Preoperative Staging of Non–Small-Cell Lung Cancer with Positron-Emission Tomography
Remge M. Pieterman, M.D., John W.G. van Putten, M.D., Jacobus J. Meuzelaar, M.D., Eduard L. Mooyaart, M.D., Willem Vaalburg, Ph.D., Gerard H. Koëter, M.D., Vaclav Fidler, Ph.D., Jan Pruim, M.D., and Harry J.M. Groen, M.D.
Background Determining the stage of non–small-cell lungcancer often requires multiple preoperative tests and invasiveprocedures. Whole-body positron-emission tomography (PET) maysimplify and improve the evaluation of patients with this tumor.
Methods We prospectively compared the ability of a standardapproach to staging (computed tomography [CT], ultrasonography,bone scanning, and, when indicated, needle biopsies) and oneinvolving PET to detect metastases in mediastinal lymph nodesand at distant sites in 102 patients with resectable non–small-celllung cancer. The presence of mediastinal metastatic diseasewas confirmed histopathologically. Distant metastases that weredetected by PET were further evaluated by standard imaging testsand biopsies. Patients were followed postoperatively for sixmonths by standard methods to detect occult metastases. Logistic-regressionanalysis was used to evaluate the ability of PET and CT to identifymalignant mediastinal lymph nodes.
Results The sensitivity and specificity of PET for the detectionof mediastinal metastases were 91 percent (95 percent confidenceinterval, 81 to 100 percent) and 86 percent (95 percent confidenceinterval, 78 to 94 percent), respectively. The correspondingvalues for CT were 75 percent (95 percent confidence interval,60 to 90 percent) and 66 percent (95 percent confidence interval,55 to 77 percent). When the results of PET and CT were adjustedfor each other, only PET results were positively correlatedwith the histopathological findings in mediastinal lymph nodes(P<0.001). PET identified distant metastases that had notbeen found by standard methods in 11 of 102 patients. The sensitivityand specificity of PET for the detection of both mediastinaland distant metastatic disease were 95 percent (95 percent confidenceinterval, 88 to 100 percent) and 83 percent (95 percent confidenceinterval, 74 to 92 percent), respectively. The use of PET forclinical staging resulted in a different stage from the onedetermined by standard methods in 62 patients: the stage waslowered in 20 and raised in 42.
Conclusions PET improves the rate of detection of local anddistant metastases in patients with non–small-cell lungcancer.
The occurrence of distant metastases and metastases to mediastinallymph nodes profoundly affects the prognosis of non–small-celllung cancer, making accurate staging crucial for selecting appropriatetreatment. When used alone, the results of most staging methods,such as computed tomography (CT), ultrasonography, and radionuclidebone scanning, are far from ideal. Whole-body positron-emissiontomography (PET) with 18F-fluorodeoxyglucose (fludeoxyglucoseF 18) as a tracer is a new metabolic imaging technique thatrelies on the fact that there is increased metabolism of glucosein tumor cells.1,2 Pulmonary tumors actively metabolize thetracer, and several studies have shown that the method has about95 percent sensitivity for detecting primary bronchial tumors3,4and mediastinal lymph-node metastases.5,6,7 Within the body,the method has a lower limit of resolution of 1 to 1.2 cm. Thespecificity of this method is not optimal, because the uptakeof 18F-fluorodeoxyglucose is increased by the presence of inflammatoryprocesses in the lungs. Another limitation is that histopathologicalverification of the results of the PET scan is often conductedonly on "hot spots" (areas in which the uptake of 18F-fluorodeoxyglucoseis much greater than the background uptake in all areas butthe heart, brain, and urinary tract) and does not include lymphnodes whose uptake of the radioactive glucose is not increased.The use of PET to identify distant metastases in patients withnon–small-cell lung cancer has been investigated in afew small studies.8,9 Therefore, we prospectively investigatedthe role of PET in evaluating the mediastinum and detectingdistant metastases in such patients.
Methods
Patients
Patients with potentially resectable non–small-cell lungcancer who were being evaluated with standard tests and proceduresin the outpatient department of pulmonary diseases at GroningenUniversity Hospital in Groningen, the Netherlands, were eligiblefor the study. Patients were excluded if they had hyperglycemia(defined as a serum glucose level of more than 180 mg per deciliter[10 mmol per liter]) before the PET study, since in a pilotstudy, such levels seemed to affect the quality of the PET imagesadversely, or had undergone cervical mediastinoscopy or parasternalmediastinotomy. All patients were evaluated by means of a historytaking, physical examination, blood count, measurement of electrolytes,tests of renal and liver function, bronchoscopy, cervical mediastinoscopy,and CT of the chest, including the upper abdomen. In patientswith symptoms or signs suggestive of distant metastases, appropriateadditional imaging tests and biopsies were performed. The combinationof tests and invasive procedures leading to clinical classificationaccording to the tumor–node–metastasis (TNM) stagingsystem of the American Joint Committee on Cancer10 was consideredtraditional staging. Every two months for at least six monthsafter thoracotomy, the patients underwent a physical examinationand chest radiography (as well as additional tests in patientssuspected of having distant metastases).
All patients gave written informed consent. The study was approvedby the medical ethics committee of Groningen University Hospital.
Surgery
Cervical mediastinoscopies, parasternal mediastinotomies, andexplorative thoracotomies were performed by four thoracic surgeons.Cervical mediastinoscopy was considered adequate when it included,at a minimum, biopsy specimens of the paratracheal and tracheobronchiallymph nodes on the right and left sides, and subcarinal lymphnodes. Mediastinal lymph nodes were dissected during thoracotomy,with thorough attention paid to the superior and inferior lymphnodes on the right side or the superior and inferior mediastinaland aortic lymph nodes on the left. Surgeons were strongly encouragedto dissect both normal-appearing lymph nodes and those thatappeared enlarged on CT. Lymph nodes were labeled accordingto the classification of Mountain and Dresler11 and sent forhistopathological examination, which included staining withhematoxylin and eosin.
Whole-Body PET
PET was performed with a scanner (ECAT model 951/31, Siemens/CTI,Knoxville, Tenn.) that had a field of view of 10.8 cm and afull width of 6 mm at half-maximal resolution. Data were reconstructediteratively12 into coronal, sagittal, and transverse sectionsand a three-dimensional rotating projection. 18F-fluorodeoxyglucosewas synthesized according to the method of Hamacher et al.13by a high-performance liquid chromatography controlled-synthesismodule.14 Patients were instructed to fast for six hours beforethe PET study, but they were allowed to drink water and to taketheir usual medications. 18F-fluorodeoxyglucose (370 MBq) wasadministered intravenously.
Before the prospective study, we performed a pilot study inseven patients with non–small-cell lung cancer to determinethe optimal scanning protocol, especially with regard to themediastinum. Static (i.e., isolated rather than dynamic) emissionscans were performed 30, 60, 90, and 120 minutes after the injectionof 18F-fluorodeoxyglucose. Imaging reconstruction was performedafter 2.5, 5, 8, and 10 minutes in each position for both emissionscans (which measure only 18F-fluorodeoxyglucose uptake) andtransmission scans (source, germanium-68). The results of post-emissiontransmission scans were used to correct for attenuation of the18F-fluorodeoxyglucose signal. The emission scans performed90 minutes after the injection of 18F-fluorodeoxyglucose, withreconstructions made after eight minutes in each position, wereconsidered to have provided the best images with respect tothe extent of contrast between hot spots and the backgroundlevel in mediastinal lymph-node levels. Both types of scanswere performed from the level of the first cervical vertebrato the level of the fifth lumbar vertebra. All clinicians involvedin the care of the patients were unaware of the results of PET.
