Fluorodeoxyglucose positron emission tomography integrated with computed tomography to determine resectability of primary lung cancer

Fluorodeoxyglucose positron emission tomography integrated with computed tomography (FDG-PET/CT) was evaluated as a routine staging technique for primary lung cancer. We prospectively compared FDG-PET/CT in determining clinical stage and surgical indication with conventional staging not including positron emission tomography (PET). A total of 50 consecutive patients diagnosed with primary lung cancer by cytological or histological examination were studied; 20 of them underwent surgery. Discrepancies between the two staging methods were observed in 14 patients (28%). The stage assigned by PET increased in 12 cases (24%) and decreased in 2 (4%). PET staging was accurate in eight cases with otherwise undetected distant metastases (M1) but was incorrect in six cases, including five where it overdiagnosed nodal metastases (N). Two clinical N3 patients (4%) would have missed a chance of surgery if the surgical indication had been determined by PET staging alone. According to our criteria for surgery, other patients were assigned correctly to surgery by PET staging. The maximum standard uptake value (maxSUV) of all primary lesions ranged from 0 to 23.0 (mean±standard deviation (SD), 8.0±4.4). The mean maxSUV among surgical cases (5.8±3.6) was significantly smaller than among nonsurgical cases (9.5±4.2) (P<0.05). Staging examination including FDG-PET/CT and brain magnetic resonance imaging ordinarily can determine the clinical stage and resectability of primary lung cancer. False-positive findings in regional lymph nodes, possibly reflecting past infectious disease, are the most important remaining problem. (author)