Impact of [18F]FDG-PET on the primary staging of small-cell lung cancer

• Published in: European journal of nuclear medicine and molecular imaging 2004-12, Vol.31 (12), p.1614-1620
• Main Authors: Brink, I, Schumacher, T, Mix, M, Ruhland, S, Stoelben, E, Digel, W, Henke, M, Ghanem, N, Moser, E, Nitzsche, E U
• Format: Article
• Language: English
• Subjects: Brain Neoplasms - diagnostic imaging; Brain Neoplasms - secretion; Carcinoma, Small Cell - diagnostic imaging; Carcinoma, Small Cell - secretion; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms - diagnostic imaging; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging - methods; Positron-Emission Tomography - methods; Prognosis; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-004-1606-x

The purpose of this study was to evaluate the impact of [18F]fluorodeoxy-D-glucose positron emission tomography (FDG-PET) on the primary staging of patients with small-cell lung cancer (SCLC). FDG-PET was performed in 120 consecutive patients with SCLC during primary staging. In addition, brain examinations with both FDG-PET and cranial magnetic resonance imaging (MRI) or computed tomography (CT) were performed in 91 patients. Results of FDG-PET were compared with those of conventional staging procedures. FDG-PET detected markedly increased FDG uptake in the primary tumours of all 120 patients (sensitivity 100%). Complete agreement between FDG-PET results and other staging procedures was observed in 75 patients. Differences occurred in 45 patients at 65 sites. In 47 sites the FDG-PET results were proven to be correct, and in ten, incorrect. In the remaining eight sites, the discrepancies could not be clarified. In 14/120 patients, FDG-PET caused a stage migration, correctly upstaging ten patients to extensive disease and downstaging three patients by not confirming metastases of the adrenal glands suspected on the basis of CT. Only 1/120 patients was incorrectly staged by FDG-PET, owing to failure to detect brain metastases. In all cases the stage migration led to a significant change in the treatment protocol. Sensitivity of FDG-PET was significantly superior to that of CT in the detection of extrathoracic lymph node involvement (100% vs 70%, specificity 98% vs 94%) and distant metastases except to the brain (98% vs 83%, specificity 92% vs 79%). However, FDG-PET was significantly less sensitive than cranial MRI/CT in the detection of brain metastases (46% vs 100%, specificity 97% vs 100%). The introduction of FDG-PET in the diagnostic evaluation of SCLC will improve the staging results and affect patient management, and may reduce the number of tests and invasive procedures.