title: Preoperative staging of lung cancer with combined PET-CT.
abstract: BACKGROUND
  Fast and accurate staging is essential for choosing treatment for non-small-cell lung cancer (NSCLC). The purpose of this randomized study was to evaluate the clinical effect of combined positron-emission tomography and computed tomography (PET-CT) on preoperative staging of NSCLC.
  
  
  METHODS
  We randomly assigned patients who were referred for preoperative staging of NSCLC to either conventional staging plus PET-CT or conventional staging alone. Patients were followed until death or for at least 12 months. The primary end point was the number of futile thoracotomies, defined as any one of the following: a thoracotomy with the finding of pathologically confirmed mediastinal lymph-node involvement (stage IIIA [N2]), stage IIIB or stage IV disease, or a benign lung lesion; an exploratory thoracotomy; or a thoracotomy in a patient who had recurrent disease or death from any cause within 1 year after randomization.
  
  
  RESULTS
  From January 2002 through February 2007, we randomly assigned 98 patients to the PET-CT group and 91 to the conventional-staging group. Mediastinoscopy was performed in 94% of the patients. After PET-CT, 38 patients were classified as having inoperable NSCLC, and after conventional staging, 18 patients were classified thus. Sixty patients in the PET-CT group and 73 in the conventional-staging group underwent thoracotomy (P=0.004). Among these thoracotomies, 21 in the PET-CT group and 38 in the conventional-staging group were futile (P=0.05). The number of justified thoracotomies and survival were similar in the two groups.
  
  
  CONCLUSIONS
  The use of PET-CT for preoperative staging of NSCLC reduced both the total number of thoracotomies and the number of futile thoracotomies but did not affect overall mortality. (ClinicalTrials.gov number, NCT00867412.)
authors: Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. bjerregaard.fischer@gmail.com
authors: Barbara
authors: B
authors: Fischer
authors: Ulrik
authors: U
authors: Lassen
authors: Jann
authors: J
authors: Mortensen
authors: Søren
authors: S
authors: Larsen
authors: Annika
authors: A
authors: Loft
authors: Anne
authors: A
authors: Bertelsen
authors: Jesper
authors: J
authors: Ravn
authors: Paul
authors: P
authors: Clementsen
authors: Asbjørn
authors: A
authors: Høgholm
authors: Klaus
authors: K
authors: Larsen
authors: Torben
authors: T
authors: Rasmussen
authors: Susanne
authors: S
authors: Keiding
authors: Asger
authors: A
authors: Dirksen
authors: Oke
authors: O
authors: Gerke
authors: Birgit
authors: B
authors: Skov
authors: Ida
authors: I
authors: Steffensen
authors: Hanne
authors: H
authors: Hansen
authors: Peter
authors: P
authors: Vilmann
authors: Grete
authors: G
authors: Jacobsen
authors: Vibeke
authors: V
authors: Backer
authors: Niels
authors: N
authors: Maltbaek
authors: Jesper
authors: J
authors: Pedersen
authors: Henrik
authors: H
authors: Madsen
authors: Henrik
authors: H
authors: Nielsen
authors: Liselotte
authors: L
authors: Højgaard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D013908:Thoracotomy / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed