K. Higashi et al., COMPARISON OF FLUORINE-18-FDG PET AND TL-201 SPECT IN EVALUATION OF LUNG-CANCER, The Journal of nuclear medicine, 39(1), 1998, pp. 9-15
We compared the diagnostic value of [(18)]2-fluoro-2-deoxy-D-glucose (
FDG) PET imaging and Tl-201 SPECT imaging in the detection of primary
lung cancer and mediastinal lymph node metastases. Methods: Thirty-thr
ee patients with histologically-proven primary lung cancer were examin
ed with both FDG PET and Tl SPECT (early and delayed scans) within a w
eek of each study. For semiquantitative analysis, the tumor-to-nontumo
r activity ratio (T-to-N ratio) was calculated. Results: Although both
techniques delineated focal lesions with an increase in tracer accumu
lation in 28 patients, PET identified three additional patients in who
m TI SPECT images did not visualize any lesions on both early and dela
yed scans. In the detection of lung cancer of less than 2 cm in size,
FDG PET provided higher sensitivity (six of seven, 85.7%) than did TI
SPECT early scan (one of seven, 14.3%) and delayed scan (four of seven
, 57.1%). Neither technique visualized any lesions in two patients who
had bronchioloalveolar carcinoma. The T-to-N ratio was significantly
higher with FDG PET (10.39 +/- 6.63) than it was with Tl SPECT (early
scan, 2.37 +/- 0.86; delayed scan, 3.01 +/- 1.01)(p < 0.0001), whereas
there was significant positive correlation between the FDG T-to-N rat
io and the thallium T-to-N ratio (p < 0.01). Twenty-two patients had t
horacotomies. Regarding the staging of mediastinal nodes, FDG PET dete
cted mediastinal lymph node metastasis that was negative on TI SPECT,
whereas both techniques excluded tumor involvement in enlarged node at
CT. Conclusion: Both techniques have clinical value for the noninvasi
ve detection of primary lung cancer that is 2 cm or greater in diamete
r. However, if a PET camera is available, FDG PET is considered the me
thod of choice for the evaluation of patients with suspected primary l
ung cancer that is less than 2 cm in diameter.