Diagnostic Accuracy of [18F]FDG PET/CT versus CT for NSCLC Surveillance: Secondary Analysis of a Randomized Clinical Trial.
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Guldbrandsen Kasper Foged, Bloch Martin, Skougaard Kristin, Albrecht-Beste Elisabeth, Nellemann Hanne Marie, Krakauer Martin, Gørtz Peter Michael, Grüner Julie Marie, Fledelius Joan, Nielsen Anne Lerberg, Holdgaard Paw Christian, Nielsen Søren Steen, Hjorthaug Karin, Ahlborn Lise Barlebo, Jakobsen Erik, Højsgaard Anette, Petersen Rene Horsleben, Møller Lars Borgbjerg, Dahl Morten, Sorensen Boe Sandahl, Frank Malene Støchkel, Ehlers Jeanette Haar, Saghir Zaigham, Pøhl Mette, Borissova Svetlana, Land Lotte Holm, Kristiansen Charlotte, McCulloch Tine, Mortensen Lise Saksø, Christophersen Malene Søby, Hilberg Ole, Rasmussen Thor Lind, Schwaner Signe Høyer Simonsen, Laursen Christian B, Bodtger Uffe, Lonsdale Markus Nowak, Meyer Christian Niels, Gerke Oke, Mortensen Jann, Rasmussen Torben Riis, Fischer Barbara Malene, SUPE_R Study Group
Аннотация
MATERIALS AND METHODS: This study represents a secondary analysis of data from a randomized controlled trial (SUPE_R, ClinicalTrials.gov NCT03740126) of patients with stage IA-IIIC NSCLC who completed curative-intent treatment between February 2019 and February 2022. CT and PET/CT scans were compared for recurrence detection using biopsy, multidisciplinary team assessment, or follow-up imaging as reference standards.
RESULTS: The analysis included 899 PET/CT scans and 852 CT scans from 692 patients (mean age 69 years ± 8 [SD]; 412 female). For detecting recurrence, PET/CT demonstrated a higher sensitivity (88% [95% CI, 80%-93%] vs. 62% [95% CI, 50%-73%]; P < .001) but lower specificity (89% [95% CI, 86%-91%] vs. 96% [95% CI, 94%-97%]; P < .001) compared to CT. PET/CT demonstrated a higher sensitivity compared to CT after treatment with chemoradiotherapy (100% [95% CI, 72%-100%] vs. 46% [95% CI, 19%-75%]; P = .006) and at 0 to 6 month after treatment (83% [95% CI, 63%-94%] vs. 41% [95% CI, 21%-65%]; P = .008).
CONCLUSION: The higher sensitivity of PET/CT, particularly after chemoradiotherapy and early post-treatment, suggests it may be particularly valuable in these high-risk scenarios. However, CT remains preferred for routine surveillance of low-risk patients given its superior specificity.