CT of the Chest
CT of the chest and upper abdomen including the adrenal glandswas performed with a 120-KV, 125-mA tomoscan (model SR 7000,Philips Medical Systems, Enthoven, the Netherlands) with a slicethickness of 10 mm and a scanning time of one second per slice.During CT, 200 ml of contrast medium (Omnipaque, iohexol, Nycomed,Amersham, Princeton, N.J.) was administered intravenously ata rate of 1.5 ml per second. In 13 patients no contrast mediumwas used.
Assessment of Metastases
Hot Spots Inside the Mediastinum
A positive PET scan was one that had at least one hot spot.All imaging studies were analyzed by two independent observerswho were not aware of the patients' clinical data. If they couldnot reach a consensus, the opinion of a third observer was sought.
The gold standard for the diagnosis of mediastinal metastasesis surgical exploration of the mediastinum and histopathologicalexamination of mediastinal lymph-node compartments (stations).Because the degree of anatomical resolution of mediastinal lymphnodes with PET is limited, we broadened the lymph-node categoriesin the classification of Mountain and Dresler11 in order tocompare the results of CT, PET, and histopathological analysis(Figure 1). For the interpretation of the CT findings, the mediastinallymph nodes were divided in two categories: those with a diameterof less than 1 cm in the shortest axis were considered normalin size and those with a diameter of 1 cm or more were consideredto be enlarged.
Figure 1. Mediastinal Lymph-Node Levels Used to Compare the Results of PET, CT, and Histopathological Analysis.
Level 1 included the superior mediastinum; level 2, the right side of the paratracheal and tracheobronchial areas; level 3, the left side of the paratracheal and tracheobronchial areas; level 4, the subaortic and paraaortic areas; level 5, the subcarinal area; level 6, the right side of the paraesophageal area and the pulmonary ligament; and level 7, the left side of the paraesophageal area and the pulmonary ligament.
Hot Spots Outside the Mediastinum
Hot spots outside the mediastinum were described according totheir anatomical locations and were related to data obtainedby traditional staging methods, including the data obtainedduring the six-month follow-up in the case of lesions that hadnot been detected previously by traditional staging methods.If there was a clinical suspicion of distant metastases duringthe follow-up period, biopsies or imaging tests were performed.The results of PET were considered to be falsely positive ifno metastases became apparent at a hot spot during follow-up.
Statistical Analysis
The study was designed to detect with a power of 0.85 and atwo-sided level of 0.05 a difference of 35 percent betweenthe sensitivity of PET and that of CT (whose sensitivity wasassumed to be 60 percent). In order to identify such a difference,the study required a minimum of 30 patients with mediastinalmetastases. Assuming that mediastinal metastases are presentin about 30 percent of patients with resectable non–small-celllung cancer, a minimum of 100 patients had to be enrolled.
We determined the sensitivity, specificity, and diagnostic accuracyof each imaging method and of the combination of PET and CT.
The degree of agreement between observers was quantified withthe kappa statistic. The two-sided sign test was used to comparethe differences between the TNM class identified by PET andthat identified by traditional methods of staging. Logistic-regressionanalysis was performed to evaluate the relative ability of PETand CT to identify metastatic cancer in mediastinal lymph nodes.A P value of less than 0.05 was considered to indicate statisticalsignificance. Statistical analysis was carried out with SPSSsoftware.
Results
Patients
Between September 1996 and December 1998, we evaluated 110 consecutivepatients. Non–small-cell lung cancer was diagnosed in102 patients: 58 had squamous-cell carcinoma, 28 had adenocarcinoma,13 had large-cell carcinoma, 2 had adenosquamous carcinoma,and 1 had a neuroendocrine tumor. We excluded two patients withsolitary metastases from melanoma and breast cancer, respectively;one with tuberculosis; one with sarcoidosis; and four in whommediastinal dissection was inadequate. The characteristics ofthe 102 patients who were evaluated are shown in Table 1.
Table 1. Characteristics of the 102 Patients with Resectable Non–Small-Cell Lung Cancer Who Could Be Evaluated.
Surgery
All patients underwent a cervical mediastinoscopy that exploredlymph-node levels 1, 2, 3, and 5 (Figure 1). In patients whounderwent a right-sided thoracotomy, mediastinal lymph nodesat levels 1, 2, 5, and 6 were dissected, and in those who underwenta left-sided thoracotomy, lymph nodes at levels 1, 3, 4, 5,and 7 were dissected. Six patients with solitary parenchymalmetastasis were considered to have resectable tumors. In threepatients with solitary brain metastases, curative lobectomywas performed after the removal of the brain lesion. In twopatients with two primary tumors in two lobes of the same lung,a curative pneumonectomy was performed. One patient with a non–small-celllung cancer of stage T2N2M1 had a double tumor and microscopictumor invasion of the subcarinal lymph nodes, all three of whichwere completely resected. In the group as a whole, 97 percentof the mediastinal lymph-node levels that could be reached weredissected (Table 1). At each level a median of 7 separate lymphnodes (range, 1 to 18) were dissected. Histopathological analysisshowed that a total of 37 mediastinal lymph-node levels containedmetastatic tumor.
Detection of Primary Tumor with PET
Every primary tumor was detected as an intense hot spot on PETscans (Figure 2). In one patient with two primary tumors, thesquamous-cell carcinoma appeared as a hot spot on PET, but surprisingly,the adenocarcinoma was not detected, although it was clearlyvisualized on CT.
Figure 2. CT and PET Findings in a Centrally Located Adenocarcinoma of the Left Lung and a Small Pretracheal Lymph Node in a Patient with Non–Small-Cell Lung Cancer.
On the axial CT scan of the chest (Panel A), the primary tumor (white arrow) is adjacent to the pulmonary artery; the lymph node is indicated by the dotted arrow. On the axial PET scan (Panel B) and coronal PET scan (Panel C), the primary tumor (white arrows) and lymph node (dotted arrows) show increased uptake of 18F-fluorodeoxyglucose. Physiologic uptake of 18F-fluorodeoxyglucose by the myocardium is also apparent.
Detection of Mediastinal Metastases with PET
Mediastinal lymph-node metastases were correctly detected byPET in 29 of 32 patients with positive results on histopathologicalanalysis (Table 2) and in 28 of the 37 mediastinal lymph-nodelevels that were positive for metastatic tumor on histopathologicalanalysis. PET correctly identified 60 of 70 patients who didnot have mediastinal lymph-node metastases on histopathologicalanalysis (Table 2). Distinguishing between intrapulmonary involvementand mediastinal lymph-node involvement is an important partof the process of deciding whether thoracotomy should be performed.The sensitivity and specificity of PET for detecting mediastinalmetastases were 91 percent (95 percent confidence interval,81 to 100 percent) and 86 percent (95 percent confidence interval,78 to 94 percent), respectively (Table 3). The overall negativepredictive value of the method was 95 percent (95 percent confidenceinterval, 90 to 100 percent), and the positive predictive valuewas 74 percent (95 percent confidence interval, 60 to 88 percent).Because of the presence of reactive hyperplasia in the mediastinallymph nodes of seven patients and of silicoanthracosis in three,PET produced a false positive result. False negative resultswere due to microscopic-tumor residue in two patients and tothe inability of the method to distinguish between paramediastinalprimary tumor and mediastinal lymph nodes in one patient. Thedegree of interobserver agreement (kappa value) in detectingmediastinal hot spots was 0.87 (95 percent confidence interval,0.64 to 1.0).
