Researchers from Denmark have reported that “The use of PET-CT for preoperative staging of NSCLC [non–small cell lung cancer] reduced both the total number of thoracotomies and the number of futile thoracotomies but did not affect overall mortality.” The details of this study appeared in the July 2, 2009 issue of the New England Journal of Medicine.[1]

Computerized tomography (CT) and positron-emission tomography (PET) are important diagnostic techniques for staging of patients with NSCLC. However, each technique has limitations. A combined machine has been developed and has undergone limited evaluation. The integrated PET-CT machine combines the structural information obtained by CT with the metabolic information obtained by PET into one set of images. The main value of this approach is that small lesions detected with PET can be more precisely located using CT.

Previous studies have suggested that integrated PET-CT scanning can improve the diagnostic accuracy of staging of NSCLC with therapy changed in approximately 25% of patients compared with CT alone. However, the effect of improved staging with PET-CT on survival has not been documented.

In the current study, 189 patients with NSCLC were randomly allocated to staging with PET-CT or to conventional staging. Ninety-four percent of patients underwent mediastinoscopy.

• 38 patients in the PET-CT group were deemed inoperable compared with 18 in the control group.
• 60 patients in the PET-CT group underwent thoracotomy compared with 73 in the control group.
• There were 21 futile thoracotomies in the PET-CT group compared with 38 in the control group.

Comments: PET-CT appears to be of value by reducing the number of futile thoracotomies but has no impact on overall survival.

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