ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Robert James Cerfolio
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cerfolio, R. J.
Right arrow Articles by Bartolucci, A. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cerfolio, R. J.
Right arrow Articles by Bartolucci, A. A.
Related Collections
Right arrow Lung - cancer

Ann Thorac Surg 2004;78:1017-1023
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

The accuracy of integrated PET-CT compared with dedicated pet alone for the staging of patients with nonsmall cell lung cancer

Robert James Cerfolio, MDa,*, Buddhiwardhani Ojha, MDc, Ayesha S. Bryant, MSPHb, Vanguru Raghuveer, MDc, James M. Mountz, MDc, Alfred A. Bartolucci, PhDd

a Section of Thoracic Surgery, University of Alabama at Birmingham, and Division of Cardiothoracic Surgery, Department of Surgery, Birmingham Veterans Administration Hospital, Birmingham, Alabama, USA
b Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama, USA
c Division of Clinical Nuclear Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
d Department of Biostatistics, University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama, USA

Accepted for publication February 18, 2004.

* Address reprint requests to Dr Cerfolio, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 1900 University Blvd, THT 712, Birmingham, AL, USA 35294
robert.cerfolio{at}ccc.uab.edu

Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.

BACKGROUND: The treatment of patients with nonsmall cell lung cancer (NSCLC) is determined by the stage. We evaluated the accuracy of staging using integrated positron emission tomography (PET) and computed tomography (CT) and compared it with dedicated PET visually correlated with CT scan.

METHODS: A prospective blinded trial was performed on a consecutive series of patients with NSCLC. Patients underwent integrated PET-CT scanning with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG-18). A radiologist assigned the T, N and M status. No sooner than 2 weeks the same radiologist read the dedicated PET alone, without the integrated CT images and a T, N and M status was assigned again. The most recent CT scan was available and visually correlated with both studies. All patients underwent biopsies of suspicious N2 or N3 lymph node or distant metastases and if negative, pulmonary resection with lymphadenectomy was performed.

RESULTS: There were 129 patients. Integrated PET-CT is a better predictor than PET for all stages of cancer and achieved statistical significance for stage I (52% versus 33%, p = 0.03) and for stage II (70% versus 36%, p = 0.04). It also is a better overall predictor for T status (70% versus 47%, p = 0.001) and the N status (78% versus 56%, p = 0.008). Nodal analysis shows that integrated PET-CT was more accurate for the total N2 nodes (96% versus 93%, p = 0.01) and for the total N1 nodes (90% versus 80%, p = 0.001). It was also more sensitive, specific, and had a higher positive predictive value for both N2 and N1 nodes (p < 0.05 for all). Integrated PET-CT is significantly more sensitive at the 4R, 5, 7, 10L and 11 stations and more accurate at the 7 and 11 lymph nodes stations than dedicated PET.

CONCLUSIONS: Integrated PET-CT using FDG-18 better predicts stage I and II disease as well as the T and N status of patients with NSCLC when compared with dedicated PET alone. It is more accurate at some nodal stations but still only achieves an accuracy of 96% and 90% for the N2 and N1 nodes, respectively.




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Sanli, A. F. Isik, S. Zincirkeser, O. Elbek, A. Mete, B. Tuncozgur, and L. Elbeyli
Reliability of positron emission tomography-computed tomography in identification of mediastinal lymph node status in patients with non-small cell lung cancer
J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1200 - 1205.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
S. Kligerman and S. Digumarthy
Staging of Non-Small Cell Lung Cancer Using Integrated PET/CT
Am. J. Roentgenol., November 1, 2009; 193(5): 1203 - 1211.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
C. Perigaud, B. Bridji, J. C. Roussel, C. Sagan, A. Mugniot, D. Duveau, O. Baron, and P. Despins
Prospective preoperative mediastinal lymph node staging by integrated positron emission tomography-computerised tomography in patients with non-small-cell lung cancer
Eur. J. Cardiothorac. Surg., October 1, 2009; 36(4): 731 - 736.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
A. Bille, E. Pelosi, A. Skanjeti, V. Arena, L. Errico, P. Borasio, M. Mancini, and F. Ardissone
Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography
Eur. J. Cardiothorac. Surg., September 1, 2009; 36(3): 440 - 445.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
M. L. Margolis
The PET and the Pendulum
Ann Intern Med, August 18, 2009; 151(4): 279 - 280.
[Full Text] [PDF]

Home page
 Ann OncolHome page
P. Mohr, A. M. M. Eggermont, A. Hauschild, and A. Buzaid
Staging of cutaneous melanoma
Ann. Onc., August 1, 2009; 20(suppl_6): vi14 - vi21.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
B. Fischer, U. Lassen, J. Mortensen, S. Larsen, A. Loft, A. Bertelsen, J. Ravn, P. Clementsen, A. Hogholm, K. Larsen, et al.
Preoperative Staging of Lung Cancer with Combined PET-CT
N. Engl. J. Med., July 2, 2009; 361(1): 32 - 39.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
B. Hwangbo, S. K. Kim, H.-S. Lee, H. S. Lee, M. S. Kim, J. M. Lee, H.-Y. Kim, G.-K. Lee, B.-H. Nam, and J. I. Zo
Application of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Following Integrated PET/CT in Mediastinal Staging of Potentially Operable Non-small Cell Lung Cancer
Chest, May 1, 2009; 135(5): 1280 - 1287.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
R. J. Hicks
Role of 18F-FDG PET in Assessment of Response in Non-Small Cell Lung Cancer
J. Nucl. Med., May 1, 2009; 50(Suppl_1): 31S - 42S.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
W. De Wever, S. Stroobants, J. Coolen, and J. A. Verschakelen
Integrated PET/CT in the staging of nonsmall cell lung cancer: technical aspects and clinical integration
Eur. Respir. J., January 1, 2009; 33(1): 201 - 212.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. J. Cerfolio
Counterpoint: Despite staging inaccuracies, patients with non-small cell lung cancer are best served by having integrated positron emission tomography/computed tomography before therapy.
J. Thorac. Cardiovasc. Surg., January 1, 2009; 137(1): 20 - 22.
[Full Text] [PDF]

Home page
 JNMHome page
M. Morikawa, Y. Demura, T. Ishizaki, S. Ameshima, I. Miyamori, M. Sasaki, T. Tsuchida, H. Kimura, Y. Fujibayashi, and H. Okazawa
The Effectiveness of 18F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax
J. Nucl. Med., January 1, 2009; 50(1): 81 - 87.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. S. Groth, B. A. Whitson, J. D'Cunha, M. A. Maddaus, M. Alsharif, and R. S. Andrade
Endobronchial Ultrasound-Guided Fine-Needle Aspiration of Mediastinal Lymph Nodes: A Single Institution's Early Learning Curve
Ann. Thorac. Surg., October 1, 2008; 86(4): 1104 - 1110.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
Y. Ohno, H. Koyama, Y. Onishi, D. Takenaka, M. Nogami, T. Yoshikawa, S. Matsumoto, Y. Kotani, and K. Sugimura
Non-Small Cell Lung Cancer: Whole-Body MR Examination for M-Stage Assessment--Utility for Whole-Body Diffusion-weighted Imaging Compared with Integrated FDG PET/CT
Radiology, August 1, 2008; 248(2): 643 - 654.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
B. D. Kozower, B. F. Meyers, C. E. Reed, D. R. Jones, P. A. Decker, and J. B. Putnam Jr
Does Positron Emission Tomography Prevent Nontherapeutic Pulmonary Resections for Clinical Stage IA Lung Cancer?
Ann. Thorac. Surg., April 1, 2008; 85(4): 1166 - 1170.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
B. E. Lee, J. Redwine, C. Foster, E. Abella, T. Lown, D. Lau, and D. Follette
Mediastinoscopy might not be necessary in patients with non-small cell lung cancer with mediastinal lymph nodes having a maximum standardized uptake value of less than 5.3
J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 615 - 619.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
N. Al-Sarraf, R. Aziz, K. Gately, J. Lucey, L. Wilson, E. McGovern, and V. Young
Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography
Eur. J. Cardiothorac. Surg., January 1, 2008; 33(1): 104 - 109.
[Abstract] [Full Text] [PDF]

