Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial.
BACKGROUND
Up to 50% of curative surgery for suspected non-small-cell lung cancer is unsuccessful. Accuracy of positron emission tomography (PET) with 18-fluorodeoxyglucose (18FDG) is thought to be better than conventional staging for diagnosis of this malignancy. Up to now however, there has been no evidence that PET leads to improved management of patients in routine clinical practice. We did a randomised controlled trial in patients with suspected non-small-cell lung cancer, who were scheduled for surgery after conventional workup, to test whether PET with 18FDG reduces number of futile thoracotomies.


METHODS
Before surgery (mediastinoscopy or thoracotomy), 188 patients from nine hospitals were randomly assigned to either conventional workup (CWU) or conventional workup and PET (CWU+PET). Patients were followed up for 1 year. Thoracotomy was regarded as futile if the patient had benign disease, explorative thoracotomy, pathological stage IIIA-N2/IIIB, or postoperative relapse or death within 12 months of randomisation. The primary outcome measure was futile thoracotomy. Analysis was by intention to treat.


RESULTS
96 patients were randomly assigned CWU and 92 CWU+PET. Two patients in the CWU+PET group did not undergo PET. 18 patients in the CWU group and 32 in the CWU+PET group did not have thoracotomy. In the CWU group, 39 (41%) patients had a futile thoracotomy, compared with 19 (21%) in the CWU+PET group (relative reduction 51%, 95% CI 32-80%; p=0.003).


CONCLUSIONS
Addition of PET to conventional workup prevented unnecessary surgery in one out of five patients with suspected non-small-cell lung cancer.
van Tinteren
Harm
H
Comprehensive Cancer Centre Amsterdam, Amsterdam, Netherlands. h.v.tinteren@nki.nl
Hoekstra
Otto S
OS
Smit
Egbert F
EF
van den Bergh
Jan H A M
JH
Schreurs
Ad J M
AJ
Stallaert
Roland A L M
RA
van Velthoven
Piet C M
PC
Comans
Emile F I
EF
Diepenhorst
Fred W
FW
Verboom
Paul
P
van Mourik
Johan C
JC
Postmus
Pieter E
PE
Boers
Maarten
M
Teule
Gerrit J J
GJ
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D013908:Thoracotomy / Q000706:statistics & numerical data*; D013997:Time Factors; D014055:Tomography, Emission-Computed / Q000379:methods; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18