Contrast enhanced CT versus integrated PET-CT in pre-operative nodal staging of non-small cell lung cancer

PURPOSE The purpose of this study was to retrospectively evaluate the effectiveness of integrated positron emission tomography-computed tomography (PET-CT) in comparison with contrast enhanced CT (CE-CT) in pre-operative staging of non-small cell lung cancer (NSCLC) by using surgical and pathological findings as the reference standard. MATERIALS AND METHODS From August 2008 to August 2009, 57 consecutive patients (50 males and 7 females; mean age, 59 years; range, 38-79 years) with NSCLC underwent conventional pre-operative lung cancer staging using clinical data and CE-CT of the chest, and integrated whole-body fluorine-18 fluorodeoxyglucose PET-CT studies. Histopathological results served as the reference standard. RESULTS Forty-eight of the 57 patients (84%) had no lymph node involvement (NO), five (9%) were found to have N1 disease, and four (7%) had N2 disease. There was a significant difference between CE-CT and PET-CT for nodal staging of NO disease (P < 0.05). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of hilar and mediastinal lymph node staging were 56%, 73%, 28%, 90%, and 70%, with CE-CT, respectively; and 78%, 92%, 64%, 96%, and 89% with PET-CT, respectively. CONCLUSION Integrated PET-CT is more accurate than CE-CT for lymph node staging in NSCLC.