title: [Impact of positron emission tomography on clinical management of potentially resectable non-small-cell lung cancer: a French prospective multicenter study].
abstract: BACKGROUND
  Whole-body (18)F-deoxyglucose positron emission tomography (FDG-PET) has the potential to improve the management of non-small-cell lung cancer (NSCLC). We prospectively evaluated the impact of combining FDG-PET with conventional staging methods, including computed tomography (CT), on the staging and management of patients with potentially resectable NSCLC.
  
  
  METHODS
  Ninety-four consecutive patients with newly diagnosed/suspected NSCLC were enrolled. Each patient was first staged by using conventional methods, and then by FDG-PET. FDG-PET results were forwarded in a sealed envelope and divulged at the weekly staff meeting on staging and treatment, only after "Decision 1", based on conventional staging, had been reached by consensus; reevaluation taking FDG-PET into account yielded "Decision 2". The validity of these latter decisions was analyzed retrospectively.
  
  
  RESULTS
  Eighty-nine patients were eligible. Relative to standard imaging, FDG-PET led to clinical staging changes in 26 (29.2%) patients. The stage was lowered in eight cases (9%) and raised in 18 cases (20.2%). "Decision 2" differed from "Decision 1" in 19 patients, modifying the surgical procedure in four cases, indicating other investigations to confirm FDG-PET evidence of metastases in 12 cases, or modifying the medical treatment in three cases. These modifications were retrospectively justified in 9/19 cases, and consisted of 2/4 modifications of the surgical procedure (one hilar and one adrenal metastasis not confirmed histologically), 4/12 further investigations (axillary and liver biopsies, mediastinoscopy, occult colon cancer) and three indications for palliative treatment, in patients who all died within 3 months after FDG-PET.
  
  
  CONCLUSIONS
  Based on FDG-PET, management was modified in 19/89 (21.3%) patients, but these changes were justified in only 9/89 patients (10.1%). FDG-PET can detect asymptomatic local and distant metastases and improves the preoperative assessment of NSCLC, thereby avoiding unnecessary surgery. However, histological verification is required because of the risk of false-positive results.
authors.affiliation: Service des maladies respiratoires, hôpital d'instruction des armées Percy, Clamart, France. j.margery@free.fr
authors.forename: J
authors.initials: J
authors.lastname: Margery
authors.forename: B
authors.initials: B
authors.lastname: Milleron
authors.forename: F
authors.initials: F
authors.lastname: Vaylet
authors.forename: D
authors.initials: D
authors.lastname: Grahek
authors.forename: B
authors.initials: B
authors.lastname: Lebeau
authors.forename: G
authors.initials: G
authors.lastname: Mangiapan
authors.forename: G
authors.initials: G
authors.lastname: Bonardel
authors.forename: C
authors.initials: C
authors.lastname: de Labriolle-Vaylet
authors.forename: M
authors.initials: M
authors.lastname: Meignan
authors.forename: M-F
authors.initials: MF
authors.lastname: Carette
authors.forename: J-N
authors.initials: JN
authors.lastname: Talbot
authors.forename: B
authors.initials: B
authors.lastname: Housset
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging; D003657:Decision Making; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging; D010166:Palliative Care; D010347:Patient Care Planning; D011013:Pneumonectomy; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18