Table 3. Sensitivity, Specificity, and Accuracy of CT, PET, and Both CT and PET as Compared with Histopathological Analysis for the Mediastinal Evaluation of Patients with Resectable Non–Small-Cell Lung Cancer.
Detection of Distant Metastases with PET
In 20 of 102 patients, 29 hot spots were detected outside themediastinum (Figure 3). Three malignant satellite nodules inthe resected lobe were confirmed to be present during histologicexamination, and 17 of the 29 hot spots were diagnosed as metastasesduring the follow-up period — 3 by means of biopsy, 5on the basis of the detection of new, growing lesions on ultrasonography,5 by means of CT, and 4 on the basis of a finding of lytic lesionson radiographic imaging. Nine hot spots — four in thecolon, two in the lung, and one each in the liver, adrenal glands,and rib — were considered to be false positive results,since no metastases were identified in these areas during thefollow-up period.
Figure 3. Preoperative Axial CT and PET Findings in a Patient with Non–Small-Cell Lung Cancer.
The preoperative CT scan revealed no metastases in the liver (Panel A), whereas the PET scan showed three hot spots in the liver (Panel B). Liver metastases were confirmed during follow-up. In Panel B, the asterisk indicates diffuse uptake of 18F-fluorodeoxyglucose in the stomach wall as a result of gastritis.
PET correctly identified distant metastases in 11 of 102 patients(11 percent) in whom the usual methods of staging had foundnone. In three other patients, intrapulmonary metastases hadbeen detected by CT. In three patients without hot spots, distantmetastases developed during follow-up. No distant metastaseswere diagnosed during follow-up in 79 patients without hot spotson PET. The sensitivity and specificity of PET for detectingdistant metastases alone were 82 percent (95 percent confidenceinterval, 64 to 100 percent) and 93 percent (95 percent confidenceinterval, 88 to 98 percent), respectively. The degree of interobserveragreement was 0.98 (95 percent confidence interval, 0.73 to1.0).
CT of the Chest
In 20 of the 37 lymph-node levels that were positive for metastatictumor on histopathological analysis, CT revealed enlarged mediastinallymph nodes. CT correctly identified 46 of 70 patients who didnot have mediastinal metastases on histopathological analysisand 24 of 32 patients who did have mediastinal metastases (Table 2).In eight patients with mediastinal lymph-node metastases,the size of the lymph nodes was normal. The sensitivity of CTwas 75 percent (95 percent confidence interval, 60 to 90 percent),and the specificity was 66 percent (95 percent confidence interval,55 to 77 percent). An example of a mediastinal metastasis thatwas identified as a hot spot on PET but was deemed normal onCT is shown in Figure 4.
Figure 4. CT and PET Findings in a Patient with Squamous-Cell Carcinoma of the Right Lung.
No abnormal mediastinal lymph nodes were observed at level 2 on the CT scan (Panel A). On the corresponding axial PET scan (Panel B) and coronal PET scan (Panel C), the uptake of 18F-fluorodeoxyglucose was increased (arrows). The arrow in Panel A indicates the area of increased uptake in Panels B and C.
Overall Prognostic Value of PET
The overall sensitivity and specificity of PET, as comparedwith histopathological analysis, in detecting mediastinal anddistant metastatic disease were 95 percent (95 percent confidenceinterval, 88 to 100 percent) and 83 percent (95 percent confidenceinterval, 74 to 92 percent), respectively. Logistic-regressionanalysis revealed that the results of both PET and CT were significantlycorrelated with the results of histopathological analysis. Whenadjusted for each other, however, the correlation remained significantonly for PET (P<0.001). The use of PET for clinical stagingresulted in a different stage from the one arrived at by theusual methods in 62 of 102 patients. In 20 patients the stagedetermined by PET was lower, and in 42 patients it was higher(P<0.01 by the two-sided sign test).
Discussion
The ability of PET to identify tumors depends primarily on thedegree of uptake of 18F-fluorodeoxyglucose by malignant cells,the size of the tumor, and the presence or absence of inflammation.Non–small-cell lung-cancer cells avidly incorporate 18F-fluorodeoxyglucosebecause they have an increased rate of glycolysis and overexpressthe glucose transporter.15 At presentation, most non–small-celllung cancers are large enough to have hot spots on PET scans.Inflammation from an obstructing endobronchial tumor or otherinflammatory processes cause most of the false positive hotspots on PET scans. Previous studies have found that PET hasgood sensitivity and specificity for detecting mediastinal lymph-nodemetastases, but some of these investigations did not reportto what extent surgical exploration was used to confirm thepresence of such metastases.5,6,16 The sensitivity and specificityof this method can be misleadingly high if a biopsy of normal-sizedlymph nodes with minimal tumor is not performed. To relate PETdata to histopathological data, both normal-appearing and abnormal-appearinglymph nodes must undergo biopsy or be removed for further examination.In our study, 97 percent of the mediastinal lymph-node levelsthat could be reached surgically were dissected and underwenthistopathological analysis.
A disadvantage of PET is its limited anatomical resolution,which makes assessment of the extent of the primary tumor, especiallyif it invades the mediastinum, unreliable. For the same reason,mediastinal hot spots can be related only to lymph-node levelsand not to individual lymph nodes. We defined these levels duringthe preliminary part of the study to facilitate the interpretationof distinct hot spots in the mediastinum.
Another problem with PET is that 18F-fluorodeoxyglucose accumulatesas part of the physiologic process in the brain and urinarytract, which makes an evaluation of metastases at these sitesdifficult. A qualitative analysis of PET images can serve onlyto rule out the presence of such metastases and not to identifythem.7,17 This point brings the usefulness of transmission scanningfor this purpose into question, although the results of mediastinaland hepatic scanning are slightly improved after correctionfor attenuation of the 18F-fluorodeoxyglucose signal. The useof CT together with PET may help to pinpoint the anatomicallocation of the hot spot, especially in the case of intrapulmonarylymph nodes, which are located close to the mediastinum andthus can be mistaken for mediastinal lymph nodes.18 However,in one study, computerized fusion of the two types of imagesseemed to be only marginally more beneficial than simple visualcorrelation of the PET scan and CT scan in terms of pinpointingmetastases in thoracic lymph nodes.19 We also found that combiningCT with PET did not significantly improve sensitivity and specificity.
The high negative predictive value of PET for mediastinal lymph-nodemetastases can be used to advantage in the approach to patientswith non–small-cell lung cancer, because invasive proceduresare probably not necessary in a patient with negative findingson PET in the mediastinum. However, our finding of a positivepredictive value of 74 percent means that patients in whom amediastinal hot spot is found on PET will need to undergo acervical mediastinoscopy as part of the workup for non–small-celllung cancer. The positive predictive value will be lower inpatients with inflammatory changes.20,21
Frequent sites of distant metastasis in patients with non–small-celllung cancer are the liver, adrenal glands, bone, and brain.Whole-body PET can replace other types of imaging for all thesesites except the brain, where the degree of uptake of 18F-fluorodeoxyglucoselacks specificity. The use of PET to identify distant metastasesin patients with non–small-cell lung cancer has not beenextensively studied, but the method may offer better resultsfor bone metastases than bone scanning.8 If we had not alsoperformed invasive procedures in our study, 17 percent of patientswould have been denied potentially curative surgery becauseof false positive mediastinal or distant hot spots or both.For this reason, a positive PET result requires an evaluationinvolving mediastinoscopy and, if indicated for distant lesions,additional procedures.
