Presurgical staging of non-small cell lung cancer: positron emission tomography, integrated positron emission tomography/CT, and software image fusion.
OBJECTIVE
To compare the diagnostic accuracy of positron emission tomography (PET) and integrated PET/CT and to evaluate the performance of software fusion for staging of non-small cell lung cancer (NSCLC).


METHODS
Thirty-six patients (17 men and 19 women) with NSCLC underwent staging with integrated PET/CT followed by mediastinal lymph node dissection and tumor resection. Twenty-five of the 36 patients (69%) underwent separate CT studies for software fusion of images. Two blinded reviewers analyzed in consensus all PET images, and an experienced radiologist was added to assess integrated and software-fused PET/CT images. Histopathologic findings served as "gold standard" for determining the diagnostic accuracy of all modalities.


RESULTS
Reviewers examining PET and integrated PET/CT classified T stage accurately in 67% (20 of 30 patients) and 97% (29 of 30 patients), respectively (p < 0.05). Overall, interpretations based on PET staged 57% (17 of 30 patients) correctly, over-staged 6 patients (20%), and under-staged 7 patients (23%). Interpretations based on integrated PET/CT correctly staged 83% (25 of 30 patients), over-staged 3 patients (10%), and under-staged 2 patients (7%). The overall staging accuracy of integrated PET/CT was significantly higher than that of PET (p < 0.05). Automatic software fusion of separately obtained PET and CT studies was successful in 68% of the patients but failed in 32%. In successful software fusion cases, the results of software fusion with regards to T stage and N stage were not different from integrated PET/CT.


CONCLUSIONS
Integrated PET/CT compared with PET alone was associated with 26% points-greater overall diagnostic accuracy (p = 0.01). The software fusion method failed to provide acceptable co-registration in > 30% of the patients.
Halpern
Benjamin S
BS
Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Center, UCLA David Geffen School of Medicine, AR 128 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095-6942, USA.
Schiepers
Christiaan
C
Weber
Wolfgang A
WA
Crawford
Tyler L
TL
Fueger
Barbara J
BJ
Phelps
Michael E
ME
Czernin
Johannes
J
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012984:Software