Home page
 JNCI J Natl Cancer InstHome page
Y. C. Ung, D. E. Maziak, J. A. Vanderveen, C. A. Smith, K. Gulenchyn, C. Lacchetti, W. K. Evans, and Lung Cancer Disease Site Group of Cancer Care Onta
18Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis and Staging of Lung Cancer: A Systematic Review
J Natl Cancer Inst, December 5, 2007; 99(23): 1753 - 1767.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
D. J. A. Margolis, J. M. Hoffman, R. J. Herfkens, R. B. Jeffrey, A. Quon, and S. S. Gambhir
Molecular Imaging Techniques in Body Imaging
Radiology, November 1, 2007; 245(2): 333 - 356.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. Cerfolio, A. S. Bryant, and M. A. Eloubeidi
Accessing the Aortopulmonary Window (#5) and the Paraaortic (#6) Lymph Nodes in Patients With Non-Small Cell Lung Cancer
Ann. Thorac. Surg., September 1, 2007; 84(3): 940 - 945.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
B. A. Whitson, S. S. Groth, and M. A. Maddaus
Surgical Assessment and Intraoperative Management of Mediastinal Lymph Nodes in Non-Small Cell Lung Cancer
Ann. Thorac. Surg., September 1, 2007; 84(3): 1059 - 1065.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. Cerfolio and A. S. Bryant
Predictors of Survival and Disease-Free Survival in Patients With Resected N1 Non-Small Cell Lung Cancer
Ann. Thorac. Surg., July 1, 2007; 84(1): 182 - 190.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. Cerfolio and A. S. Bryant
Surgical Techniques and Results for Partial or Circumferential Sleeve Resection of the Pulmonary Artery for Patients with Non-Small Cell Lung Cancer
Ann. Thorac. Surg., June 1, 2007; 83(6): 1971 - 1977.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. Cerfolio and A. S. Bryant
Ratio of the Maximum Standardized Uptake Value on FDG-PET of the Mediastinal (N2) Lymph Nodes to the Primary Tumor May Be a Universal Predictor of Nodal Malignancy in Patients With Nonsmall-Cell Lung Cancer
Ann. Thorac. Surg., May 1, 2007; 83(5): 1826 - 1830.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
B. E. Lee, D. von Haag, T. Lown, D. Lau, R. Calhoun, and D. Follette
Advances in positron emission tomography technology have increased the need for surgical staging in non-small cell lung cancer
J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 746 - 752.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
T. M. Blodgett, C. C. Meltzer, and D. W. Townsend
PET/CT: Form and Function
Radiology, February 1, 2007; 242(2): 360 - 385.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. S. Bryant, R. J. Cerfolio, K. M. Klemm, and B. Ojha
Maximum Standard Uptake Value of Mediastinal Lymph Nodes on Integrated FDG-PET-CT Predicts Pathology in Patients with Non-Small Cell Lung Cancer
Ann. Thorac. Surg., August 1, 2006; 82(2): 417 - 423.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. Cerfolio and A. S. Bryant
Distribution and Likelihood of Lymph Node Metastasis Based on the Lobar Location of Nonsmall-Cell Lung Cancer
Ann. Thorac. Surg., June 1, 2006; 81(6): 1969 - 1973.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. J. Cerfolio, A. S. Bryant, and B. Ojha
Restaging patients with N2 (stage IIIa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: A prospective study
J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1229 - 1235.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
V. W. Rusch
Mediastinoscopy: An Endangered Species?
J. Clin. Oncol., November 20, 2005; 23(33): 8283 - 8285.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. Cerfolio, A. S. Bryant, B. Ojha, and M. Eloubeidi
Improving the Inaccuracies of Clinical Staging of Patients with NSCLC: A Prospective Trial
Ann. Thorac. Surg., October 1, 2005; 80(4): 1207 - 1214.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
T. K. Trow
Clinical Year in Review II: Pulmonary Infections, Diagnostic Imaging, Pleural Diseases, and Neuromuscular Disease
Proceedings of the ATS, October 1, 2005; 2(3): 175 - 178.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. J. Cerfolio, A. S. Bryant, B. Ohja, A. A. Bartolucci, and M. A. Eloubeidi
The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy
J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1232 - 1241.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2004 by The Society of Thoracic Surgeons.