Our study confirms that, as compared with traditional stagingmethods, PET can result in a more accurate classification ofthe stage of disease in patients with resectable non–small-celllung cancer. The increased accuracy may improve survival, butthis outcome was not the primary end point of our study. Therefore,a randomized study is necessary to determine whether a diagnosticstrategy that includes PET can improve survival. However, somesmall studies have suggested that the use of standardized uptakevalues for the primary tumor has independent prognostic value.22,23
Concurrent detection of mediastinal and distant metastases by18F-fluorodeoxyglucose PET will decrease the number of testsand invasive procedures required in the evaluation of patientswith non–small-cell lung cancer. Implementing PET at thestart of the staging process may improve the efficiency of theworkup, but at this time the procedure is not cost effective,given the limited availability of dedicated PET cameras.
Supported by a grant for data management from Groningen UniversityHospital.
Source Information
From the Departments of Pulmonary Diseases (R.M.P., J.W.G.P., G.H.K., H.J.M.G.), Thoracic Surgery (J.J.M.), Radiology (E.L.M.), and Biostatistics and Epidemiology (V.F.) and the Positron-Emission Tomography Center (R.M.P., W.V., J.P.), Groningen University Hospital, Groningen, the Netherlands. Presented in part at the International Conference of the American Thoracic Society–American Lung Association, San Diego, Calif., April 23–28, 1999, and at the Annual Meeting of the American Society of Clinical Oncology, Atlanta, May 15–18, 1999.
Address reprint requests to Dr. Groen at the Department of Pulmonary Diseases, Groningen University Hospital, Hanzeplein 1, 9700 RB Groningen, the Netherlands, or at h.j.m.groen{at}int.azg.nl.
References
Dahlbom M, Hoffman EJ, Hoh CK, et al. Whole-body positron emission tomography. I. Methods and performance characteristics. J Nucl Med 1992;33:1191-1199. [Free Full Text]
Nolop KB, Rhodes CG, Brudin LH, et al. Glucose utilization in vivo by human pulmonary neoplasms. Cancer 1987;60:2682-2689. [CrossRef][Medline]
Sazon DAD, Santiago SM, Soo Hoo GW, et al. Fluorodeoxyglucose-positron emission tomography in the detection and staging of lung cancer. Am J Respir Crit Care Med 1996;153:417-421. [Abstract]
Dewan NA, Gupta NC, Redepenning LS, Phalen JJ, Frick MP. Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules: potential role in evaluation and management. Chest 1993;104:997-1002. [Free Full Text]
Chin R Jr, Ward R, Keyes JW, et al. Mediastinal staging of non-small-cell lung cancer with positron emission tomography. Am J Respir Crit Care Med 1995;152:2090-2096. [Abstract]
Steinert HC, Hauser M, Allemann F, et al. Non-small cell lung cancer: nodal staging with FDG PET versus CT with correlative lymph node mapping and sampling. Radiology 1997;202:441-446. [Free Full Text]
Vansteenkiste JF, Stroobants SG, De Leyn PR, et al. Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. J Clin Oncol 1998;16:2142-2149. [Abstract]
Bury T, Barreto A, Daenen F, Barthelemy N, Ghaye B, Rigo P. Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer. Eur J Nucl Med 1998;25:1244-1247. [CrossRef][Medline]
Weder W, Schmid RA, Bruchhaus H, Hillinger S, von Schulthess GK, Steinert HC. Detection of extrathoracic metastases by positron emission tomography in lung cancer. Ann Thorac Surg 1998;66:886-892. [Free Full Text]
Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest 1997;111:1710-1717. [Free Full Text]
Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997;111:1718-1723. [Free Full Text]
Lonneux M, Borbath I, Bol A, et al. Attenuation correction in whole-body FDG oncological studies: the role of statistical reconstruction. Eur J Nucl Med 1999;26:591-598. [CrossRef][Medline]
Hamacher K, Coenen HH, Stöcklin G. Efficient stereospecific synthesis of no-carrier-added 2-(18F)-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 1986;27:235-238. [Free Full Text]
Medema J, Luurtsema G, Keizer H, Tilkema SP, Elsinga PH, Vaalburg W. Performance of a fully automated and unattended production system of [18F]FDG. J Labelled Compd Radiopharm 1999;42:Suppl 1:S853-S855.
Brown RS, Leung JY, Kison PV, Zasadny KR, Flint A, Wahl RL. Glucose transporters and FDG uptake in untreated primary human non-small cell lung cancer. J Nucl Med 1999;40:556-565. [Free Full Text]
Valk PE, Pounds TR, Hopkins DM, et al. Staging non-small cell lung cancer by whole-body positron emission tomographic imaging. Ann Thorac Surg 1995;60:1573-1581. [Free Full Text]
Imran MB, Kubota K, Yamada S, et al. Lesion-to-background ratio in nonattenuation-corrected whole-body FDG PET images. J Nucl Med 1998;39:1219-1223. [Medline]
Wahl RL, Quint LE, Greenough RL, Meyer CR, White RI, Orringer MB. Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluation. Radiology 1994;191:371-377. [Free Full Text]
Vansteenkiste JF, Stroobants SG, Dupont PJ, et al. FGD-PET scan in potentially operable non-small cell lung cancer: do anatometabolic PET-CT fusion images improve the localisation of regional lymph node metastases? Eur J Nucl Med 1998;25:1495-1501. [CrossRef][Medline]
Lewis PJ, Salama A. Uptake of fluorine-18-fluorodeoxyglucose in sarcoidosis. J Nucl Med 1994;35:1647-1649. [Free Full Text]
Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992;33:1972-1980. [Free Full Text]
Ahuja V, Coleman RE, Herndon J, Patz EF Jr. The prognostic significance of fluorodeoxyglucose positron emission tomography imaging for patients with nonsmall cell lung carcinoma. Cancer 1998;83:918-924. [CrossRef][Medline]
Vansteenkiste JF, Stroobants SG, Dupont PJ, et al. Prognostic importance of the standardized uptake value on 18F-fluoro-2-deoxy-glucose-positron emission tomography scan in non-small-cell lung cancer: an analysis of 125 cases. J Clin Oncol 1999;17:3201-3206. [Free Full Text]
Yi, C. A, Shin, K. M., Lee, K. S., Kim, B.-T., Kim, H., Kwon, O J., Choi, J. Y., Chung, M. J.
(2008). Non-Small Cell Lung Cancer Staging: Efficacy Comparison of Integrated PET/CT versus 3.0-T Whole-Body MR Imaging. Radiology
248: 632-642
[Abstract][Full Text]
Chee, K. G., Nguyen, D. V., Brown, M., Gandara, D. R., Wun, T., Lara, P. N. Jr
(2008). Positron Emission Tomography and Improved Survival in Patients With Lung Cancer: The Will Rogers Phenomenon Revisited. Arch Intern Med
168: 1541-1549
[Abstract][Full Text]
Hanin, F.-X., Lonneux, M., Cornet, J., Noirhomme, P., Coulon, C., Distexhe, J., Poncelet, A. J.
(2008). Prognostic value of FDG uptake in early stage non-small cell lung cancer. Eur. J. Cardiothorac. Surg.
33: 819-823
[Abstract][Full Text]
Kozower, B. D., Meyers, B. F., Reed, C. E., Jones, D. R., Decker, P. A., Putnam, J. B. Jr
(2008). Does Positron Emission Tomography Prevent Nontherapeutic Pulmonary Resections for Clinical Stage IA Lung Cancer?. Ann. Thorac. Surg.
85: 1166-1170
[Abstract][Full Text]
Silvestri, G A, Spiro, S G
(2008). Carcinoma of the bronchus 60 years later. Postgrad. Med. J.
