title: An initial experience with FDG-PET in the imaging of residual disease after induction therapy for lung cancer.
abstract: 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.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. akhurstt@mskcc.org
authors.forename: Tim
authors.initials: T
authors.lastname: Akhurst
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Downey
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Ginsberg
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Manjit
authors.initials: M
authors.lastname: Bains
authors.forename: Robert
authors.initials: R
authors.lastname: Korst
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ginsberg
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.forename: Steven M
authors.initials: SM
authors.lastname: Larson
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18