title: Impact of [18F]FDG-PET on the primary staging of small-cell lung cancer.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of [18F]fluorodeoxy-D-glucose positron emission tomography (FDG-PET) on the primary staging of patients with small-cell lung cancer (SCLC).
  
  
  METHODS
  FDG-PET was performed in 120 consecutive patients with SCLC during primary staging. In addition, brain examinations with both FDG-PET and cranial magnetic resonance imaging (MRI) or computed tomography (CT) were performed in 91 patients. Results of FDG-PET were compared with those of conventional staging procedures. FDG-PET detected markedly increased FDG uptake in the primary tumours of all 120 patients (sensitivity 100%).
  
  
  RESULTS
  Complete agreement between FDG-PET results and other staging procedures was observed in 75 patients. Differences occurred in 45 patients at 65 sites. In 47 sites the FDG-PET results were proven to be correct, and in ten, incorrect. In the remaining eight sites, the discrepancies could not be clarified. In 14/120 patients, FDG-PET caused a stage migration, correctly upstaging ten patients to extensive disease and downstaging three patients by not confirming metastases of the adrenal glands suspected on the basis of CT. Only 1/120 patients was incorrectly staged by FDG-PET, owing to failure to detect brain metastases. In all cases the stage migration led to a significant change in the treatment protocol. Sensitivity of FDG-PET was significantly superior to that of CT in the detection of extrathoracic lymph node involvement (100% vs 70%, specificity 98% vs 94%) and distant metastases except to the brain (98% vs 83%, specificity 92% vs 79%). However, FDG-PET was significantly less sensitive than cranial MRI/CT in the detection of brain metastases (46% vs 100%, specificity 97% vs 100%).
  
  
  CONCLUSIONS
  The introduction of FDG-PET in the diagnostic evaluation of SCLC will improve the staging results and affect patient management, and may reduce the number of tests and invasive procedures.
authors.affiliation: Division of Nuclear Medicine, University Hospital, Freiburg, Germany. ibrink@ukl.uni-freiburg.de
authors.forename: I
authors.initials: I
authors.lastname: Brink
authors.forename: T
authors.initials: T
authors.lastname: Schumacher
authors.forename: M
authors.initials: M
authors.lastname: Mix
authors.forename: S
authors.initials: S
authors.lastname: Ruhland
authors.forename: E
authors.initials: E
authors.lastname: Stoelben
authors.forename: W
authors.initials: W
authors.lastname: Digel
authors.forename: M
authors.initials: M
authors.lastname: Henke
authors.forename: N
authors.initials: N
authors.lastname: Ghanem
authors.forename: E
authors.initials: E
authors.lastname: Moser
authors.forename: E U
authors.initials: EU
authors.lastname: Nitzsche
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging* / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18