Diagnosis of recurrence and follow-up using FDG-PET/CT for postoperative non-small-cell lung cancer patients
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ORIGINAL ARTICLE
Diagnosis of recurrence and follow‑up using FDG‑PET/CT for postoperative non‑small‑cell lung cancer patients Hiroaki Toba1 · Naoya Kawakita1 · Mika Takashima1 · Daisuke Matsumoto1 · Hiromitsu Takizawa1 · Hideki Otsuka2 · Akira Tangoku1 Received: 30 March 2020 / Accepted: 28 August 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Background There is currently no consensus regarding the best program for postoperative follow-up and surveillance after a curative resection for non-small-cell lung cancer (NSCLC) patients. We examined the diagnostic capability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting recurrence in postoperative NSCLC patients, and we evaluated the results of postoperative surveillance using FDG-PET/CT in asymptomatic patients. Patients and methods Between 2005 and 2013, 496 FDG-PET/CT examinations were performed to detect recurrences for 187 NSCLC patients who had undergone potentially curative operations at our institution. Follow-up FDG-PET/CT was performed ≥ 1 × /year in principle in 172 asymptomatic patients without clinical or radiological evidence of recurrence, and the results were retrospectively reviewed. Results FDG-PET/CT correctly diagnosed recurrence in 46 of 47 (97.9%) patients and 68 of 69 (98.6%) recurrent sites. The following were obtained: 97.9% sensitivity, 97.1% specificity, 92.0% positive predictive value, 99.3% negative predictive value, and 97.3% accuracy. In six patients, other diseases were detected and treated appropriately. In asymptomatic patients, the detection rate of recurrence in the stage III group was significantly higher than the detection rates in the stage I and II groups, and FDG-PET/CT performed ≤ 3 years post-resection detected significantly more FDG-positive lesions compared to that performed after 4 years. Conclusion FDG-PET/CT is very useful for detecting recurrence in NSCLC patients after a potentially curative operation. It might be sufficient to perform follow-up FDG-PET/CT until 3 years post-resection for advanced-stage patients. Further randomized clinical trials are needed to determine whether the early detection of recurrences leads to better prognoses. Keywords Follow-up · FDG-PET/CT · Non-small-cell lung cancer · Asymptomatic postoperative patients
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01477-1) contains supplementary material, which is available to authorized users. * Hiroaki Toba ht1109@tokushima‑u.ac.jp 1
Department of Thoracic and Endocrine Surgery and Oncology, Institute of Health Biosciences, University of Tokushima Graduate School, 3‑18‑15 Kuramoto‑cho, Tokushima 770‑8503, Japan
Department of Medical Imaging/Nuclear Medicine, Institute of Health Biosciences, University of Tokushima Graduate School, Kuramoto‑cho, Tokushima, Japan
2
Among the many types of cancer observed worldwide, nonsmall -cell lung cancer (NSCLC) has been one of the leading causes of
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