84: 182-187
[Full Text]
Fletcher, J. W., Djulbegovic, B., Soares, H. P., Siegel, B. A., Lowe, V. J., Lyman, G. H., Coleman, R. E., Wahl, R., Paschold, J. C., Avril, N., Einhorn, L. H., Suh, W. W., Samson, D., Delbeke, D., Gorman, M., Shields, A. F.
(2008). Recommendations on the Use of 18F-FDG PET in Oncology. JNM
49: 480-508
[Abstract][Full Text]
Melek, H., Gunluoglu, M. Z., Demir, A., Akin, H., Olcmen, A., Dincer, S. I.
(2008). Role of positron emission tomography in mediastinal lymphatic staging of non-small cell lung cancer. Eur. J. Cardiothorac. Surg.
33: 294-299
[Abstract][Full Text]
Sung, Y. M., Lee, K. S., Kim, B.-T., Kim, S., Kwon, O J., Choi, J. Y., Yang, S.-O.
(2008). Nonpalpable Supraclavicular Lymph Nodes in Lung Cancer Patients: Preoperative Characterization with 18F-FDG PET/CT. Am. J. Roentgenol.
190: 246-252
[Abstract][Full Text]
Ung, Y. C., Maziak, D. E., Vanderveen, J. A., Smith, C. A., Gulenchyn, K., Lacchetti, C., Evans, W. K., Lung Cancer Disease Site Group of Cancer Care Onta,
(2007). 18Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis and Staging of Lung Cancer: A Systematic Review. JNCI J Natl Cancer Inst
99: 1753-1767
[Abstract][Full Text]
Giaccone, G.
(2007). 18Fluorodeoxyglucose Positron Emission Tomography, a Standard Diagnostic Tool in Lung Cancer. JNCI J Natl Cancer Inst
99: 1741-1743
[Full Text]
Kaira, K., Oriuchi, N., Otani, Y., Shimizu, K., Tanaka, S., Imai, H., Yanagitani, N., Sunaga, N., Hisada, T., Ishizuka, T., Dobashi, K., Kanai, Y., Endou, H., Nakajima, T., Endo, K., Mori, M.
(2007). Fluorine-18-{alpha}-Methyltyrosine Positron Emission Tomography for Diagnosis and Staging of Lung Cancer: A Clinicopathologic Study. Clin. Cancer Res.
13: 6369-6378
[Abstract][Full Text]
Pawlik, T. M., Gleisner, A. L., Bauer, T. W., Adams, R. B., Reddy, S. K., Clary, B. M., Martin, R. C., Scoggins, C. R., Tanabe, K. K., Michaelson, J. S., Kooby, D. A., Staley, C. A., Schulick, R. D., Vauthey, J.-N., Abdalla, E. K., Curley, S. A, Choti, M. A, Elias, D.
(2007). Liver-Directed Surgery for Metastatic Squamous Cell Carcinoma to the Liver: Results of a Multi-Center Analysis. Ann. Surg. Oncol.
14: 2807-2816
[Abstract][Full Text]
de Geus-Oei, L.-F., van der Heijden, H. F.M., Visser, E. P., Hermsen, R., van Hoorn, B. A., Timmer-Bonte, J. N.H., Willemsen, A. T., Pruim, J., Corstens, F. H.M., Krabbe, P. F.M., Oyen, W. J.G.
(2007). Chemotherapy Response Evaluation with 18F-FDG PET in Patients with Non-Small Cell Lung Cancer. JNM
48: 1592-1598
[Abstract][Full Text]
Wang, F., Wang, Z., Yao, W., Xie, H., Xu, J., Tian, L.
(2007). Role of 99mTc-Octreotide Acetate Scintigraphy in Suspected Lung Cancer Compared with 18F-FDG Dual-Head Coincidence Imaging. JNM
48: 1442-1448
[Abstract][Full Text]
Silvestri, G. A., Gould, M. K., Margolis, M. L., Tanoue, L. T., McCrory, D., Toloza, E., Detterbeck, F.
(2007). Noninvasive Staging of Non-small Cell Lung Cancer: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition). Chest
132: 178S-201S
[Abstract][Full Text]
Port, J. L., Lee, P. C., Korst, R. J., Liss, Y., Meherally, D., Christos, P., Mazumdar, M., Altorki, N. K.
(2007). Positron Emission Tomographic Scanning Predicts Survival After Induction Chemotherapy for Esophageal Carcinoma. Ann. Thorac. Surg.
84: 393-400
[Abstract][Full Text]
Tournoy, K G, Maddens, S, Gosselin, R, Van Maele, G, van Meerbeeck, J P, Kelles, A
(2007). Integrated FDG-PET/CT does not make invasive staging of the intrathoracic lymph nodes in non-small cell lung cancer redundant: a prospective study. Thorax
62: 696-701
[Abstract][Full Text]
Kong, F.-M. S., Frey, K. A., Quint, L. E., Haken, R. K. T., Hayman, J. A., Kessler, M., Chetty, I. J., Normolle, D., Eisbruch, A., Lawrence, T. S.
(2007). A Pilot Study of [18F]Fluorodeoxyglucose Positron Emission Tomography Scans During and After Radiation-Based Therapy in Patients With Non Small-Cell Lung Cancer. JCO
25: 3116-3123
[Abstract][Full Text]
Torigian, D. A., Huang, S. S., Houseni, M., Alavi, A.
(2007). Functional Imaging of Cancer with Emphasis on Molecular Techniques. CA Cancer J Clin
57: 206-224
[Abstract][Full Text]
Okada, M., Tauchi, S., Iwanaga, K., Mimura, T., Kitamura, Y., Watanabe, H., Adachi, S., Sakuma, T., Ohbayashi, C.
(2007). Associations among bronchioloalveolar carcinoma components, positron emission tomographic and computed tomographic findings, and malignant behavior in small lung adenocarcinomas. J. Thorac. Cardiovasc. Surg.
133: 1448-1454
[Abstract][Full Text]
Riedl, C. C., Akhurst, T., Larson, S., Stanziale, S. F., Tuorto, S., Bhargava, A., Hricak, H., Klimstra, D., Fong, Y.
(2007). 18F-FDG PET Scanning Correlates with Tissue Markers of Poor Prognosis and Predicts Mortality for Patients After Liver Resection for Colorectal Metastases. JNM
48: 771-775
[Abstract][Full Text]
Moghissi, K., Dixon, K., Thorpe, J. A. C., Stringer, M., Oxtoby, C.
(2007). Photodynamic therapy (PDT) in early central lung cancer: a treatment option for patients ineligible for surgical resection. Thorax
62: 391-395
[Abstract][Full Text]
Yi, C. A, Lee, K. S., Kim, B.-T., Shim, S. S., Chung, M. J., Sung, Y. M., Jeong, S. Y.
(2007). Efficacy of Helical Dynamic CT Versus Integrated PET/CT for Detection of Mediastinal Nodal Metastasis in Non-Small Cell Lung Cancer. Am. J. Roentgenol.
188: 318-325
[Abstract][Full Text]
Blodgett, T. M., Meltzer, C. C., Townsend, D. W.
(2007). PET/CT: Form and Function. Radiology
242: 360-385
[Abstract][Full Text]
Daniels, C. E., Lowe, V. J., Aubry, M.-C., Allen, M. S., Jett, J. R.
(2007). The Utility of Fluorodeoxyglucose Positron Emission Tomography in the Evaluation of Carcinoid Tumors Presenting as Pulmonary Nodules. Chest
131: 255-260
[Abstract][Full Text]
Gregoire, V., Haustermans, K., Geets, X., Roels, S., Lonneux, M.
