Reviewer: Neha Vapiwala, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 6, 2004
Presenter: G.J. Herder
Presenter's Affiliation: POORT Study Group, Netherlands
Type of Session: Scientific
The use of FDG-PET scan as an add-on study in non-small-cell-lung-cancer (NSCLC) patients scheduled to undergo surgery has been shown to be a cost-effective and useful tool in guiding patient management. When employed after traditional staging studies, just prior to the planned surgical intervention, PET has revealed previously unsuspected extrathoracic disease and changed the management plan, preventing unnecessary surgery. This study evaluated the use of PET scan as an up-front study, performed upon initial presentation, in lieu of more traditional staging procedures. Its goal was to evaluate if initial PET scanning could simplify the staging process by providing comprehensive and accurate whole-body data equivalent to the information obtained from multiple traditional staging studies. As the appropriate and timely management of NSCLC patients is so strongly dependent on the patient's stage, any simplification of the process is worthy of investigation.
Materials and Methods
The data presented here offer some interesting insight on the use of FDG-PET as an initial part of staging NSCLC patients. Whereas the role of PET as an additonal tool following completion of standard imaging and other work-up tests has been demonstrated to be a cost-effective tool that can prevent unnecessary surgical intervention, the data here are not as encouraging for PET as a substitution tool. Although its use provided data of comparable accuracy to more traditional workup, there was no siginificant benefit in terms of reduction in cost or number of studies. However, PET did help to shorten the staging process by 9 days, which is important for the expeditious treatment of NSCLC patients.
Of note, most staging studies and procedures in the Netherlands are ordered by the pulmonologists and oncologists, often after conferreing with each other on each patient case. Given the long enrollment period, the issue is raised of changing practice patterns and increasing expertise on the part of radiologists in radiographic study interpretation, and the possible effect of this on the study data. However, the authors state that clinical practice trends did not change significantly over the time period of the study, thereby reducing the effect of this potential confounder. Nonetheless, it is interesting to note that there was only a 20% staging error with the traditonal workup in this trial, markedly better than the typical 40% error rate reported previously with traditional imaging studies. Regardless, the PET scan was able to meet this standard of accuracy. Future studies may further explore the use of PET as a complementary staging tool rather than a substitutive one.
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