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J Thorac Cardiovasc Surg 2009;137:20-22
© 2009 The American Association for Thoracic Surgery

Point/Counterpoint

COUNTERPOINT: Despite staging inaccuracies, patients with non–small cell lung cancer are best served by having integrated positron emission tomography/computed tomography before therapy

Department of Surgery, the Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala

Received for publication June 21, 2008; accepted for publication August 29, 2008.

^_* Address for reprints: Robert J. Cerfolio, MD, FACS, FCCP, Professor, Department of Surgery, Chief of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham (UAB), 703 19^th St S, ZRB 739, Birmingham, AL 35294. (Email: robert.cerfolio@ccc.uab.edu).

The first 300 words of the full text of this article appear below.

	Introduction

 

For related article see page 13.

 

We just heard and read an eloquent presentation from Stiles and associates¹ from New York Hospital. The basic import of their study is that when positron emission tomography (PET) using fluorodeoxyglucose (FDG) scan predicts that a patient has stage IA non–small cell lung cancer (NSCLC), the patient truly has pathologic stage IA disease only 65% of the time. There are a few concerns about the methodology of this well done study: not all patients received integrated positron emission tomography/computed tomography (PET/CT), which has been shown to be superior in several studies and two prospective studies when compared to dedicated PET.^2-4 The time interval between the PET scan and the eventual operation is not specified. However, their findings are accurate, honest, and important. Moreover, the results of their study are very similar to a previous study from our group, which was presented at a meeting of The Society of Thoracic Surgeons and published in 2005.⁵ The real question that should be posed is not about the validity of this study's findings but rather about its clinical significance. In this point–counterpoint article, I will focus on the specific results of the article by Stiles and associates¹ and repeatedly query how the inaccuracy of PET injured patient care. How many patients had their treatment or care misguided by the PET's incorrect prediction? Inasmuch as these patients underwent anatomic pulmonary resection and complete thoracic lymphadenectomy, the answer is few to none. The same question must then be asked if the patient had undergone a less invasive procedure, which may be more commonly chosen in the future.

	Review of Stiles and Associates' Findings—Miscalculation of the T Status

 
Stiles and colleagues¹ found that PET was correct in predicting the T status as T1 in 192 of the 266 (72%) patients and incorrect in the remaining 28%. Interestingly, in our study, . . . [Full Text of this Article]

Related Article

POINT: Clinical stage IA non–small cell lung cancer determined by computed tomography and positron emission tomography is frequently not pathologic IA non–small cell lung cancer: The problem of understaging

Brendon M. Stiles, Elliot L. Servais, Paul C. Lee, Jeffrey L. Port, Subroto Paul, and Nasser K. Altorki
J. Thorac. Cardiovasc. Surg. 2009 137: 13-19. [Abstract] [Full Text] [PDF]

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