(2007). PET-Based Treatment Planning in Radiotherapy: A New Standard?. JNM
48: 68S-77S
[Abstract][Full Text]
Silvestri, G A, Spiro, S G
(2006). Carcinoma of the bronchus 60 years later.. Thorax
61: 1023-1028
[Full Text]
Biehl, K. J., Kong, F.-M., Dehdashti, F., Jin, J.-Y., Mutic, S., El Naqa, I., Siegel, B. A., Bradley, J. D.
(2006). 18F-FDG PET Definition of Gross Tumor Volume for Radiotherapy of Non-Small Cell Lung Cancer: Is a Single Standardized Uptake Value Threshold Approach Appropriate?. JNM
47: 1808-1812
[Abstract][Full Text]
Kim, B.-T., Lee, K. S., Shim, S. S., Choi, J. Y., Kwon, O J., Kim, H., Shim, Y. M., Kim, J., Kim, S.
(2006). Stage T1 Non-Small Cell Lung Cancer: Preoperative Mediastinal Nodal Staging with Integrated FDG PET/CT--A Prospective Study. Radiology
241: 501-509
[Abstract][Full Text]
Posther, K. E., McCall, L. M., Harpole, D. H. Jr., Reed, C. E., Putnam, J. B. Jr., Rusch, V. W., Siegel, B. A.
(2006). Yield of Brain 18F-FDG PET in Evaluating Patients with Potentially Operable Non-Small Cell Lung Cancer. JNM
47: 1607-1611
[Abstract][Full Text]
Yasufuku, K., Nakajima, T., Motoori, K., Sekine, Y., Shibuya, K., Hiroshima, K., Fujisawa, T.
(2006). Comparison of Endobronchial Ultrasound, Positron Emission Tomography, and CT for Lymph Node Staging of Lung Cancer.. Chest
130: 710-718
[Abstract][Full Text]
Lee, K.-H., Lee, S.-H., Kim, D.-W., Kang, W. J., Chung, J.-K., Im, S.-A., Kim, T.-Y., Kim, Y. W., Bang, Y.-J., Heo, D. S.
(2006). High fluorodeoxyglucose uptake on positron emission tomography in patients with advanced non-small cell lung cancer on platinum-based combination chemotherapy.. Clin. Cancer Res.
12: 4232-4236
[Abstract][Full Text]
Barentsz, J., Takahashi, S., Oyen, W., Mus, R., De Mulder, P., Reznek, R., Oudkerk, M., Mali, W.
(2006). Commonly Used Imaging Techniques for Diagnosis and Staging. JCO
24: 3234-3244
[Abstract][Full Text]
Quon, A., Napel, S., Beaulieu, C. F., Gambhir, S. S.
(2006). "Flying Through" and "Flying Around" a PET/CT Scan: Pilot Study and Development of 3D Integrated 18F-FDG PET/CT for Virtual Bronchoscopy and Colonoscopy. JNM
47: 1081-1087
[Abstract][Full Text]
Lobrano, M. B.
(2006). Partnerships in Oncology and Radiology: The Role of Radiology in the Detection, Staging, and Follow-up of Lung Cancer. The Oncologist
11: 774-779
[Abstract][Full Text]
Bernasconi, M., Chhajed, P. N., Gambazzi, F., Bubendorf, L., Rasch, H., Kneifel, S., Tamm, M.
(2006). Combined transbronchial needle aspiration and positron emission tomography for mediastinal staging of NSCLC. Eur Respir J
27: 889-894
[Abstract][Full Text]
Mawlawi, O., Erasmus, J. J., Pan, T., Cody, D. D., Campbell, R., Lonn, A. H., Kohlmyer, S., Macapinlac, H. A., Podoloff, D. A.
(2006). Truncation Artifact on PET/CT: Impact on Measurements of Activity Concentration and Assessment of a Correction Algorithm.. Am. J. Roentgenol.
186: 1458-1467
[Abstract][Full Text]
Herder, G. J.M., Kramer, H., Hoekstra, O. S., Smit, E. F., Pruim, J., van Tinteren, H., Comans, E. F., Verboom, P., Uyl-de Groot, C. A., Welling, A., Paul, M. A., Boers, M., Postmus, P. E., Teule, G. J., Groen, H. J.M.
(2006). Traditional Versus Up-Front [18F] Fluorodeoxyglucose-Positron Emission Tomography Staging of Non-Small-Cell Lung Cancer: A Dutch Cooperative Randomized Study. JCO
24: 1800-1806
[Abstract][Full Text]
Hishida, T., Nagai, K., Yoshida, J., Nishimura, M., Ishii, G.-i., Iwasaki, M., Nishiwaki, Y.
(2006). Is surgical resection indicated for a solitary non-small cell lung cancer recurrence?. J. Thorac. Cardiovasc. Surg.
131: 838-842
[Abstract][Full Text]
Shim, S. S., Lee, K. S., Chung, M. J., Kim, H., Kwon, O J., Kim, S.
(2006). Do hemodynamic studies of stage t1 lung cancer enable the prediction of hilar or mediastinal nodal metastasis?. Am. J. Roentgenol.
186: 981-988
[Abstract][Full Text]
Bernstein, E. D., Herbert, S. M., Hanna, N. H.
(2006). Chemotherapy and Radiotherapy in the Treatment of Resectable Non-Small-Cell Lung Cancer. Ann. Surg. Oncol.
13: 291-301
[Abstract][Full Text]
Bunyaviroch, T., Coleman, R. E.
(2006). PET Evaluation of Lung Cancer. JNM
47: 451-469
[Full Text]
Hendrickx, B. W., van Herpen, C. M.L., Bonenkamp, J. J., Bulten, J., Oyen, W. J.G.
(2005). Positive Positron Emission Tomography Scan in Sarcoidosis and Two Challenging Cases of Metastatic Cancer: CASE 1. Mediastinal Sarcoidosis in a Melanoma Patient Treated With Interferon. JCO
23: 8906-8907
[Full Text]
Port, J. L., Andrade, R. S., Levin, M. A., Korst, R. J., Lee, P. C., Becker, D. E., Altorki, N. K.
(2005). Positron emission tomographic scanning in the diagnosis and staging of non-small cell lung cancer 2 cm in size or less. J. Thorac. Cardiovasc. Surg.
130: 1611-1615
[Abstract][Full Text]
Rusch, V. W.
(2005). Mediastinoscopy: An Endangered Species?. JCO
23: 8283-8285
[Full Text]
Annema, J. T., Versteegh, M. I., Veselic, M., Voigt, P., Rabe, K. F.
(2005). Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis and Staging of Lung Cancer and Its Impact on Surgical Staging. JCO
23: 8357-8361
[Abstract][Full Text]
Pozo-Rodriguez, F., Martin de Nicolas, J. L., Sanchez-Nistal, M. A., Maldonado, A., Garcia de Barajas, S., Calero-Garcia, R., Pozo, M. A., Martin-Escribano, P., Martin-Garcia, I., Garcia-Lujan, R., Lopez-Encuentra, A., Arenas de Pablo, A.
(2005). Accuracy of Helical Computed Tomography and [18F] Fluorodeoxyglucose Positron Emission Tomography for Identifying Lymph Node Mediastinal Metastases in Potentially Resectable Non-Small-Cell Lung Cancer. JCO
23: 8348-8356
[Abstract][Full Text]
Lardinois, D., Weder, W., Roudas, M., von Schulthess, G. K., Tutic, M., Moch, H., Stahel, R. A., Steinert, H. C.
