title: The clinical impact of integrated FDG PET-CT on management decisions in patients with lung cancer.
abstract: OBJECTIVE
  To retrospectively evaluate the clinical impact of FDG PET-CT on the management pathway of patients with lung cancer.
  
  
  METHODS
  One hundred and sixty-one patients with suspected lung cancer undergoing FDG PET-CT during the study period were analyzed. Before PET-CT, lung cancer MDT recorded scan indication, conventional clinical stage, and proposed treatment plan. The accuracy of integrated PET-CT compared with stand alone CT in preoperative staging of lung cancer was evaluated with pathological staging used as the reference standard. The effect of PET-CT on the subsequent management of patients was also evaluated.
  
  
  RESULTS
  The agreement between CT and integrated PET-CT in preoperative staging of lung cancer was significant (p<0.001). In 16 (10%) patients PET-CT excluded tumour as there was no FDG uptake. PET-CT revealed occult metastasis in 25 (16%) patients. It was also a better overall predictor for T status (64% vs. 58%) and N status (78% vs. 65%). For N staging PET-CT was more accurate for N1 (82% vs. 72%) and N2 (85% vs. 80%) disease. Regression analyses suggested that PET-CT was a better predictor of overall TNM staging for lung cancer. FDG PET scanning changed or influenced management decisions in 66 (41%) patients with lung cancer. Changes in TNM staging following PET-CT were significant predictors (p=0.02) in making a decision to abandon thoracotomies.
  
  
  CONCLUSIONS
  Addition of PET-CT to comprehensive evaluation of lung cancer can have significant clinical impact. There is marked improvement in staging the disease. Patients were frequently spared unnecessary treatment, and management was more appropriately targeted. PET permits reduction in the number of thoracotomies performed for non-resectable disease with predicted reduction in the morbidity rate and cost associated with unnecessary interventions.
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom. nrsubedi@yahoo.com
authors.forename: N
authors.initials: N
authors.lastname: Subedi
authors.forename: A
authors.initials: A
authors.lastname: Scarsbrook
authors.forename: M
authors.initials: M
authors.lastname: Darby
authors.forename: K
authors.initials: K
authors.lastname: Korde
authors.forename: P
authors.initials: P
authors.lastname: Mc Shane
authors.forename: M F
authors.initials: MF
authors.lastname: Muers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002283:Carcinoma, Bronchogenic / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010347:Patient Care Planning; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013908:Thoracotomy / Q000191:economics