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Preoperative Staging of Non-Small
Cell Lung Cancer
Fax Watch Inc.
August 04, 2000
Another study of positron-emission tomography (PET) has revealed the
procedure to simplify and improve the detection of local and distant
metastases in patients with non-small-cell lung cancer (NSCLC.)
Investigators in the current trial prospectively compared the ability
of a standard approach to staging computed tomography (CT),
ultrasonography, bone scanning, and needle biopsies and PET to detect
metastases in mediastinal lymph nodes and distant sites in 102 NSCLC
patients with resectable disease.
Histopathology
was used to confirm the presence of mediastinal metastatic disease,
and PET-detected metastasis were further evaluated using standard
imaging tests and biopsies. Follow-up occurred for 6 months after
surgery to detect occult metastasis. The ability of PET and CT to
identify malignant mediastinal lymph nodes was evaluated using
logistic-regression analysis.
The
sensitivity and specificity of PET were 91% and 86%, respectively, for
the detection of mediastinal metastasis as compared with the
corresponding values of 75% and 66%, respectively, with CT. When
adjusted for each other, only PET results were positively correlated
with the histopathological findings (P<.001). Metastases that had
not been previously detected were identified by PET in 11 of 102
patients.
For
the detection of both mediastinal and distant metastatic disease, the
sensitivity and specificity of PET were 95% and 83%, respectively.
Among 62 patients, the use of PET resulted in a different clinical
stage assignment than that determined by standard methods; the stage
of disease was lowered in 20 patients and raised in 42 when staged
with PET methods.
"Our
study confirms that, as compared with traditional staging methods, PET
can result in a more accurate classification of the stage of disease
in patients with resectable NSCLC,"the researchers concluded.
"The increased accuracy may improve survival. Concurrent
detection of mediastinal and distant metastases by
18F-fluorodeoxyglucose PET will decrease the number of tests and
invasive procedures required in the evaluation of patients with NSCLC."
They
noted that "Implementing PET at the start of the staging process
may improve the efficiency of the workup, but at this time the
procedure is not cost effective, given the limited availability of
dedicated PET cameras." (Pieterman R, et al. N Engl J Med
2000;343:254-61.)
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Rights Reserved.
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