Advantages of positron emission tomography over computed tomography in mediastinal staging of non-small cell lung cancer.
BACKGROUND
New treatment algorithms in early stage non-small cell lung cancer (NSCLC) involving preoperative chemotherapy require accurate clinical staging of the mediastinum. This study compares the accuracy of 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) scanning with that of computed tomography (CT) scanning in the clinical staging of non-small cell lung cancer.


METHODS
A retrospective review was performed on 52 patients with NSCLC who were evaluated with both CT and PET scans. All patients had their mediastinal lymph nodes sampled by mediastinoscopy or at the time of thoracotomy for pulmonary resection. Each imaging study was evaluated separately and correlated with histopathologic results.


RESULTS
For detecting mediastinal metastases the sensitivities of PET and CT scans were 67 and 50%, respectively; specificities were 91 and 65%, respectively; accuracies were 88 and 63%, respectively; positive predictive values were 50 and 16%, respectively; negative predictive values were 95 and 88%, respectively. PET scans were significantly better than CT scans at detecting mediastinal metastases (PET, 4/8; CT, 3/19) (P = 0.01).


CONCLUSIONS
PET scanning is superior to CT scanning for clinical staging of the mediastinum in NSCLC. A more confident decision regarding stratification of patients into current treatment algorithms can be made when the decision is based on PET scanning rather than the current "gold standard" of CT scanning.
von Haag
Derek W
DW
Division of Cardiothoracic Surgery, University of California-Davis, Sacramento, California 95817, USA.
Follette
David M
DM
Roberts
Peter F
PF
Shelton
David
D
Segel
Leigh D
LD
Taylor
Tracy M
TM
D000465:Algorithms; D002283:Carcinoma, Bronchogenic / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008482:Mediastinum; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed