The impact of respiratory gated positron emission tomography on clinical staging and management of patients with lung cancer. Issue 2 (November 2015)

• Record Type: Journal Article
• Authors: Grootjans, Willem; Hermsen, Rick; der Heijden, Erik H.F.M.van; Schuurbiers-Siebers, Olga C.J.; Visser, Eric P.; Oyen, Wim J.G.; Geus-Oei, Lioe-Fee de
• Is Part Of: Lung cancer. Volume 90:Issue 2(2015:Nov.)
• Page Start: 217
• Page End: 223
• Publication Date: 2015-11
• Subjects: Optimal respiratory gating -- Lung cancer -- Patient management -- PET/CT -- [18F]fluorodeoxyglucose; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2015.09.016
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Respiratory gating resulted in the detection of more lesions and lymph nodes. Staging based on respiratory gated PET/CT images was slightly more accurate. For patients with advanced disease stages, no relevant changes in management occurred. The expected impact of respiratory gating will be in patients with early disease stages. Abstract: Objectives: Respiratory motion artefacts during positron emission tomography (PET) deteriorate image quality, potentially introducing diagnostic uncertainties. The objective of this study was to determine the impact of optimal respiratory gating on clinical staging and management of patients with primary lung cancer. Materials and methods: From our fast-track outpatient diagnostic program, 55 patients with primary lung cancer, who underwent whole body [ 18 F]-fluorodeoxyglucose (FDG) PET, were included. Respiratory gating was performed on bed positions covering the thorax and abdomen. Independent reading was conducted by two nuclear medicine physicians. The observers scored the number and anatomical location of the lesions, lymph node basins and the presence of distant metastasis in non-gated and gated images. A tumor (T), lymph node (N), and metastasis (M) stage was assigned to each patient according to the 7th revision of the TNM classification. Staging accuracy was determined using histopathological data and follow-up CT imaging. In addition, a management plan was created for each patient based on non-gated and gated images by an experienced pulmonologist. Results: For nuclear medicine physician 1 and 2, respiratory gating resulted in detection of more lesions in five and eight patients (9% and 15%) respectively. However, this did not result in any migration in T or M-stage. Migration in N-stage was observed in four and seven patients (7% and 13%) for nuclear medicine physician 1 and 2 respectively. Staging accuracy was slightly improved when respiratory gating was performed. Furthermore, there was substantial agreement in patient management between non-gated and gated images. Conclusions: Respiratory gating improved staging accuracy, mainly in assessment of lymph node involvement. However, the effect on patient management was limited due to the presence of already advanced disease stage in many patients. These findings suggest that the expected impact of respiratory gating will be solely on management of patients with early disease.