Optimal anatomic coverage for CT in staging lung cancer: lessons from PET-CT correlation

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Accurate staging of non-small cell lung cancer (NSCLC) is crucial for treatment planning.
• Computed tomography (CT) is a primary imaging modality for lung cancer staging.
• The optimal anatomic coverage for CT staging remains a subject of investigation.

Purpose of the Study:

• To determine the optimal anatomic coverage at CT for accurate staging of NSCLC.
• To compare the accuracy of CT staging with varying anatomic ranges against positron emission tomography-CT (PET-CT).

Main Methods:

• Retrospective review of 113 patients with NSCLC who underwent both PET-CT and chest CT within 50 days.
• Correlation of CT staging with final patient staging determined by subsequent imaging, surgical, and biopsy results.
• Evaluation of staging accuracy based on CT scan coverage from lung apices to lung bases, and extended coverage.

Main Results:

• PET-CT and CT from lung apices to bases yielded identical staging in 76% of patients.
• PET-CT upstaged 19% of patients compared to standard CT.
• Extended CT coverage to include supraclavicular regions, adrenal glands, or abdomen improved staging accuracy in these upstaged patients.

Conclusions:

• CT scanning from the supraclavicular region through the caudal adrenal glands enhances the accuracy of lung cancer staging compared to scanning from lung apices to bases.
• Anatomic coverage beyond the adrenal glands provides minimal improvement in staging yield.
• Extending CT coverage requires oral contrast administration, impacting all patients undergoing staging.