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Advances in Positron Emission Tomography (PET) Technology Have Increased the Need for Surgical Staging in Non-Small Cell Lung Cancer (NSCLC)
B. E. Lee, D. Von Haag, T. Lown, D. Lau, R. Calhoun, D. Follette*. UC Davis Medical Center, Sacramento, CA,
BACKGROUND:
Pre-treatment staging of patients with NSCLC is critically important in determining an appropriate treatment plan. As PET and computed tomography (CT) are proven complementary modalities in clinical staging, recent advances in PET technology have brought forth fusion PET/CT as the new standard. We tested the hypothesis that improvements in PET technology have not increased the sensitivity or specificity of PET in NSCLC staging to an extent that surgical staging is no longer required.
METHODS:
This is a retrospective, single institution review of 336 patients from 1995-2005 with biopsy proven NSCLC who underwent FDG-PET prior to mediastinal lymph node sampling by cervical mediastinoscopy or thoracotomy. Clinical records, histopathologic reports, and PET findings were reviewed. Data was analyzed using the Pearson chi-squared test.
RESULTS:
Within the study population, 210 patients had routine PET and 126 had fusion PET/CT. For detecting mediastinal metastases the sensitivities of PET vs. fusion PET/CT were 61.1% vs. 85.7% (p < 0.05); specificities were 94.3% vs. 80.6% (p < 0.001); positive predictive values were 68.8% vs. 55.8%; negative predictive values were 92.1% vs. 95.2%; overall accuracy was 88.6% vs. 81.7%.
CONCLUSIONS:
This study shows that improvements in PET technology have increased fusion PET/CT sensitivity at the cost of significantly decreased specificity. Thus, while it may appear that fusion PET/CT incurs fewer false negatives, the dramatic increase in false positives reinforces the notion that fusion PET/CT should only be used as an adjunct to clinical staging and that surgical staging remains the standard of care in NSCLC.
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