title: Accuracy of fluorodeoxyglucose-positron emission tomography within the clinical practice of the American College of Surgeons Oncology Group Z4031 trial to diagnose clinical stage I non-small cell lung cancer.
abstract: BACKGROUND
  Fluorodeoxyglucose-positron emission tomography (FDG-PET) is recommended for diagnosis and staging of non-small cell lung cancer (NSCLC). Meta-analyses of FDG-PET diagnostic accuracy demonstrated sensitivity of 96% and specificity of 78% but were performed in select centers, introducing potential bias. This study evaluates the accuracy of FDG-PET to diagnose NSCLC and examines differences across enrolling sites in the national American College of Surgeons Oncology Group (ACOSOG) Z4031 trial.
  
  
  METHODS
  Between 2004 and 2006, 959 eligible patients with clinical stage I (cT1-2 N0 M0) known or suspected NSCLC were enrolled in the Z4031 trial, and with a baseline FDG-PET available for 682. Final diagnosis was determined by pathologic examination. FDG-PET avidity was categorized into avid or not avid by radiologist description or reported maximum standard uptake value. FDG-PET diagnostic accuracy was calculated for the entire cohort. Accuracy differences based on preoperative size and by enrolling site were examined.
  
  
  RESULTS
  Preoperative FDG-PET results were available for 682 participants enrolled at 51 sites in 39 cities. Lung cancer prevalence was 83%. FDG-PET sensitivity was 82% (95% confidence interval, 79 to 85) and specificity was 31% (95% confidence interval, 23% to 40%). Positive and negative predictive values were 85% and 26%, respectively. Accuracy improved with lesion size. Of 80 false-positive scans, 69% were granulomas. False-negative scans occurred in 101 patients, with adenocarcinoma being the most frequent (64%), and 11 were 10 mm or less. The sensitivity varied from 68% to 91% (p=0.03), and the specificity ranged from 15% to 44% (p=0.72) across cities with more than 25 participants.
  
  
  CONCLUSIONS
  In a national surgical population with clinical stage I NSCLC, FDG-PET to diagnose lung cancer performed poorly compared with published studies.
authors.affiliation: Veterans Affairs Medical Center, Nashville, Tennessee; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee. Electronic address: eric.grogan@vanderbilt.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Grogan
authors.affiliation: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Deppen
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Karla V
authors.initials: KV
authors.lastname: Ballman
authors.affiliation: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Gabriela M
authors.initials: GM
authors.lastname: Andrade
authors.affiliation: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Francys C
authors.initials: FC
authors.lastname: Verdial
authors.affiliation: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Melinda C
authors.initials: MC
authors.lastname: Aldrich
authors.affiliation: Center for Quantitative Sciences, Mayo Clinic, Rochester, Minnesota.
authors.forename: Chiu L
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Decker
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.affiliation: Department of Surgery, University of Alabama, Birmingham, Alabama.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
authors.affiliation: Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Keenan
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Department of Surgery, Stanford University, Stanford, California.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
authors.affiliation: Department of Surgery, Washington University, St. Louis, Missouri.
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.affiliation: Veterans Affairs Medical Center, Nashville, Tennessee; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18