18F-FDG PET/Contrast-Enhanced CT for Initial Staging
and Strategic Treatment of Non-Small Cell Lung
Cancer: A Prospective Study
Chetsadaporn Promteangtrong MD*,
Anchisa Kunawudhi MD*, Rossarin Phadungrerk RN*,
Chanidapa Iamsa-art RT*, Chanisa Chotipanich MD*
Affiliation :
* National Cyclotron and PET Centre, Chulabhorn Hospital, Bangkok, Thailand
Background : Selection of the best treatment option for non-small cell lung cancer (NSCLC) depends on optimal initial
staging.
Objective : Evaluate the clinical impact of 18F-FDG PET/CT on the management of Thai patients with NSCLC.
Material and Method: Twenty-four patients with NSCLC underwent FDG PET/CT for initial staging. The best treatment
options between pre- and post-FDG PET/CT staging were identified for each patient. Changes in treatment management
decisions and the diagnostic values (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy)
of nodal and distant metastases were assessed.
Results : Pre-FDG PET/CT staging included five patients with stage IA, four patients with stage IB, one patient with stage IIB,
three patients with stage IIIA, and 11 patients with stage IV disease. A difference between pre- and post-FDG PET/CT
staging was noted in 10/24 patients (41.7%). FDG PET/CT examination resulted in upstaging in 7/24 patients (29%) and
downstaging in three patients (12.5%). The pre-FDG PET/CT staging was accurate in 14/24 patients (58.3%) while the
post-FDG PET/CT staging was accurate in 19/24 patients (79.2%). The treatment management decisions were changed in
5/24 patients (20.8%). FDG PET/CT prevented futile surgery in two patients.
Conclusion : FDG PET/CT has an important role in NSCLC staging. Additional PET/CT information could influence
therapeutic options and reduced unnecessary surgery in patients with metastatic disease.
Keywords : Lung cancer, Non-small cell, FDG, PET/CT, Staging
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