Preoperative staging of NSCLC patients with chest computed tomography (CT) is standard but has an overall accuracy of only ∼50%. Identification of extra-thoracic metastases can prevent unnecessary surgeries that are unlikely to affect any survival benefit. This study evaluated the addition of PET to chest CT in the preoperative staging of potential surgical candidates with histologically-proven NSCLC.
Between July 2002 and April 2004 patients with NSCLC that presented to our thoracic surgery clinic for consideration of surgical resection were staged preoperatively with PET in addition to chest CT scan. All patients that had a histological diagnosis of NSCLC, chest CT, and a PET scan (performed at our institution) during their preoperative evaluation were included in this retrospective review. Patients with suspicious, FDG-avid, supraclavicular nodes identified by PET had physical exam or ultrasound-guided, fine needle aspiration (FNA) of the suspicious supraclavicular node(s).
A total of 17 potential surgical candidates (Adeno n=6, Squamous n=10, Poorly Differentiated n=1) with NSCLC had preoperative PET scans performed at our institution. Three (18%) were found to have FDG-avid supraclavicular nodes not identified on chest CT scan. Nodal metastases were confirmed in all 3 patients cytologically with FNA. An additional 4 patients (24%) were found to have unsuspected hilar (n=3) or mediastinal (n=1) nodal metastases not identified on chest CT scan. In total, 7/17 patients (41%) had occult locoregional nodal metastases resulting in upstaging; 5 (29%) were rendered unresectable.
The addition of PET to our preoperative staging algorithm for NSCLC patients resulted in significant upward clinical stage migration and identified unresectable disease in nearly 1/3 of patients considered respectable by CT. Supraclavicular nodal metastases are common in patients with NSCLC, and are poorly evaluated by chest CT.
Routine preoperative staging of NSCLC patients with PET may prevent unnecessary surgeries. Positive PET findings can be easily confirmed cytologically by FNA, and may significantly impact on treatment decisions.
J.L. Bobadilla, None.