(2005). Etiology of Solitary Extrapulmonary Positron Emission Tomography and Computed Tomography Findings in Patients With Lung Cancer. JCO
23: 6846-6853
[Abstract][Full Text]
Halpern, B. S., Schiepers, C., Weber, W. A., Crawford, T. L., Fueger, B. J., Phelps, M. E., Czernin, J.
(2005). Presurgical Staging of Non-small Cell Lung Cancer: Positron Emission Tomography, Integrated Positron Emission Tomography/CT, and Software Image Fusion. Chest
128: 2289-2297
[Abstract][Full Text]
Tournoy, K. G., Praet, M. M., Van Maele, G., Van Meerbeeck, J. P.
(2005). Esophageal Endoscopic Ultrasound With Fine-Needle Aspiration With an On-site Cytopathologist: High Accuracy for the Diagnosis of Mediastinal Lymphadenopathy. Chest
128: 3004-3009
[Abstract][Full Text]
Onn, A., Choe, D. H., Herbst, R. S., Correa, A. M., Munden, R. F., Truong, M. T., Vaporciyan, A. A., Isobe, T., Gilcrease, M. Z., Marom, E. M.
(2005). Tumor Cavitation in Stage I Non-Small Cell Lung Cancer: Epidermal Growth Factor Receptor Expression and Prediction of Poor Outcome. Radiology
237: 342-347
[Abstract][Full Text]
Shim, S. S., Lee, K. S., Kim, B.-T., Chung, M. J., Lee, E. J., Han, J., Choi, J. Y., Kwon, O J., Shim, Y. M., Kim, S.
(2005). Non-Small Cell Lung Cancer: Prospective Comparison of Integrated FDG PET/CT and CT Alone for Preoperative Staging. Radiology
236: 1011-1019
[Abstract][Full Text]
Annema, J. T., Versteegh, M. I., Veselic, M., Welker, L., Mauad, T., Sont, J. K., Willems, L. N. A., Rabe, K. F.
(2005). Endoscopic Ultrasound Added to Mediastinoscopy for Preoperative Staging of Patients With Lung Cancer. JAMA
294: 931-936
[Abstract][Full Text]
Sachs, S., Bilfinger, T. V.
(2005). The Impact of Positron Emission Tomography on Clinical Decision Making in a University-Based Multidisciplinary Lung Cancer Practice. Chest
128: 698-703
[Abstract][Full Text]
Juweid, M. E., Wiseman, G. A., Vose, J. M., Ritchie, J. M., Menda, Y., Wooldridge, J. E., Mottaghy, F. M., Rohren, E. M., Blumstein, N. M., Stolpen, A., Link, B. K., Reske, S. N., Graham, M. M., Cheson, B. D.
(2005). Response Assessment of Aggressive Non-Hodgkin's Lymphoma by Integrated International Workshop Criteria and Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography. JCO
23: 4652-4661
[Abstract][Full Text]
Cerfolio, R. J., Bryant, A. S., Ohja, B., Bartolucci, A. A.
(2005). The maximum standardized uptake values on positron emission tomography of a non-small cell lung cancer predict stage, recurrence, and survival. J. Thorac. Cardiovasc. Surg.
130: 151-159
[Abstract][Full Text]
Shankar, L. K., Sullivan, D. C.
(2005). Functional Imaging in Lung Cancer. JCO
23: 3203-3211
[Abstract][Full Text]
Ohtsuka, T., Nomori, H., Watanabe, K., Naruke, T., Orikasa, H., Yamazaki, K., Suemasu, K., Uno, K.
(2005). False-positive Findings on [18F]FDG-PET Caused by Non-neoplastic Cellular Elements After Neoadjuvant Chemoradiotherapy for Non-small Cell Lung Cancer. Jpn J Clin Oncol
35: 271-273
[Abstract][Full Text]
Kelloff, G. J., Hoffman, J. M., Johnson, B., Scher, H. I., Siegel, B. A., Cheng, E. Y., Cheson, B. D., O'Shaughnessy, J., Guyton, K. Z., Mankoff, D. A., Shankar, L., Larson, S. M., Sigman, C. C., Schilsky, R. L., Sullivan, D. C.
(2005). Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development. Clin. Cancer Res.
11: 2785-2808
[Abstract][Full Text]
Beal, K. P., Yeung, H. W., Yahalom, J.
(2005). FDG-PET scanning for detection and staging of extranodal marginal zone lymphomas of the MALT type: a report of 42 cases. Ann Oncol
16: 473-480
[Abstract][Full Text]
Erturan, S., Yaman, M., Aydin, G., Uzel, I., Musellim, B., Kaynak, K.
(2005). The Role of Whole-Body Bone Scanning and Clinical Factors in Detecting Bone Metastases in Patients With Non-small Cell Lung Cancer. Chest
127: 449-454
[Abstract][Full Text]
LeBlanc, J. K., Devereaux, B. M., Imperiale, T. F., Kesler, K., DeWitt, J. M., Cummings, O., Ciaccia, D., Sherman, S., Mathur, P., Conces, D., Brooks, J., Chriswell, M., Einhorn, L., Collins, E.
(2005). Endoscopic Ultrasound in Non-Small Cell Lung Cancer and Negative Mediastinum on Computed Tomography. Am. J. Respir. Crit. Care Med.
171: 177-182
[Abstract][Full Text]
Eloubeidi, M. A., Cerfolio, R. J., Chen, V. K., Desmond, R., Syed, S., Ojha, B.
(2005). Endoscopic Ultrasound-Guided Fine Needle Aspiration of Mediastinal Lymph Node in Patients With Suspected Lung Cancer After Positron Emission Tomography and Computed Tomography Scans. Ann. Thorac. Surg.
79: 263-268
[Abstract][Full Text]
Cerfolio, R. J., Bryant, A. S., Winokur, T. S., Ohja, B., Bartolucci, A. A.
(2004). Repeat FDG-PET After Neoadjuvant Therapy is a Predictor of Pathologic Response in Patients With Non-Small Cell Lung Cancer. Ann. Thorac. Surg.
78: 1903-1909
[Abstract][Full Text]
Antoch, G., Saoudi, N., Kuehl, H., Dahmen, G., Mueller, S. P., Beyer, T., Bockisch, A., Debatin, J. F., Freudenberg, L. S.
(2004). Accuracy of Whole-Body Dual-Modality Fluorine-18-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Tumor Staging in Solid Tumors: Comparison With CT and PET. JCO
22: 4357-4368
[Abstract][Full Text]
Wong, C.-y. O., Salem, R., Qing, F., Wong, K. T., Barker, D., Gates, V., Lewandowski, R., Hill, E. A., Dworkin, H. J., Nagle, C.
(2004). Metabolic Response After Intraarterial 90Y-Glass Microsphere Treatment for Colorectal Liver Metastases: Comparison of Quantitative and Visual Analyses by 18F-FDG PET. JNM
45: 1892-1897
[Abstract][Full Text]
Schrevens, L., Lorent, N., Dooms, C., Vansteenkiste, J.
(2004). The Role of PET Scan in Diagnosis, Staging, and Management of Non-Small Cell Lung Cancer. The Oncologist
9: 633-643
[Abstract][Full Text]
Deserno, W. M. L. L. G., Harisinghani, M. G., Taupitz, M., Jager, G. J., Witjes, J. A., Mulders, P. F., Hulsbergen van de Kaa, C. A., Kaufmann, D., Barentsz, J. O.
(2004). Urinary Bladder Cancer: Preoperative Nodal Staging with Ferumoxtran-10-enhanced MR Imaging. Radiology
233: 449-456
[Abstract][Full Text]
Hillner, B. E., Tunuguntla, R., Fratkin, M.
