The Journal of Thoracic and Cardiovascular Surgery
Volume 126, Issue 6 , Pages 1943-1951, December 2003

Results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non–small cell lung cancer☆

Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.

  • Carolyn E Reed, MD

      Affiliations

    • Hollings Cancer Center, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
    • Corresponding Author InformationAddress for reprints: Carolyn E. Reed, MD, Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC 29425, USA
    • ,
  • David H Harpole, MD

      Affiliations

    • Thoracic Oncology Program, Duke Comprehensive Cancer Center, Durham, NC, USA
    • ,
  • Katherine E Posther, MD

      Affiliations

    • Department of Surgery, Duke University Medical Center, Durham, NC, USA
    • ,
  • Sandra L Woolson, MPh

      Affiliations

    • Department of Biostatistics, Duke University Medical Center, Durham, NC, USA
    • ,
  • Robert J Downey, MD

      Affiliations

    • Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Bryan F Meyers, MD

      Affiliations

    • Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo, USA
    • ,
  • Robert T Heelan, MD

      Affiliations

    • Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
    • ,
  • Homer A MacApinlac, MD

      Affiliations

    • Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, Tex, USA
    • ,
  • Sin-Ho Jung, PhD

      Affiliations

    • Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
    • ,
  • Gerard A Silvestri, MD

      Affiliations

    • Division of Pulmonary Medicine, Medical University of South Carolina, Charleston, SC, USA
    • ,
  • Barry A Siegel, MD

      Affiliations

    • Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo, USA
    • ,
  • Valerie W Rusch, MD

      Affiliations

    • Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Received 29 April 2003; received in revised form 25 July 2003; accepted 30 July 2003.

Abstract 

Objectives

The American College of Surgeons Oncology Group undertook a trial to ascertain whether positron emission tomography with 18F-fluorodeoxyglucose could detect lesions that would preclude pulmonary resection in a group of patients with documented or suspected non–small cell lung cancer found to be surgical candidates by routine staging procedures.

Methods

A total of 303 eligible patients registered from 22 institutions underwent positron emission tomography after routine staging (computed tomography of chest and upper abdomen, bone scintigraphy, and brain imaging) had deemed their tumors resectable. Positive findings required confirmatory procedures.

Results

Positron emission tomography was significantly better than computed tomography for the detection of N1 and N2/N3 disease (42% vs 13%, P = .0177, and 58% vs 32%, P = .0041, respectively). The negative predictive value of positron emission tomography for mediastinal node disease was 87%. Unsuspected metastatic disease or second primary malignancy was identified in 18 of 287 patients (6.3%). Distant metastatic disease indicated in 19 of 287 patients (6.6%) was subsequently shown to be benign. By correctly identifying advanced disease (stages IIIA, IIIB, and IV) or benign lesions, positron emission tomography potentially avoided unnecessary thoracotomy in 1 of 5 patients.

Conclusions

In patients with suspected or proven non–small cell lung cancer considered resectable by standard staging procedures, positron emission tomography can prevent nontherapeutic thoracotomy in a significant number of cases. Use of positron emission tomography for mediastinal staging should not be relied on as a sole staging modality, and positive findings should be confirmed by mediastinoscopy. Metastatic disease, especially a single site, identified by positron emission tomography requires further confirmatory evaluation.

Keywords: 10

 

☆ Supported by ACOSOG Grant I-U10-CA76001-01.Barry A. Siegel and Valerie W. Rusch are senior contributing authors.

PII: S0022-5223(03)01502-2

doi:10.1016/j.jtcvs.2003.07.030

Refers to erratum:

  • Notice of Correction: Results of ACOSOG Z0050 trial: The utility of FDG-PET in staging potentially operable non–small cell lung cancer

    The Journal of Thoracic and Cardiovascular Surgery April 2007 (Vol. 133, Issue 4, Page 864)

The Journal of Thoracic and Cardiovascular Surgery
Volume 126, Issue 6 , Pages 1943-1951, December 2003

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