Abstract:
Purpose
Positron emission tomography (PET) is a costly new technology with potential to improve preoperative
evaluation for patients with non-small-cell lung cancer (NSCLC). There is increasing pressure for PET to
be included in standard diagnostic work-up before decisions about surgical management of NSCLC. The
resource implications of its widespread use in staging NSCLC are significant.
Methods
A randomized controlled trial was conducted to investigate the impact of PET on clinical management
and surgical outcomes for patients with stage I-II NSCLC. The primary hypothesis was that PET would
reduce the proportion of patients with stage I-II NSCLC who underwent thoracotomy by at least 10%
through identification of patients with inoperable disease.
Results
One hundred eighty-four patients with stage I-II NSCLC were recruited and randomly assigned; 92% had
stage I disease. Following exclusion of one ineligible patient, 92 patients were assigned to no PET and
91 to PET, Compared with conventional staging, PET upstaged 22 patients, confirmed staging in 61 and
staged two patients as benign. Stage IV disease was rarely detected (two patients). PET led to further
investigation or a change in clinical management in 13% of patients and provided information that could
have affected management in a further 13% of patients. There was no significant difference between
the trial arms in the number of thoracotomies avoided (P = .2).
Conclusion
For patients who are carefully and appropriately staged as having stage I-II disease, PET provides
potential for more appropriate stage-specific therapy but may not lead to a significant reduction in the
number of thoracotomies avoided.
