Non-small cell lung cancer: nodal staging with FDG PET versus CT with correlative lymph node mapping and sampling

To prospectively compare the accuracy of positron emission tomography (PET) with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG) with that of computed tomography (CT) in the nodal staging of non-small cell lung cancer.

PET and contrast material-enhanced CT were performed in 47 patients suspected of having or with newly diagnosed non-small cell lung cancer. Each imaging study was evaluated separately, and nodal stations were localized according to the American Thoracic Society mapping system. Extensive lymph node sampling (599 nodes from 191 nodal stations) of the ipsi- and contralateral tracheobronchial and mediastinal nodal stations was performed at thoracotomy and/or mediastinoscopy. Imaging findings were correlated with histopathologic staging results.

The sensitivity of PET and CT was 89% and 57%, respectively, for the staging of N2 or N3 disease in mediastinal nodes; specificity was 99% and 94%, respectively; positive predictive value was 96% and 76%, respectively; negative predictive value was 97% and 87%, respectively; and accuracy was 96% and 85%, respectively. In assigning the correct N stage, PET was correct in 96% and CT in 79% of cases.

PET with FDG appears to be superior to CT for nodal staging of non-small cell lung cancer.