(2004). Clinical Decisions Associated With Positron Emission Tomography in a Prospective Cohort of Patients With Suspected or Known Cancer at One United States Center. JCO
22: 4147-4156
[Abstract][Full Text]
Keidar, Z., Haim, N., Guralnik, L., Wollner, M., Bar-Shalom, R., Ben-Nun, A., Israel, O.
(2004). PET/CT Using 18F-FDG in Suspected Lung Cancer Recurrence: Diagnostic Value and Impact on Patient Management. JNM
45: 1640-1646
[Abstract][Full Text]
Cobben, D. C.P., Elsinga, P. H., Hoekstra, H. J., Suurmeijer, A. J.H., Vaalburg, W., Maas, B., Jager, P. L., Groen, H. M.J.
(2004). Is 18F-3'-Fluoro-3'-Deoxy-L-Thymidine Useful for the Staging and Restaging of Non-Small Cell Lung Cancer?. JNM
45: 1677-1682
[Abstract][Full Text]
Younes-Mhenni, S., Janier, M. F., Cinotti, L., Antoine, J. C., Tronc, F., Cottin, V., Ternamian, P. J., Trouillas, P., Honnorat, J.
(2004). FDG-PET improves tumour detection in patients with paraneoplastic neurological syndromes. Brain
127: 2331-2338
[Abstract][Full Text]
Cerfolio, R. J., Ojha, B., Bryant, A. S., Raghuveer, V., Mountz, J. M., Bartolucci, A. A.
(2004). The accuracy of integrated PET-CT compared with dedicated pet alone for the staging of patients with nonsmall cell lung cancer. Ann. Thorac. Surg.
78: 1017-1023
[Abstract][Full Text]
Aquino, S. L., Fischman, A. J.
(2004). Does Whole-Body 2-[18F]-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Have an Advantage Over Thoracic Positron Emission Tomography for Staging Patients With Lung Cancer?. Chest
126: 755-760
[Abstract][Full Text]
Torabi, M., Aquino, S. L., Harisinghani, M. G.
(2004). Current Concepts in Lymph Node Imaging. JNM
45: 1509-1518
[Abstract][Full Text]
Lynch, T. J., Wright, C. D., Choi, N. C., Aquino, S. L., Mark, E. J.
(2004). Case 26-2004 - A 56-Year-Old Woman with Cough and a Lung Nodule. NEJM
351: 809-817
[Full Text]
Benamore, R. E, Entwisle, J. J, Peake, M. D
(2004). Bone scanning in lung cancer: Evidence is not sufficient to justify routine bone scanning. BMJ
329: 230-231
[Full Text]
Kramer, H, van Putten, J W G, Post, W J, van Dullemen, H M, Bongaerts, A H H, Pruim, J, Suurmeijer, A J H, Klinkenberg, T J, Groen, H, Groen, H J M
(2004). Oesophageal endoscopic ultrasound with fine needle aspiration improves and simplifies the staging of lung cancer. Thorax
59: 596-601
[Abstract][Full Text]
van Overhagen, H., Brakel, K., Heijenbrok, M. W., van Kasteren, J. H. L. M., van de Moosdijk, C. N. F., Roldaan, A. C., van Gils, A. P., Hansen, B. E.
(2004). Metastases in Supraclavicular Lymph Nodes in Lung Cancer: Assessment with Palpation, US, and CT. Radiology
232: 75-80
[Abstract][Full Text]
Viney, R. C., Boyer, M. J., King, M. T., Kenny, P. M., Pollicino, C. A., McLean, J. M., McCaughan, B. C., Fulham, M. J.
(2004). Randomized Controlled Trial of the Role of Positron Emission Tomography in the Management of Stage I and II Non-Small-Cell Lung Cancer. JCO
22: 2357-2362
[Abstract][Full Text]
Kramer, H., Pieterman, R. M., Slebos, D.-J., Timens, W., Vaalburg, W., Koeter, G. H., Groen, H. J.M.
(2004). PET for the Evaluation of Pleural Thickening Observed on CT. JNM
45: 995-998
[Abstract][Full Text]
Detterbeck, F. C., Falen, S., Rivera, M. P., Halle, J. S., Socinski, M. A.
(2004). Seeking a Home for a PET, Part 2: Defining the Appropriate Place for Positron Emission Tomography Imaging in the Staging of Patients With Suspected Lung Cancer. Chest
125: 2300-2308
[Abstract][Full Text]
Jacobson, B. C., Gould, M. K., Silvestri, G. A., Detterbeck, F., Papagiannis, A., Buyukcelik, A., Yalcin, B., Utkan, G., Spira, A., Ettinger, D. S.
(2004). Multidisciplinary Management of Lung Cancer. NEJM
350: 2008-2010
[Full Text]
Sihoe, A. D.L., Lee, T. W., Ahuja, A. T., Yim, A. P.C.
(2004). Should cervical ultrasonography be a routine staging investigation for lung cancer patients with impalpable cervical lymph nodes?. Eur. J. Cardiothorac. Surg.
25: 486-491
[Abstract][Full Text]
Asad, S., Aquino, S. L., Piyavisetpat, N., Fischman, A. J.
(2004). False-Positive FDG Positron Emission Tomography Uptake in Nonmalignant Chest Abnormalities. Am. J. Roentgenol.
182: 983-989
[Full Text]
Sharma, A., Fidias, P., Hayman, L. A., Loomis, S. L., Taber, K. H., Aquino, S. L.
(2004). Patterns of Lymphadenopathy in Thoracic Malignancies. RadioGraphics
24: 419-434
[Abstract][Full Text]
Kahn, D., Menda, Y., Kernstine, K., Bushnell, D., McLaughlin, K., Miller, S., Berbaum, K.
(2004). The Utility of 99mTc Depreotide Compared With F-18 Fluorodeoxyglucose Positron Emission Tomography and Surgical Staging in Patients With Suspected Non-small Cell Lung Cancer. Chest
125: 494-501
[Abstract][Full Text]
Boucher, L., Rodrigue, S., Lecomte, R., Benard, F.
(2004). Respiratory Gating for 3-Dimensional PET of the Thorax: Feasibility and Initial Results. JNM
45: 214-219
[Abstract][Full Text]
Spira, A., Ettinger, D. S.
(2004). Multidisciplinary Management of Lung Cancer. NEJM
350: 379-392
[Full Text]
Pfister, D. G., Johnson, D. H., Azzoli, C. G., Sause, W., Smith, T. J., Baker, S. Jr, Olak, J., Stover, D., Strawn, J. R., Turrisi, A. T., Somerfield, M. R.
(2004). American Society of Clinical Oncology Treatment of Unresectable Non-Small-Cell Lung Cancer Guideline: Update 2003. JCO
22: 330-353
[Full Text]
Port, J. L., Kent, M. S., Korst, R. J., Keresztes, R., Levin, M. A., Altorki, N. K.
(2004). Positron emission tomography scanning poorly predicts response to preoperative chemotherapy in non-small cell lung cancer. Ann. Thorac. Surg.
77: 254-259
[Abstract][Full Text]
Goerres, G. W., von Schulthess, G. K., Steinert, H. C.
(2004). Why Most PET of Lung and Head-and-Neck Cancer Will Be PET/CT. JNM
45: 66S-71
[Abstract][Full Text]
level of 0.05 a difference of 35 percent between the sensitivity of PET and that of CT (whose sensitivity was assumed to be 60 percent). In order to identify such a difference, the study required a minimum of 30 patients with mediastinal metastases. Assuming that mediastinal metastases are present in about 30 percent of patients with resectable non–small-cell lung cancer, a minimum of 100 patients had to be enrolled. 
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