Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 2003 Jan;58(1):47–51. doi: 10.1136/thorax.58.1.47

Prospective use of serial questionnaires to evaluate the therapeutic efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in suspected lung cancer

G Herder 1, H van Tinteren 1, E Comans 1, O Hoekstra 1, G Teule 1, P Postmus 1, U Joshi 1, E Smit 1
PMCID: PMC1746467  PMID: 12511720

Abstract

Background: A study was undertaken to study the effect of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the diagnosis and management of clinically problematic patients with suspected non-small cell lung cancer (NSCLC).

Methods: A prospective before-after study was performed in a cohort of all 164 patients (university/community settings) referred for PET between August 1997 and July 1999. PET was restricted to cases where non-invasive tests had failed to solve clinical problems. The impact on diagnostic understanding and management was assessed using questionnaires (intended treatment without PET, actual treatment choice after PET, post hoc clinical assessment).

Results: Diagnostic problems especially pertained to unclear radiological findings (n=112; 63%), mediastinal staging (n=36; 20%), and distant staging issues (n=16; 9%). PET findings were validated by reviewing medical records. PET had a positive influence on diagnostic understanding in 84%. Improved diagnostic understanding solely based on PET was reported in 26%. According to referring physicians, PET resulted in beneficial change of treatment in 50%. Cancelled surgery was the most frequent change in treatment after PET (35%).

Conclusion: FDG PET applied as "add on" technology in patients with these clinical problems appears to be a clinically useful tool, directly improving treatment choice in 25% of patients. The value of increased confidence induced by PET scanning requires further evaluation.

Full Text

The Full Text of this article is available as a PDF (123.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Dwamena B. A., Sonnad S. S., Angobaldo J. O., Wahl R. L. Metastases from non-small cell lung cancer: mediastinal staging in the 1990s--meta-analytic comparison of PET and CT. Radiology. 1999 Nov;213(2):530–536. doi: 10.1148/radiology.213.2.r99nv46530. [DOI] [PubMed] [Google Scholar]
  2. Eccles M., Steen N., Grimshaw J., Thomas L., McNamee P., Soutter J., Wilsdon J., Matowe L., Needham G., Gilbert F. Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial. Lancet. 2001 May 5;357(9266):1406–1409. doi: 10.1016/S0140-6736(00)04564-5. [DOI] [PubMed] [Google Scholar]
  3. Goldman L., Feinstein A. R., Batsford W. P., Cohen L. S., Gottschalk A., Zaret B. L. Ordering patterns and clinical impact of cardiovascular nuclear medicine procedures. Circulation. 1980 Oct;62(4):680–687. doi: 10.1161/01.cir.62.4.680. [DOI] [PubMed] [Google Scholar]
  4. Gould M. K., Maclean C. C., Kuschner W. G., Rydzak C. E., Owens D. K. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA. 2001 Feb 21;285(7):914–924. doi: 10.1001/jama.285.7.914. [DOI] [PubMed] [Google Scholar]
  5. Guyatt G. H., Tugwell P. X., Feeny D. H., Drummond M. F., Haynes R. B. The role of before-after studies of therapeutic impact in the evaluation of diagnostic technologies. J Chronic Dis. 1986;39(4):295–304. doi: 10.1016/0021-9681(86)90051-2. [DOI] [PubMed] [Google Scholar]
  6. Kalff V., Hicks R. J., MacManus M. P., Binns D. S., McKenzie A. F., Ware R. E., Hogg A., Ball D. L. Clinical impact of (18)F fluorodeoxyglucose positron emission tomography in patients with non-small-cell lung cancer: a prospective study. J Clin Oncol. 2001 Jan 1;19(1):111–118. doi: 10.1200/JCO.2001.19.1.111. [DOI] [PubMed] [Google Scholar]
  7. McCain T. W., Dunagan D. P., Chin R., Jr, Oaks T., Harkness B. A., Haponik E. F. The usefulness of positron emission tomography in evaluating patients for pulmonary malignancies. Chest. 2000 Dec;118(6):1610–1615. doi: 10.1378/chest.118.6.1610. [DOI] [PubMed] [Google Scholar]
  8. Pieterman R. M., van Putten J. W., Meuzelaar J. J., Mooyaart E. L., Vaalburg W., Koëter G. H., Fidler V., Pruim J., Groen H. J. Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med. 2000 Jul 27;343(4):254–261. doi: 10.1056/NEJM200007273430404. [DOI] [PubMed] [Google Scholar]
  9. Saunders C. A., Dussek J. E., O'Doherty M. J., Maisey M. N. Evaluation of fluorine-18-fluorodeoxyglucose whole body positron emission tomography imaging in the staging of lung cancer. Ann Thorac Surg. 1999 Mar;67(3):790–797. doi: 10.1016/s0003-4975(98)01257-0. [DOI] [PubMed] [Google Scholar]
  10. Tucker R., Coel M., Ko J., Morris P., Druger G., McGuigan P. Impact of fluorine-18 fluorodeoxyglucose positron emission tomography on patient management: first year's experience in a clinical center. J Clin Oncol. 2001 May 1;19(9):2504–2508. doi: 10.1200/JCO.2001.19.9.2504. [DOI] [PubMed] [Google Scholar]
  11. Wittenberg J., Fineberg H. V., Black E. B., Kirkpatrick R. H., Schaffer D. L., Ikeda M. K., Ferrucci J. T., Jr Clinical efficacy of computed body tomography. AJR Am J Roentgenol. 1978 Jul;131(1):5–14. doi: 10.2214/ajr.131.1.5. [DOI] [PubMed] [Google Scholar]
  12. van Tinteren H., Hoekstra O. S., Smit E. F., Verboom P., Boers M., PLUS Study Group Toward less futile surgery in non-small cell lung cancer? A randomized clinical trial to evaluate the cost-effectiveness of positron emission tomography. Control Clin Trials. 2001 Feb;22(1):89–98. doi: 10.1016/s0197-2456(00)00119-7. [DOI] [PubMed] [Google Scholar]
  13. van Tinteren Harm, Hoekstra Otto S., Smit Egbert F., van den Bergh Jan H. A. M., Schreurs Ad J. M., Stallaert Roland A. L. M., van Velthoven Piet C. M., Comans Emile F. I., Diepenhorst Fred W., Verboom Paul. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet. 2002 Apr 20;359(9315):1388–1393. doi: 10.1016/s0140-6736(02)08352-6. [DOI] [PubMed] [Google Scholar]
  14. van Zandwijk N. Consensusbijeenkomst diagnostiek longcarcinoom. Ned Tijdschr Geneeskd. 1991 Oct 12;135(41):1915–1919. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES