Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer.

BACKGROUND Positron emission tomography (PET) scanning is used increasingly to detect and stage lung cancer, but the test performance characteristics and relationship of PET to patient outcomes remain undefined. OBJECTIVE To determine the test performance characteristics and relationship of PET scanning stage to patient outcomes relative to the 1997 International System for the Staging of Lung Cancer. DESIGN Survival analysis using pathologic staging as the criterion standard for comparison of survival as predicted by staging by PET and CT. SETTING University-based hospital. PATIENTS All consecutive patients undergoing PET scanning for the evaluation of possible non-small cell lung cancer (NSCLC) during a 5-year period. MAIN OUTCOME MEASURES Long-term survival of patients with NSCLC after staging by PET. RESULTS One hundred fifty-two thoracic PET scans were obtained for the staging of possible NSCLC during a 5-year period. One hundred twenty-three patients (81%) demonstrated increased (18)F-fluorodeoxyglucose uptake. The overall sensitivity and specificity of PET for detecting malignancy were 95% and 67%, respectively, compared with 100% and 27% for chest CT. PET and CT had similar accuracy for staging the overall extent of disease (91% and 89%, respectively). PET stage correlated highly with survival using either nodal location or overall stage (p = 0.003, p = 0.002), as did pathologic staging (p = 0.0001, p = 0.0001). CT scan results did not accurately predict survival (p = 0.608, p = 0.338). CONCLUSION PET scanning is a highly sensitive technologic advance in detecting and staging of thoracic malignancy and may more accurately predict the likelihood of long-term survival in patients with NSCLC than chest CT does.