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Ann Thorac Surg. 2014 Apr;97(4):1142-8. doi: 10.1016/j.athoracsur.2013.12.043. Epub 2014 Feb 25.

Accuracy of fluorodeoxyglucose-positron emission tomography within the clinical practice of the American College of Surgeons Oncology Group Z4031 trial to diagnose clinical stage I non-small cell lung cancer.

Author information

  • 1Veterans Affairs Medical Center, Nashville, Tennessee; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee. Electronic address: eric.grogan@vanderbilt.edu.
  • 2Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.
  • 3Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
  • 4Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 5Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 6Center for Quantitative Sciences, Mayo Clinic, Rochester, Minnesota.
  • 7Department of Surgery, Duke University, Durham, North Carolina.
  • 8Department of Surgery, University of Alabama, Birmingham, Alabama.
  • 9Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
  • 10Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
  • 11Department of Surgery, Stanford University, Stanford, California.
  • 12Department of Surgery, Washington University, St. Louis, Missouri.
  • 13Veterans Affairs Medical Center, Nashville, Tennessee; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

Abstract

BACKGROUND:

Fluorodeoxyglucose-positron emission tomography (FDG-PET) is recommended for diagnosis and staging of non-small cell lung cancer (NSCLC). Meta-analyses of FDG-PET diagnostic accuracy demonstrated sensitivity of 96% and specificity of 78% but were performed in select centers, introducing potential bias. This study evaluates the accuracy of FDG-PET to diagnose NSCLC and examines differences across enrolling sites in the national American College of Surgeons Oncology Group (ACOSOG) Z4031 trial.

METHODS:

Between 2004 and 2006, 959 eligible patients with clinical stage I (cT1-2 N0 M0) known or suspected NSCLC were enrolled in the Z4031 trial, and with a baseline FDG-PET available for 682. Final diagnosis was determined by pathologic examination. FDG-PET avidity was categorized into avid or not avid by radiologist description or reported maximum standard uptake value. FDG-PET diagnostic accuracy was calculated for the entire cohort. Accuracy differences based on preoperative size and by enrolling site were examined.

RESULTS:

Preoperative FDG-PET results were available for 682 participants enrolled at 51 sites in 39 cities. Lung cancer prevalence was 83%. FDG-PET sensitivity was 82% (95% confidence interval, 79 to 85) and specificity was 31% (95% confidence interval, 23% to 40%). Positive and negative predictive values were 85% and 26%, respectively. Accuracy improved with lesion size. Of 80 false-positive scans, 69% were granulomas. False-negative scans occurred in 101 patients, with adenocarcinoma being the most frequent (64%), and 11 were 10 mm or less. The sensitivity varied from 68% to 91% (p=0.03), and the specificity ranged from 15% to 44% (p=0.72) across cities with more than 25 participants.

CONCLUSIONS:

In a national surgical population with clinical stage I NSCLC, FDG-PET to diagnose lung cancer performed poorly compared with published studies.

Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

PMID:
24576597
[PubMed - indexed for MEDLINE]
PMCID:
PMC4008142
Free PMC Article
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