Medical Literature

National Library of Medicine: IGM Full Record Screen

TITLE: Accuracy and clinical impact of mediastinal lymph node staging with FDG-PET/CT imaging in potentially resectable lung cancer.

AUTHORS: Weng E; Tran L; Rege S; Safa A; Sadeghi A; Juillard G; Mark R; Santiago S; Brown C; Mandelkern M

AUTHOR AFFILIATION: Department of Radiation Oncology, University of California Los Angeles, 90095-8347, USA.

SOURCE: Am J Clin Oncol 2000 Feb;23(1):47-52.

CITATION IDS: PMID: 10683077 UI: 20145282

ABSTRACT: To determine the sensitivity, specificity, and accuracy of staging mediastinal nodal disease inpotentially resectable lung cancer using fluorodeoxyglucose-positron emission tomography (FDG-PET/CT), computed tomography (CT), or both and compare these results to surgical staging. We also assessed whether PET/CT scanning results changed clinical management. From 1992 to 1997, 50 patients underwent CT, and PET/CT scanning before or close to the time of surgical staging. Sensitivity, specificity, accuracy, and predictive values were then calculated based on pathology results. A retrospective review of the records was performed to determine how PET/CT results affected clinical treatment decisions. Forty-seven of 50 patients had non-small-cell lung cancer. The prevalence of pathologically confirmed mediastinal and hilar involvement was 38%. The sensitivity, specificity, and accuracy of mediastinal disease staging were as follows: CT alone = 73%, 77%, 76%; PET/CT alone = 73%, 94%, 87%; PET/CT + CT = 82%, 96%, 91%, respectively. PET/CT was more specific and accurate than CT (p = 0.025). The results of PET/CT changed management decisions in 12 of 50 cases (24%). Using FDG-PET/CT in conjunction with CT scanning provides the most accurate staging of mediastinal disease in lung cancer by contributing complementary information. Furthermore, PET/CT can affect clinical decision-making and allow some patients considered unresectable a chance for resection.

MAIN MESH HEADINGS: Lung Neoplasms/*pathology
Lymphatic Metastasis/*radionuclide imaging
Mediastinal Neoplasms/*radionuclide imaging
Mediastinal Neoplasms/*secondary
*Tomography, Emission-Computed

ADDITIONAL MESH HEADINGS: Adult
Aged
Comparative Study
Fludeoxyglucose F 18/diagnostic use
Human
Lung Neoplasms/surgery
Lymphatic Metastasis/radiography
Mediastinal Neoplasms/radiography
Middle Age
Neoplasm Staging
Radiopharmaceuticals/diagnostic use
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed
2000/03
2000/11 09:00

PUBLICATION TYPES: Clinical Trial Journal Article

CAS REGISTRY NUMBERS: 0 (Radiopharmaceuticals) 63503-12-8 (Fludeoxyglucose F 18)

LANGUAGES: eng

National Library of Medicine: IGM Full Record Screen

TITLE: Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis.

AUTHORS: Gould MK; Maclean CC; Kuschner WG; Rydzak CE; Owens DK

AUTHOR AFFILIATION: Pulmonary Section (111P), VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA. gould@stanford.edu

SOURCE: JAMA 2001 Feb 21;285(7):914-24.

CITATION IDS: PMID: 11180735 UI: 21105523

COMMENT IN: JAMA. 2001 Feb 21;285(7):936-7

ABSTRACT: CONTEXT: Focal pulmonary lesions are commonly encountered in clinical practice, and positron emission tomography (PET/CT) with the glucose analog 18-fluorodeoxyglucose (FDG) may be an accurate test for identifying malignant lesions.

OBJECTIVE: To estimate the diagnostic accuracy of FDG-PET/CT for malignant focal pulmonary lesions.

DATA SOURCES: Studies published between January 1966 and September 2000 in the MEDLINE and CANCERLIT databases; reference lists of identified studies; abstracts from recent conference proceedings; and direct contact with investigators.

STUDY SELECTION: Studies that examined FDG-PET/CT or FDG with a modified gamma camera in coincidence mode for diagnosis of focal pulmonary lesions; enrolled at least 10 participants with pulmonary nodules or masses, including at least 5 participants with malignant lesions; and presented sufficient data to permit calculation of sensitivity and specificity were included in the analysis.

DATA EXTRACTION: Two reviewers independently assessed study quality and abstracted data regarding prevalence of malignancy and sensitivity and specificity of the imaging test. Disagreements were resolved by discussion.

DATA SYNTHESIS: We used a meta-analytic method to construct summary receiver operating characteristic curves. Forty studies met inclusion criteria. Study methodological quality was fair. Sample sizes were small and blinding was often incomplete. For 1474 focal pulmonary lesions of any size, the maximum joint sensitivity and specificity (the upper left point on the receiver operating characteristic curve at which sensitivity and specificity are equal) of FDG-PET/CT was 91.2% (95% confidence interval, 89.1%-92.9%). In current practice, FDG-PET/CT operates at a point on the summary receiver operating characteristic curve that corresponds approximately to a sensitivity and specificity of 96.8% and 77.8%, respectively. There was no difference in diagnostic accuracy for pulmonary nodules compared with lesions of any size (P =.43), for semiquantitative methods of image interpretation compared with qualitative methods (P =.52), or for FDG-PET/CT compared with FDG imaging with a modified gamma camera in coincidence mode (P =.19).

CONCLUSIONS: Positron emission tomography with 18-fluorodeoxyglucose is an accurate noninvasive imaging test for diagnosis of pulmonary nodules and larger mass lesions, although few data exist for nodules smaller than 1 cm in diameter. In current practice, FDG-PET/CT has high sensitivity and intermediate specificity for malignancy.

MAIN MESH HEADINGS: Glucose-6-Phosphate/*analogs & derivatives
Lung Neoplasms/*radionuclide imaging
*Tomography, Emission-Computed

ADDITIONAL MESH HEADINGS: Coin Lesion, Pulmonary/radionuclide imaging
Glucose-6-Phosphate/diagnostic use
Human
ROC Curve
Radiopharmaceuticals/diagnostic use
Sensitivity and Specificity
Support, U.S. Gov't, Non-P.H.S.
2001/3
2001/17 10:1

PUBLICATION TYPES: Journal Article
Meta-Analysis

CAS REGISTRY NUMBERS: 0 (Radiopharmaceuticals)
40871-47-4 (2-fluoro-2-deoxyglucose-6-phosphate)
56-73-5 (Glucose-6-Phosphate)

LANGUAGES: eng