Staging in Patients with Small-Cell Lung Carcinoma; PET-CT versus Standard Staging Procedures

Objective: The most important factor for accurate treatment of patients with small cell lung carcinoma (SCLC) is accuracy of the initial staging. The aim of this study was to determine how often patients, staged as local or local-advanced disease by standard staging procedures (SSPs), would be staged to have a metastatic disease based on the findings of the positron emission tomography-computed tomography (PET-CT) scan. Methods: Patients with SCLC who were staged as I, II, or III disease by SSPs (according to the American Joint Committee on Cancer Staging, 7th edition) formed the study population. SSPs included computed tomography of chest, abdomen, brain (or magnetic resonance imaging of brain), and bone scintigraphy. These patients were re-staged with F-18-FDG PET-CT scan. Results: Between 2013 and 2015, 27 patients were prospectively studied. Of these patients, 92.5% were male and the median age was 61. Among 27 patients, distant metastasis was detected by PET-CT in 7 (25.9%) patients. Two of 7 patients were determined as stage IIIA by SSPs and 5 of 17 patients that were determined as stage IIIB by SSPs were upstaged to metastatic disease by PET-CT. All of the 7 patients had bone metastasis by PET-CT. But bone metastasis could not be detected with bone scintigraphy. Conclusion: PET-CT detected distant metastasis in one quarter of SCLC stage III patients by SSPs. Patients who staged local-advanced SCLC with CT of the chest have to be assessed by PET-CT for extracranial distant metastasis.