Improved non-invasive T-Staging in non-small cell lung cancer by integrated18F-FDG PET/CT

S. Pauls; A. K. Buck; K. Hohl; G. Halter; M. Hetzel; N. M. Blumstein; F. M. Mottaghy; G. Glatting; S. Krüger; L. Sunder-Plassmann; P. Möller; V. Hombach; H.-J. Brambs; S. N. Reske

doi:10.1055/s-0037-1616618

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2007; 46(01): 09-14
DOI: 10.1055/s-0037-1616618

Original Article

Schattauer GmbH

Improved non-invasive T-Staging in non-small cell lung cancer by integrated¹⁸F-FDG PET/CT

Integrierte ¹⁸F-FDG PET/CT verbessert das nicht invasive T-Staging beim nicht kleinzelligen Bronchialkarzinom

Authors

S. Pauls^*

¹Department of Diagnostic and Interventional Radiology
A. K. Buck^*

²Department of Nuclear Medicine
K. Hohl

³Department of Biometry and Medical Documentation
G. Halter

⁴Department of Thoracic Surgery
M. Hetzel

⁵Department of Internal Medicine II
N. M. Blumstein

²Department of Nuclear Medicine
F. M. Mottaghy

²Department of Nuclear Medicine
G. Glatting

²Department of Nuclear Medicine
S. Krüger

⁵Department of Internal Medicine II
L. Sunder-Plassmann

⁴Department of Thoracic Surgery
P. Möller

⁶Department of Pathology, University Hospital Ulm, Germany
V. Hombach

⁵Department of Internal Medicine II
H.-J. Brambs

¹Department of Diagnostic and Interventional Radiology
S. N. Reske

²Department of Nuclear Medicine

Abstract

Summary

Aim: In this prospective study, reliability of integrated 18F-FDG PET/CT for staging of NSCLC was evaluated and compared to MDCT or PET alone. Patients, methods: 240 patients (pts) with suspected NSCLC were examined using PET/CT. Of those patients 112 underwent surgery comprising 80 patients with NSCLC (T1 n = 26, T2 n = 37, T3 n = 11, T4 n = 6). Imaging modalities were evaluated independently. Results: MDCT, PET and PET/CT diagnosed the correct T-stage in 40/80 pts (50%; CI: 0.39-0.61), 40/80 pts (50%; CI: 0.39-0.61) and 51/80 pts (64%; CI: 0.52-0.74), respectively, whereas equivocal T-stage was found in 15/80 pts (19%; CI: 0.11-0.19), 12/80 pts (15%; CI: 0.08-0.25) and 4/80 pts (5%; CI: 0.01-0.12), respectively. With PET/CT, T-stage was more frequently correct compared to MDCT (p = 0.003) or PET (p = 0.019). Pooling stages T1/T2, T-stage was correctly diagnosed with MDCT, PET and PET/CT in 54/80 pts (68%; CI: 0.56-0.78), 56/80 pts (70%; CI: 0.59-0.80) and 65/80 pts (81%; CI: 0.71-0.89). T3 stage was most difficult to diagnose. T3 tumors were correctly diagnosed with MDCT in 2/11 pts (18%; CI: 0.02-0.52) versus 0/11 pts (0%; CI: 0.00-0.28) with PET and 5/11 pts (45%; CI: 0.17-0.77) with PET/CT. In all imaging modalities, there were no equivocal findings for T4 tumors. Of these, MDCT found the correct tumor stage in 4/6 pts (67%; CI: 0.22-0.95), PET in 3/6 pts (50%; CI: 0.12-0.88) and PET/ CT in 5/6 pts (83%; CI: 0.36-0.99). Conclusion: Integrated PET/CT was significantly more accurate for T-staging of NSCLC compared to MDCT or PET alone. The advantages of PET/CT are especially pronounced combining T1- and T2-stage as well as in advanced tumors.

Zusammenfassung

Ziel: Evaluation der diagnostischen Genauigkeit der integrierten 18F-FDG PET/CT bezüglich des T-Stagings bei nicht-kleinzelligem Bronchialkarzinom (NSCLC) im Vergleich zu den Einzelverfahren MDCT und PET. Patienten, Methode: 240 Patienten (Pat) mit Verdacht auf NSCLC wurden mit PET/CT untersucht, 112 Pat wurden operiert. Bei 80 Pat lag ein NSCLC vor (T1 n = 26, T2 n = 37, T3 n = 11, T4 n = 6). Die Untersuchungsverfahren wurden jeweils unabhängig voneinander ausgewertet. Ergebnisse: MDCT, PET und PET/CT diagnostizierten das T-Stadium bei 40/80 Pat (50%; CI: 0,39-0,61), 40/80 Pat (50%; CI: 0,39-0,61) und 51/80 Pat (64%; CI: 0,52-0,74) korrekt, wobei das T-Stadium bei 15/80 Pat (19%; CI: 0,11-0,19), 12/80 Pat (15%; CI: 0,08-0,25) und 4/80 Pat (5%; CI: 0,01-0,12) unsicher angegeben wurde. Mit PET/CT wurde das T-Stadium im Vergleich zur MDCT (p = 0,003) oder PET (p = 0,019) häufiger korrekt festgelegt. Bei Zusammenfassung der Stadien T1 und T2 als eine Gruppe wurde das korrekte T-Stadium mit MDCT, PET und PET/CT bei 54/80 Pat (68%; CI: 0,56-0,78), 56/80 Pat (70%; CI: 0,59-0,80) und 65/80 Pat (81%; CI: 0,71-0,89) diagnostiziert. T3-Stadien waren am schwierigsten festzulegen. T3-Tumoren wurden mit MDCT bei 2/11 Pat (18%; CI: 0,02-0,52), mit PET bei 0/11 Pat (0%; CI: 0,00-0,28) und mit PET/CT bei 5/11 Pat (45%; CI: 0,17-0,77) korrekt klassifiziert. T4-Tumoren wurden mit MDCT bei 4/6 Pat (67%; CI: 0,22-0,95), mit PET bei 3/6 Pat (50%; CI: 0,12-0,88) und mit PET/CT bei 5/6 Pat (83%; CI: 0,36-0,99) korrekt klassifiziert. Schlussfolgerung: Durch die integrierte PET/CT kann das T-Stadium bei NSCLC signifikant häufiger korrekt bestimmt werden im Vergleich zu den Einzelverfahren MDCT oder PET. Die Vorteile der PET/CT kommen besonders bei T1- und T2-Tumoren und bei fortgeschrittenen Tumorstadien zum Tragen.

Keywords

NSCLC - PET/CT - PET - MDCT - T-staging

Schlüsselwörter

NSCLC - PET/CT - PET - MDCT - T-Staging

Full Text

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