Can positron emission tomography be used as a staging tool for small-cell lung cancer?
OBJECTIVE
Positron emission tomography (PET) is widely used for the staging evaluation of non-small-cell lung cancer; however, its use in small-cell lung cancer (SCLC) remains investigational.


METHODS
We did a retrospective study of 137 patients to evaluate the role of PET in SCLC. Fifty-one of 137 patients had computed tomography (CT) and PET scans during initial evaluation of a lung mass.


RESULTS
All 51 patients had PET-positive results for malignancy (100% sensitivity). In 40 of 51 cases (78%), the PET staging correlated with that on CT. Two of 51 patients (4%) had disease that was accurately upstaged by PET. Positron emission tomography accurately downstaged disease in 6 of 51 patients (12%). Positron emission tomography detected additional sites of disease in 13 of 42 patients (32%). Of the 13 additional sites of disease, PET detected supraclavicular nodes in 4 of 13 patients (30%) and bone lesions in 4 of 13 patients (30%). The sensitivity to detect brain lesions was 5 of 11 patients (45%) in this series. In this series, the PET results from 8 of 51 patients (16%) resulted in a change in disease management. Because of PET results, 6 of 51 patients (12%) who otherwise would not have been treated, were treated with radiation.


CONCLUSIONS
Positron emission tomography is potentially useful for accurate initial staging of SCLC and can ensure that a patient's disease is not overstaged by CT scan, which might result in denied potentially curative treatment for limited-stage SCLC. It can identify the occult adrenal metastasis and metastasis to supraclavicular lymph nodes that are missed by CT; however, brain lesions are difficult to assess by PET.
Vinjamuri
Mridula
M
Section of Hematology/Oncology, Mary Babb Randolph Cancer Center, West Virginia University Hospital, Morgantown 26506, USA.
Craig
Michael
M
Campbell-Fontaine
Annette
A
Almubarak
Mohammed
M
Gupta
Naresh
N
Rogers
John S
JS
D018288:Carcinoma, Small Cell / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D014057:Tomography, X-Ray Computed