeoxyglucose • Positron emission tomography

This article has been cited by other articles:

				G. A. Silvestri, M. K. Gould, M. L. Margolis, L. T. Tanoue, D. McCrory, E. Toloza, and F. Detterbeck Noninvasive Staging of Non-small Cell Lung Cancer: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 178S - 201S. [Abstract] [Full Text] [PDF]

				M. K. Gould, W. G. Kuschner, C. E. Rydzak, C. C. Maclean, A. N. Demas, H. Shigemitsu, J. K. Chan, and D. K. Owens Test Performance of Positron Emission Tomography and Computed Tomography for Mediastinal Staging in Patients with Non-Small-Cell Lung Cancer: A Meta-Analysis Ann Intern Med, December 2, 2003; 139(11): 879 - 892. [Abstract] [Full Text] [PDF]

				J.F. Vansteenkiste Imaging in lung cancer: positron emission tomography scan Eur. Respir. J., February 1, 2002; 19(35_suppl): 49S - 60s. [Abstract] [Full Text] [PDF]

				T. Akhurst, R. J. Downey, M. S. Ginsberg, M. Gonen, M. Bains, R. Korst, R. J. Ginsberg, V. W. Rusch, and S. M. Larson An initial experience with FDG-PET in the imaging of residual disease after induction therapy for lung cancer Ann. Thorac. Surg., January 1, 2002; 73(1): 259 - 266. [Abstract] [Full Text] [PDF]

				G Laking and P Price 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) and the staging of early lung cancer Thorax, September 1, 2001; 56(90002): ii38 - 44. [Full Text] [PDF]

				J.F. Vansteenkiste and S.G. Stroobants The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology Eur. Respir. J., April 1, 2001; 17(4): 802 - 820. [Abstract] [Full Text] [PDF]

				S. U. Berlangieri and A. M. Scott Metabolic Staging of Lung Cancer N. Engl. J. Med., July 27, 2000; 343(4): 290 - 292. [Full Text]