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J Thorac Cardiovasc Surg 2003;126:1943-1951
© 2003 The American Association for Thoracic Surgery
General thoracic surgery |
a Hollings Cancer Center, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
b Thoracic Oncology Program, Duke Comprehensive Cancer Center, Durham, NC, USA
c Department of Surgery, Duke University Medical Center, Durham, NC, USA
d Department of Biostatistics, Duke University Medical Center, Durham, NC, USA
e Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
f Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo, USA
g Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
h Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, Tex, USA
i Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
j Division of Pulmonary Medicine, Medical University of South Carolina, Charleston, SC, USA
k Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo, USA
l Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.
Received for publication April 29, 2003; revisions received July 25, 2003; accepted for publication July 30, 2003.
* Address for reprints: Carolyn E. Reed, MD, Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC 29425, USA
reedce{at}musc.edu
OBJECTIVES: The American College of Surgeons Oncology Group undertook a trial to ascertain whether positron emission tomography with 18F-fluorodeoxyglucose could detect lesions that would preclude pulmonary resection in a group of patients with documented or suspected non–small cell lung cancer found to be surgical candidates by routine staging procedures.
METHODS: A total of 303 eligible patients registered from 22 institutions underwent positron emission tomography after routine staging (computed tomography of chest and upper abdomen, bone scintigraphy, and brain imaging) had deemed their tumors resectable. Positive findings required confirmatory procedures.
RESULTS: Positron emission tomography was significantly better than computed tomography for the detection of N1 and N2/N3 disease (42% vs 13%, P = .0177, and 58% vs 32%, P = .0041, respectively). The negative predictive value of positron emission tomography for mediastinal node disease was 87%. Unsuspected metastatic disease or second primary malignancy was identified in 18 of 287 patients (6.3%). Distant metastatic disease indicated in 19 of 287 patients (6.6%) was subsequently shown to be benign. By correctly identifying advanced disease (stages IIIA, IIIB, and IV) or benign lesions, positron emission tomography potentially avoided unnecessary thoracotomy in 1 of 5 patients.
CONCLUSIONS: In patients with suspected or proven non–small cell lung cancer considered resectable by standard staging procedures, positron emission tomography can prevent nontherapeutic thoracotomy in a significant number of cases. Use of positron emission tomography for mediastinal staging should not be relied on as a sole staging modality, and positive findings should be confirmed by mediastinoscopy. Metastatic disease, especially a single site, identified by positron emission tomography requires further confirmatory evaluation.
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