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Improved Accuracy Of Non-Small-Cell Lung Cancer Staging Achieved With Integrated Positron-Emission Tomography/Computed Tomography

Integrated positron-emission tomography (PET) and computed tomography (CT) together provides improved diagnostic accuracy over CT or PET alone, or conventional visual correlation of PET and CT, in disease staging for patients with non-small-cell lung cancer.

Dr. Hans C. Steinert of the University Hospital of Zurich, Switzerland and colleagues conducted a prospective study comparing integrated PET-CT for tumour, node, and metastasis staging with CT and PET alone or visually correlated PET and CT in 28 men and 21 women with non-small- cell lung cancer. The patient cohort consisted of 28 patients with adenocarcinoma, 13 with squamous-cell carcinoma, and 8 with large-cell carcinoma.

All patients, who were a mean age of 62 years, underwent conventional staging based on their medical history, blood test results, physical findings, bronchoscopy, and contrast- enhanced CT of the chest and upper abdomen. The patients were also evaluated using integrated whole-body PET-CT after receiving an intravenous injection of 350 MBq to 400 MBq of fludeoxyglucose F 18 approximately 50 minutes prior to imaging.

Lung resection and mediastinal lymphadenectomy was performed in 35 patients while 3 patients had exploratory thoracotomy. Two patients underwent wedge resection because of lung function too limited for lobectomy. Excluded from surgery were 8 patients with occult extrathoracic metastases and 1 patient with malignant cells in pleural fluid.

Integrated PET-CT, compared with visual correlation PET and CT, provided additional diagnostic information in 20 (41%) of the 49 patients. The additional information included the exact location of lymph nodes, precise evaluation of chest- wall infiltration, mediastinal invasion, correct differentiation between tumour and peritumoral inflammation or atelectasis, and the exact location of distant metastases.

In tumour staging integrated PET-CT was significantly more accurate than CT alone (P=0.001), than PET alone (P less than 0.001), or than visual correlation of PET and CT (P=0.013). Integrated PET-CT was also significantly more accurate in node staging than was PET alone (P=0.013). In metastasis staging integrated PET-CT increased the diagnostic certainty in 2 of 8 patients.

The investigators conclude that integrated PET-CT is superior to the other imaging methods in tumour staging, in providing precise information on chest-wall or mediastinal invasion, and in identifying hilar, mediastinal, and supraclavicular lymph nodes. Dr. Steinert's team surmises that integrated PET-CT, when widely available, will become the preferred approach for disease staging in non-small- cell lung cancer.
N Engl J Med 2003; 348:2500-7

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