18-Fluorodeoxyglucose positron emission tomography (FDG-PET) and the staging of early lung cancer.

Background: Determining the stage of non-small-cell lung cancer often requires multiple preoperative tests and invasive procedures. Whole body positron-emission tomography (PET) may simplify and improve the evaluation of patients with this tumor. Methods: We prospectively compared the ability of a standard approach to staging (computed tomography (CT), ultrasonography, bone scanning, and, when indicated, needle biopsies) and one involving PET to detect metastases in mediastinal lymph nodes and at distant sites in 102 patients with resectable non-small-cell lung cancer. The presence of mediastinal metastatic disease was confirmed histopathologically. Distant metastases that were detected by PET were further evaluated by standard imaging tests and biopsies. Patients were followed postoperatively for six months by standard methods to detect occult metastases. Logisticregression analysis was used to evaluate the ability of PET and CT to identify malignant mediastinal lymph nodes. Results: The sensitivity and specificity of PET for the detection of mediastinal metastases were 91% (95% confidence interval 81 to 100%) and 86% (95% confidence interval 78 to 94%), respectively. The corresponding values for CT were 75% (95% confidence interval 60 to 90%) and 66% (95% confidence interval 55 to 77%). When the results of PET and CT were adjusted for each other, only PET results were positively correlated with the histopathological findings in mediastinal lymph nodes (P<0.001). PET identified distant metastases that had not been found by standard methods in 11 of 102 patients. The sensitivity and specificity of PET for the detection of both mediastinal and distant metastatic disease were 95% (95% confidence interval 88 to 100%) and 83% (95% confidence interval 74 to 92%), respectively. The use of PET for clinical staging resulted in a different stage from the one determined by standard methods in 62 patients: the stage was lowered in 20 and raised in 42. Conclusions: PET improves the rate of detection of local and distant metastases in patients with non-small-cell lung cancer. (N Engl J Med 2000;343:254–61.)