18F-FDG PET/Contrast-Enhanced CT for Initial Staging and Strategic Treatment of Non-Small Cell Lung Cancer: A Prospective Study.

BACKGROUND: Selection of the best treatment option for non-small cell lung cancer (NSCLC) depends on optimal initial staging. OBJECTIVE: Evaluate the clinical impact of 18F-FDG PET/CT on the management of Thai patients with NSCLC. MATERIAL AND METHOD: Twenty-four patients with NSCLC underwent FDG PET/CTfor initial staging. The best treatment options between pre- and post-FDG PET/CT staging were identified for each patient. Changes in treatment management decisions and the diagnostic values (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of nodal and distant metastases were assessed. RESULTS: Pre-FDG PET/CT staging included five patients with stage IA, four patients with stage IB, one patient with stage IIB, three patients with stage IIIA, and 11 patients with stage IV disease. A difference between pre- and post-FDG PET/CT staging was noted in 10/24 patients (41.7%). FDG PET/CT examination resulted in upstaging in 7/24 patients (29%) and downstaging in three patients (12.5%). The pre-FDG PET/CT staging was accurate in 14/24 patients (58.3%) while the post-FDG PET/CTstaging was accurate in 19/24 patients (79.2%). The treatment management decisions were changed in 5/24 patients (20.8%). FDG PET/CT prevented futile surgery in two patients. CONCLUSION: FDG PET/CT has an important role in NSCLC staging. Additional PET/CT information could influence therapeutic options and reduced unnecessary surgery in patients with metastatic disease.