title: Improved non-invasive T-Staging in non-small cell lung cancer by integrated 18F-FDG PET/CT.
abstract: OBJECTIVE
  In this prospective study, reliability of integrated (18)F-FDG PET/CT for staging of NSCLC was evaluated and compared to MDCT or PET alone.
  
  
  METHODS
  240 patients (pts) with suspected NSCLC were examined using PET/CT. Of those patients 112 underwent surgery comprising 80 patients with NSCLC (T1 n = 26, T2 n = 37, T3 n = 11, T4 n = 6). Imaging modalities were evaluated independently.
  
  
  RESULTS
  MDCT, PET and PET/CT diagnosed the correct T-stage in 40/80 pts (50%; CI: 0.39-0.61), 40/80 pts (50%; CI: 0.39-0.61) and 51/80 pts (64%; CI: 0.52-0.74), respectively, whereas equivocal T-stage was found in 15/80 pts (19%; CI: 0.11-0.19), 12/80 pts (15%; CI: 0.08-0.25) and 4/80 pts (5%; CI: 0.01-0.12), respectively. With PET/CT, T-stage was more frequently correct compared to MDCT (p = 0.003) or PET (p = 0.019). Pooling stages T1/T2, T-stage was correctly diagnosed with MDCT, PET and PET/CT in 54/80 pts (68%; CI: 0.56-0.78), 56/80 pts (70%; CI: 0.59-0.80) and 65/80 pts (81%; CI: 0.71-0.89). T3 stage was most difficult to diagnose. T3 tumors were correctly diagnosed with MDCT in 2/11 pts (18%; CI: 0.02-0.52) versus 0/11 pts (0%; CI: 0.00-0.28) with PET and 5/11 pts (45%; CI: 0.17-0.77) with PET/CT. In all imaging modalities, there were no equivocal findings for T4 tumors. Of these, MDCT found the correct tumor stage in 4/6 pts (67%; CI: 0.22-0.95), PET in 3/6 pts (50%; CI: 0.12-0.88) and PET/CT in 5/6 pts (83%; CI: 0.36-0.99).
  
  
  CONCLUSIONS
  Integrated PET/CT was significantly more accurate for T-staging of NSCLC compared to MDCT or PET alone. The advantages of PET/CT are especially pronounced combining T1- and T2-stage as well as in advanced tumors.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Pauls
authors.forename: A K
authors.initials: AK
authors.lastname: Buck
authors.forename: K
authors.initials: K
authors.lastname: Hohl
authors.forename: G
authors.initials: G
authors.lastname: Halter
authors.forename: M
authors.initials: M
authors.lastname: Hetzel
authors.forename: N M
authors.initials: NM
authors.lastname: Blumstein
authors.forename: F M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: G
authors.initials: G
authors.lastname: Glatting
authors.forename: S
authors.initials: S
authors.lastname: Krüger
authors.forename: L
authors.initials: L
authors.lastname: Sunder-Plassmann
authors.forename: P
authors.initials: P
authors.lastname: Möller
authors.forename: V
authors.initials: V
authors.lastname: Hombach
authors.forename: H-J
authors.initials: HJ
authors.lastname: Brambs
authors.forename: S N
authors.initials: SN
authors.lastname: Reske
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18