Preoperative Staging of Non-Small-Cell Lung Cancer with Positron-Emission Tomography

Remge M. Pieterman, John W.G. van Putten, Jacobus J. Meuzelaar, Eduard L. Mooyaart, Willem Vaalburg, Gerard H. Koeter, Vaclav Fidler, Jan Pruim, Harry J.M. Groen

We prospectively compared the ability of a standard approach to staging (computed tomography [CT], ultrasonography, bone scanning, and, when indicated, needle biopsies) and one involving PET to detect metastases in mediastinal lymph nodes and at distant sites in 102 patients with resectable non-small-cell lung cancer. The presence of mediastinal metastatic disease was confirmed histopathologically. Distant metastases that were detected by PET were further evaluated by standard imaging tests and biopsies. Patients were followed postoperatively for six months by standard methods to detect occult metastases. Logistic-regression analysis was used to evaluate the ability of PET and CT to identify malignant mediastinal lymph nodes.

Results. The sensitivity and specificity of PET for the detection of mediastinal metastases were 91 percent and 86 percent, respectively. The corresponding values for CT were 75 percent  and 66 percent. When the results of PET and CT were adjusted for each other, only PET results were positively correlated with the histopathological findings in mediastinal lymph nodes. Conclusions. PET improves the rate of detection of local and distant metastases in patients with non-small-cell lung cancer. (N Engl J Med 2000;343:254-61.)