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Original Article
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Volume 343:254-261 July 27, 2000 Number 4
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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.

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ABSTRACT

Background Determining the stage of non–small-cell lung cancer often requires multiple preoperative tests and invasive procedures. Whole-body positron-emission tomography (PET) may simplify and improve the evaluation of patients with this tumor.

Methods 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 (95 percent confidence interval, 81 to 100 percent) and 86 percent (95 percent confidence interval, 78 to 94 percent), respectively. The corresponding values 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 adjusted for each other, only PET results were positively correlated with the histopathological findings in mediastinal lymph nodes (P<0.001). PET identified distant metastases that had not been found by standard methods in 11 of 102 patients. The sensitivity and specificity of PET for the detection of both mediastinal and distant metastatic disease were 95 percent (95 percent confidence interval, 88 to 100 percent) and 83 percent (95 percent confidence interval, 74 to 92 percent), respectively. The use of PET for clinical staging resulted in a different stage from the one determined by standard methods in 62 patients: the stage was lowered in 20 and raised in 42.

Conclusions PET improves the rate of detection of local and distant metastases in patients with non–small-cell lung cancer.


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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.

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Related Letters:

Staging of Non–Small-Cell Lung Cancer with Positron-Emission Tomography
Miller Y. E., Rosell R., Donckier J. E., Roelants V., Pochet J.-M., Groen H. J.M.
Extract | Full Text  
N Engl J Med 2000; 343:1571-1573, Nov 23, 2000. Correspondence

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