Chest 2001 Feb;119(2):333-9
Staging by positron emission tomography predicts survival in patients
with non-small cell lung cancer.
Dunagan D, Chin R Jr, McCain T, Case L, Harkness B, Oaks T, Haponik E.
BACKGROUND: Positron emission tomography (PET) scanning is used increasingly to detect and
stage lung cancer, but the test performance characteristics and relationship of PET to
patient outcomes remain undefined. OBJECTIVE: To determine the test performance
characteristics and relationship of PET scanning stage to patient outcomes relative to the
1997 International System for the Staging of Lung Cancer. DESIGN: Survival analysis using
pathologic staging as the criterion standard for comparison of survival as predicted by
staging by PET and CT. SETTING: University-based hospital. PATIENTS: All consecutive
patients undergoing PET scanning for the evaluation of possible non-small cell lung cancer
(NSCLC) during a 5-year period. Main outcome measures: Long-term survival of patients with
NSCLC after staging by PET. RESULTS: One hundred fifty-two thoracic PET scans were
obtained for the staging of possible NSCLC during a 5-year period. One hundred
twenty-three patients (81%) demonstrated increased (18)F-fluorodeoxyglucose uptake. The
overall sensitivity and specificity of PET for detecting malignancy were 95% and 67%,
respectively, compared with 100% and 27% for chest CT. PET and CT had similar accuracy for
staging the overall extent of disease (91% and 89%, respectively). PET stage correlated
highly with survival using either nodal location or overall stage (p = 0.003, p = 0.002),
as did pathologic staging (p = 0.0001, p = 0.0001). CT scan results did not accurately
predict survival (p = 0.608, p = 0.338). CONCLUSION: PET scanning is a highly sensitive
technologic advance in detecting and staging of thoracic malignancy and may more
accurately predict the likelihood of long-term survival in patients with NSCLC than chest
CT does.
PMID: 11171706
