title: Impact of 18F-FDG PET/CT in the treatment of patients with non-small cell lung cancer.
abstract: BACKGROUND
  Disease stage is the most important prognostic factor in lung cancer, and optimal staging is important to determine the best therapeutic option. FDG-PET/CT has demonstrated its value in early stage non-small cell lung cancer (NSCLC) but there is still insufficient data to define its role in other stages.
  
  
  OBJECTIVE
  Information provided by FDG-PET/CT has an impact on the therapeutic management of patients with NSCLC.
  
  
  METHODS
  A retrospective review was made of patients who underwent FDG-PET/CT between January 2008 and December 2010 for the diagnosis of NSCLC. Clinical stage before and after FDG-PET/CT and information about any change in therapeutic decision due to information provided by FDG-PET/CT were collected. Using pathologic evaluation as the gold standard, sensitivity, specificity, and positive and negative predictive values for CT and FDG-PET/CT were calculated.
  
  
  RESULTS
  Of the 522 patients diagnosed of NSCLC, FDG-PET/CT was performed in 246 (47.1%). In 85 cases (34.6%) FDG-PET/CT led to stage migration. Treatment was modified in 60 patients (24.4% of all FDG-PET/CT performed), avoiding a futile thoracotomy in 13 cases (5.2%), and allowing treatment with curative intent in 26 (10.5%). Out of 90 patients (36.5%) evaluated as stage iii by CT staging, FDG-PET/CT modified the therapeutic approach in 36 (40%). For the 133 cases (54%) with pathological assessment of the mediastinal lymph nodes, sensitivity, specificity, positive predictive value and negative predictive value were 0.57, 0.64, 0.48 and 0.72 for CT, and 0.68, 0.86, 0.75 and 0.81 for FDG-PET/CT.
  
  
  CONCLUSIONS
  Our data support previous reports that FDG-PET/CT is essential in the staging process not only for patients with potentially operable NSCLC but also for stage iii patients, as demonstrated by our data.
authors.affiliation: Departamento de Oncología Médica, Hospital del Mar-Parc de Salut Mar, Barcelona, España. Electronic address: ataus@parcdesalutmar.cat.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Taus
authors.affiliation: Departamento de Cirugía Torácica, Hospital del Mar-Parc de Salut Mar, Barcelona, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Aguiló
authors.affiliation: Departamento de Neumología, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias, Barcelona, España.
authors.forename: Víctor
authors.initials: V
authors.lastname: Curull
authors.affiliation: Departamento de Medicina Nuclear, Hospital del Mar-Parc de Salut Mar, Barcelona, España.
authors.forename: Marina
authors.initials: M
authors.lastname: Suárez-Piñera
authors.affiliation: Departamento de Cirugía Torácica, Hospital del Mar-Parc de Salut Mar, Barcelona, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rodríguez-Fuster
authors.affiliation: Departamento de Radioterapia, Hospital de la Esperança-Parc de Salut Mar, Barcelona, España.
authors.forename: Nuria
authors.initials: N
authors.lastname: Rodríguez de Dios
authors.affiliation: Departamento de Anatomía Patológica, Hospital de la Esperança-Parc de Salut Mar, Barcelona, España.
authors.forename: Lara
authors.initials: L
authors.lastname: Pijuan
authors.affiliation: Departamento de Radiología, Hospital del Mar-Parc de Salut Mar, Barcelona, España.
authors.forename: Flavio
authors.initials: F
authors.lastname: Zuccarino
authors.affiliation: Departamento de Radiología, Hospital del Mar-Parc de Salut Mar, Barcelona, España.
authors.forename: Iván
authors.initials: I
authors.lastname: Vollmer
authors.affiliation: Departamento de Neumología, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias, Barcelona, España.
authors.forename: Albert
authors.initials: A
authors.lastname: Sánchez-Font
authors.affiliation: Departamento de Cirugía Torácica, Hospital del Mar-Parc de Salut Mar, Barcelona, España.
authors.forename: José
authors.initials: J
authors.lastname: Belda-Sanchis
authors.affiliation: Departamento de Oncología Médica, Hospital del Mar-Parc de Salut Mar, Barcelona, España.
authors.forename: Edurne
authors.initials: E
authors.lastname: Arriola
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003657:Decision Making; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D064847:Multimodal Imaging; D009367:Neoplasm Staging / Q000379:methods*; D011013:Pneumonectomy / Q000379:methods; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; Computed tomography scan; Cáncer de pulmón no microcítico; Estadificación; FDG PET/TC; Non-small cell lung cancer; Staging; Tomografía computarizada