F-18 Fluorodeoxyglucose Gamma Camera Positron Emission Tomography identifies those patients with non-small cell lung cancer who are suitable for surgery?

This study assessed the accuracy of positron emission tomography using a modified gamma camera (GC-PET) versus that of CT for staging mediastinal involvement in non-small cell lung cancer. The potential impact of GCPET imaging on patient management was also estimated. 98 patients underwent CT imaging as part of routine management followed by GC-PET imaging as part of the study. GC-PET images were reported without knowledge of CT findings. For each patient, nodal resectability status derived from GC-PET and that from CT were compared with the histological stage established by mediastinoscopy or surgery. Potential impact on management was assessed by comparing actual management with that which would have resulted had the guidelines of the National Institute for Health and Clinical Excellence (NICE) for the use of dedicated PET been applied to GC-PET results. GC-PET differentiated resectable from unresectable lymph node involvement with an accuracy of 90%. Sensitivity and specificity were 79% and 93% respectively (ppv 73%, npv 95%). CT differentiated resectable from unresectable lymph node involvement with an accuracy of 72%, and a sensitivity and specificity of 64% and 74% respectively (ppv 39%, npv 89%). Management based on GC-PET results and NICE recommendations would have avoided 14 unnecessary mediastinoscopies and prevented three or possibly four abandoned resections. Two additional unnecessary mediastinoscopies would have resulted. This study suggests that GC-PET is more accurate than CT for nodal staging in NSCLC, and likely to impact favourably on management where dedicated PET is unavailable. (author)