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Thoracic staging with 18F-FDG PET/MR in non-small cell lung cancer – does it change therapeutic decisions in comparison to 18F-FDG PET/CT?

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Abstract

Objective

To investigate whether differences in thoracic tumour staging between 18F-FDG PET/CT and PET/MR imaging lead to different therapeutic decisions in Non-Small Cell Lung Cancer (NSCLC).

Material and methods

Seventy-seven NSCLC patients that underwent whole-body 18F-FDG PET/CT from the base of skull to the upper thighs and thoracic PET/MR were enrolled in this retrospective study. Thoracic PET/CT and PET/MR images were staged according to the 7th edition of the AJCC staging manual. Staging results of both modalities were discussed separately in a simulated interdisciplinary tumour board and therapeutic decisions based on both imaging modalities were recorded. Descriptive statistics were used to compare the results and reasons for changes in the therapeutic decision were investigated.

Results

Staging results differed in 35 % of patients (27 patients) between thoracic PET/CT and PET/MR. Differences were detected when assessing the T-stage in 18 % (n = 14), the N-stage in 23 % (n = 18), and the M-stage in 1 % (n = 1). However, patient therapy management was changed in only six patients (8 %).

Conclusion

Despite the variability of thoracic 18F-FDG PET/CT and PET/MR in TNM-staging, both modalities lead to comparable therapeutic decisions in patients suffering from NSCLC. Hence, 18F-FDG PET/MR can be considered an possible alternative to 18F-FDG PET/CT for clinical NSCLC staging.

Key points

• PET/CT and PET/MR provide comparable results in early stages in NSCLC

• Clinical impact of different staging results has not been investigated

• PET/CT and PET/MR lead to comparable therapeutic decisions

• PET/MR can be considered an alternative to PET/CT for NSCLC staging

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Acknowledgments

The scientific guarantor of this publication is Christian Buchbender. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required because no study on animals was performed. Some study subjects or cohorts have been previously reported in two studies: 1) Heusch P, Buchbender C, Köhler J, et al. (2014) Thoracic Staging in Lung Cancer: Prospective Comparison of 18F-FDG PET/MR Imaging and 18F-FDG PET/CT. J Nucl Med 55:373–378. 2) Schaarschmidt B, Buchbender C, Gomez B, et al. (2015) Thoracic staging of non-small-cell lung cancer using integrated 18F-FDG PET/MR imaging: diagnostic value of different MR sequences. Eur J Nucl Med Mol Imaging 42:1257–1267 Methodology: retrospective, observational, performed at one institution.

Author information

Authors and Affiliations

  1. Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany

    Benedikt M. Schaarschmidt, Philipp Heusch, Gerald Antoch & Christian Buchbender

  2. Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Duisburg-Essen, D-45147, Essen, Germany

    Benedikt M. Schaarschmidt, Johannes Grueneisen & Lale Umutlu

  3. Medical Faculty, Department of Medical Oncology, University Duisburg-Essen, Essen, Germany

    Martin Metzenmacher

  4. Medical Faculty, Department of Nuclear Medicine, University Duisburg-Essen, D-45147, Essen, Germany

    Benedikt Gomez & Verena Ruhlmann

  5. Medical Faculty, Radiation and Tumour Clinic, University Duisburg-Essen, D-45147, Essen, Germany

    Thomas Gauler

  6. Ruhrlandklinik, Thoracic Surgery and Endoscopy, University Duisburg-Essen, Essen, Germany

    Christian Roesel

Authors
  1. Benedikt M. Schaarschmidt
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  2. Johannes Grueneisen
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  4. Benedikt Gomez
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Corresponding author

Correspondence to Benedikt M. Schaarschmidt.

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Schaarschmidt, B.M., Grueneisen, J., Metzenmacher, M. et al. Thoracic staging with 18F-FDG PET/MR in non-small cell lung cancer – does it change therapeutic decisions in comparison to 18F-FDG PET/CT?. Eur Radiol 27, 681–688 (2017). https://doi.org/10.1007/s00330-016-4397-0

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  • DOI: https://doi.org/10.1007/s00330-016-4397-0

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