PET-CT staging spared more patients from unnecessary surgery than conventional staging

Staging with PET-CT correctly identified more patients with mediastinal and extrathoracic non–small cell lung carcinoma than conventional staging, and in effect prevented more stage-inappropriate surgery.

Researchers randomly assigned 170 patients to PET-CT with cranial imaging and 167 patients to conventional staging with cranial imaging.

Disease was correctly upstaged in more patients with PET-CT (13.8%) than with conventional staging (6.8%; 95% CI, 0.3-13.7). Disease was also incorrectly understaged in fewer patients with PET-CT (14.9%) than with conventional staging (29.6%; 95% CI, 5.7-23.4).

Disease was incorrectly upstaged, however, in more PET-CT patients (4.8%) than conventional staging patients (0.6%; 95% CI, 0.5-8.6).

During the three-year study, 52 patients in the PET-CT group and 57 patients in the conventional staging group died, according to researchers.

“We will need additional comparisons between PET-CT and other staging tests — preferably studies that measure clinical outcomes and include cost analysis — as lung cancer staging continues to transform and improve,” Mitchell L. Margolis, MD, associate professor of medicine at the University of Pennsylvania Medical Center, said in an accompanying editorial.

Maziak DE. Ann Intern Med. 2009;151.