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Clinical Investigations: LUNG CANCER |

Staging by Positron Emission Tomography Predicts Survival in Patients With Non-small Cell Lung Cancer*

Donnie P. Dunagan, MD, FCCP; Robert Chin, Jr., MD, FCCP; Trent W. McCain, MD; L. Doug Case, PhD; Beth A. Harkness, MS; Timothy Oaks, MD; Edward F. Haponik, MD, FCCP
Author and Funding Information

*From the Section of Pulmonary and Critical Care Medicine (Drs. Dunagan, Chin, and McCain) and Departments of Public Health Sciences (Dr. Case), Radiology (Ms. Harkness), and Cardiothoracic Surgery (Dr. Oaks), Wake Forest University School of Medicine, Winston-Salem, NC; and the Division of Pulmonary and Critical Care Medicine (Dr. Haponik), Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.

Correspondence to: Donnie P. Dunagan, MD, FCCP, Section on Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1054; e-mail: ddunagan@wfubmc.edu



Chest. 2001;119(2):333-339. doi:10.1378/chest.119.2.333
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Background: Positron emission tomography (PET) scanning is used increasingly to detect and stage lung cancer, but the test performance characteristics and relationship of PET to patient outcomes remain undefined.

Objective: To determine the test performance characteristics and relationship of PET scanning stage to patient outcomes relative to the 1997 International System for the Staging of Lung Cancer.

Design: Survival analysis using pathologic staging as the criterion standard for comparison of survival as predicted by staging by PET and CT.

Setting: University-based hospital.

Patients: All consecutive patients undergoing PET scanning for the evaluation of possible non-small cell lung cancer (NSCLC) during a 5-year period.

Main outcome measures: Long-term survival of patients with NSCLC after staging by PET.

Results: One hundred fifty-two thoracic PET scans were obtained for the staging of possible NSCLC during a 5-year period. One hundred twenty-three patients (81%) demonstrated increased 18F-fluorodeoxyglucose uptake. The overall sensitivity and specificity of PET for detecting malignancy were 95% and 67%, respectively, compared with 100% and 27% for chest CT. PET and CT had similar accuracy for staging the overall extent of disease (91% and 89%, respectively). PET stage correlated highly with survival using either nodal location or overall stage (p = 0.003, p = 0.002), as did pathologic staging (p = 0.0001, p = 0.0001). CT scan results did not accurately predict survival (p = 0.608, p = 0.338).

Conclusion: PET scanning is a highly sensitive technologic advance in detecting and staging of thoracic malignancy and may more accurately predict the likelihood of long-term survival in patients with NSCLC than chest CT does.

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