CT, [18F]FDG-PET und [18F]FDG-PET/CT zur Dignitätsbeurteilung von Lungenrundherden und zum Staging des nicht-kleinzelligen Lungenkarzinoms

Abstract

Fast and accurate staging is essential for choosing treatment for NSCLC. The purpose of this prospective, non-randomized trial was to evaluate the reliability of PET/CT for determination of malignancy in newly diagnosed pulmonary lesions and staging of NSCLC compared to CT and PET alone. Furthermore the ability of PET/CT in clinical decision making for further individual treatment dependent on UICC should be evaluated. 267 patients with suspected NSCLC were examined using PET/CT. A biopsy was performed on all patients.185 patients showed NSCLC. 80 of these patients underwent surgery (pathologic staging). Imaging modalities were evaluated independently. The patients were divided into 2 groups: curative surgery (UICC <= IIIA) vs. futile surgery (palliative situation;UICC > IIIA). Follow-up data for all patients were obtained. Endpoint was death of any cause. The accuracy in detecting malignancy was 82 % for CT, 93,6 % for PET and 91 % for PET/CT. PET/CT and PET were significantly superior to CT alone (p < 0,05). In 80 operated NSCLC-patients the accuracy of CT, PET and PET/CT in T-staging was 66.3 %, 70.0 % and 80.0 %,respectively. PET/CT was significantly superior (p < 0.05). In N-staging the accuracy of CT was 45.0 %, of PET 67.5 % and of PET/CT 73.8 %,respectively. PET/CT was significantly superior to CT alone (p < 0.05).There was no significant difference compared to PET alone (p > 0.05).The median follow-up was 453 (6 - 1710) days. At close-out 55 patients were alive, 103 patients had died, 25 patients were censored at the last contact date. For 2 patients no follow-up data could be received (drop-outs). All diagnostic methods significantly distinguished between operable vs. inoperable NSCLS (p < 0.05).Only in the PET/CT subgroup (UICC <= IIIA) no median survival was established. PET/CT was significantly more accurate than CT for differentiation of benign from malignant lung lesions; staging of NSCLC and a better differentiation between operable vs. inoperable NSCLC stadium was obtained.