title: Clinical value of F18-fluorodeoxyglucose positron emission tomography-computed tomography in patients with non-small cell lung cancer after potentially curative surgery: experience with 241 patients.
abstract: OBJECTIVE
  F18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT), which allows differentiation between malignant and benign lesions based on difference in tissue glucose metabolism, has become increasingly important in lung cancer diagnosis. This study examined the clinical value of FDG-PET/CT in a large number of patients with non-small cell lung cancer (NSCLC) after potentially curative surgery.
  
  
  METHODS
  Four hundred and ninety FDG-PET/CT of 241 patients (143 males and 98 females; age range 38-87 years; mean 68.0 years) between May 2006 and February 2008 were retrospectively evaluated. All the 241 patients had undergone potentially curative surgery for NSCLC >6 months before FDG-PET/CT and their pathologic stages were stage I and II according to the tumor-node-metastasis (TNM) classification. A final diagnosis of recurrence was confirmed by histologic or cytologic examination of the disease or by clinical and radiologic follow-up image analysis. Confirmation of recurrence-free status was based on a clinical and radiologic image analysis follow-up period of at least 12 months with no evidence of active malignancy. The diagnostic performance of FDG-PET/CT was evaluated. Details of false results and incidental detection of diseases other than recurrent lung cancer by FDG-PET/CT was also analyzed.
  
  
  RESULTS
  Recurrences were confirmed in 35 (15%) patients, and 206 patients (85%) had no evidence of recurrence. FDG-PET/CT correctly diagnosed recurrence in 34 of 35 patients and provided true negative findings in 198 of 206 patients who had no evidence of recurrence (sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 97%, 96%, 96%, 81%, and 99%, respectively), indicating a high diagnostic performance. However, one patient had false negative studies and eight patients had false positive studies; misdiagnosis was more frequently in intrathoracic sites associated with postoperative changes. Malignancies other than recurrence were detected in nine of all 241 patients (4%) including five second primary lung cancers.
  
  
  CONCLUSIONS
  The present study demonstrated the high diagnostic performance of FDG-PET/CT in detecting recurrences in a large group of patients with NSCLC after potentially curative surgery. FDG-PET/CT is useful not only for diagnosis of recurrence but also for detection of other diseases.
authors.affiliation: Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. rkanzaki@tj8.so-net.ne.jp
authors.forename: Ryu
authors.initials: R
authors.lastname: Kanzaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Higashiyama
authors.forename: Jun
authors.initials: J
authors.lastname: Maeda
authors.forename: Jiro
authors.initials: J
authors.lastname: Okami
authors.forename: Takuya
authors.initials: T
authors.lastname: Hosoki
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Motohisa
authors.initials: M
authors.lastname: Takami
authors.forename: Ken
authors.initials: K
authors.lastname: Kodama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000601:surgery; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18