Presurgical staging of non-small cell lung cancer: positron emission tomography, integrated positron emission tomography/CT, and software image fusion

Chest. 2005 Oct;128(4):2289-97. doi: 10.1378/chest.128.4.2289.


Purposes: To compare the diagnostic accuracy of positron emission tomography (PET) and integrated PET/CT and to evaluate the performance of software fusion for staging of non-small cell lung cancer (NSCLC).

Methods: Thirty-six patients (17 men and 19 women) with NSCLC underwent staging with integrated PET/CT followed by mediastinal lymph node dissection and tumor resection. Twenty-five of the 36 patients (69%) underwent separate CT studies for software fusion of images. Two blinded reviewers analyzed in consensus all PET images, and an experienced radiologist was added to assess integrated and software-fused PET/CT images. Histopathologic findings served as "gold standard" for determining the diagnostic accuracy of all modalities.

Results: Reviewers examining PET and integrated PET/CT classified T stage accurately in 67% (20 of 30 patients) and 97% (29 of 30 patients), respectively (p < 0.05). Overall, interpretations based on PET staged 57% (17 of 30 patients) correctly, over-staged 6 patients (20%), and under-staged 7 patients (23%). Interpretations based on integrated PET/CT correctly staged 83% (25 of 30 patients), over-staged 3 patients (10%), and under-staged 2 patients (7%). The overall staging accuracy of integrated PET/CT was significantly higher than that of PET (p < 0.05). Automatic software fusion of separately obtained PET and CT studies was successful in 68% of the patients but failed in 32%. In successful software fusion cases, the results of software fusion with regards to T stage and N stage were not different from integrated PET/CT.

Conclusions: Integrated PET/CT compared with PET alone was associated with 26% points-greater overall diagnostic accuracy (p = 0.01). The software fusion method failed to provide acceptable co-registration in > 30% of the patients.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery
  • Lymph Node Excision*
  • Lymphatic Metastasis
  • Male
  • Neoplasm Staging* / methods
  • Positron-Emission Tomography
  • Preoperative Care
  • Radiography
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Software