ABSTRACTS XVI ALASBIMN CONGRESS  NUCLEAR MEDICINE 1999.

9. LUNG

R.P. Baum¹, K. Plichta¹, M. Schmücking², R. Bonnet¹, N. Presselt¹ , K. Plichta¹, A. Niesen¹, E. Lopatta² , J. Leonhardi¹

Zentralklinik Bad Berka¹ (PET Center, Dept. of Diagnostic Radiology, Dept. of Thoracic Surgery, and Dept. of Pneumology) Bad Berka, Germany

University of Jena Medical School², Dept. of Radiotherapy, Jena, Germany

baum@em.uni-frankfurt.de

Objective: To determine the role of F- 1 8 FDG-PET for solitary pulmonary nodules or bronchogenic carcinoma with regard to therapeutic management and definition of planning target volume (PTV) for radiation therapy, findings in 89 patients, receiving a PET between June 1998 to May 1999, were analyzed retrospectively.

Methods: F- 1 8 FDG-PET was done for the following indications:

• Suspicion for bronchogenic carcinoma / solitary pulmonary nodules of unknown dignity (n=28).

• Tumor staging of histologically confirmed bronchogenic carcinoma (n=33).

• Restaging during multimodality (neoadjuvant) therapy / suspicion for recurrence (n=28). PET data were correlated with CT data and histological findings (McNemar / Bowker-test).

Results: Based on histopathological findings, a differentiation between benign or malign lesions was achieved with a sensitivity of 100% and a specificity of 85% (accuracy: 89%). Comparing F- 1 8 FDG-PET with CT, nodal involvement and M-status differed in 52% and 27% of the patients, respectively. Consequently, therapeutic management was changed in 52%, curative to palliative treatment in 19% of the patients. Based on histopathological findings, PET correctly identified lymph node metastases with a sensitivity of 73% (8/11, however 100% for pN2 and pN3), a specificity of 82% (18/22) and an accuracy of 79%. If PET was used additionally for the planning procedure of radiation therapy in the multimodality approach PTV could be reduced in a range of 3 % to 19% as compared with conventional imaging methods. Using PET additionally, differentiation between tumor and atelectasis is possible resulting in smaller PTV.

Conclusions: PET provides a good complementary tool to the morphological imaging modalities for an optimal therapeutic management of solitary pulmonary nodules or bronchogenic carcinoma. Distant metastases of bronchogenic carcinoma could be excluded with high sensitivity. Due to smaller PTV radiation therapy could be delivered with less toxicity in multimodality approaches of bronchogenic carcinoma.

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