Sang Hyun Hwang, Jin Chul Paeng, Arthur Cho, Shin Young Jeong, So Won Oh, Jung Mi Park, Ji Sun Park, Joon Young Choi, Won Jun Kang
Surveillance 18F-FDG PET/CT showed high diagnostic performance for detecting clinically unsuspected recurrence and unexpected second primary cancers in patients with NSCLC after curative resection. However, its incremental value over guideline-recommended CT surveillance, clinical impact, cost-effectiveness, and optimal surveillance interval require prospective evaluation.
PURPOSE: Early detection of non-small cell lung cancer (NSCLC) recurrence after curative resection is critical for improving survival rates. Although 18F-fluorodeoxyglucose (FDG) PET/CT provides comprehensive whole-body surveillance, its optimal timing and clinical benefits remain underexplored. Therefore, this study aimed to evaluate the role of 18F-FDG PET/CT in detecting asymptomatic lung cancer recurrence post-resection and to inform post-operative surveillance strategies.
METHODS: A total of 6,789 consecutive 18F-FDG PET/CT studies involving 3,671 patients with NSCLC after definitive treatment were retrospectively enrolled from eight hospitals. Recurrence-suggestive abnormal lesions on 18F-FDG PET/CT were evaluated. Recurrence was determined by pathological confirmation or other clinical assessment based on follow-up imaging findings.
RESULTS: Diagnostic sensitivity and specificity of ¹⁸F-FDG PET/CT for detecting NSCLC recurrence were 89.1% (496/557) and 98.4% (6,133/6,232), respectively. Overall diagnostic performance remained consistent regardless of initial stage, histology, or time between operation and scan. Specifically, the positive predictive value for detecting recurrence was significantly higher for scans performed within 12 months than for those performed between 12 and 36 months, whereas the negative predictive value was significantly higher for scans performed after 12 months. Additionally, overall accuracy was higher for stage I than stage II disease. 18F-FDG PET/CT revealed unexpected second primary cancers in 71 scans from 71 patients (1.0%).
CONCLUSIONS: Surveillance 18F-FDG PET/CT showed high diagnostic performance for detecting clinically unsuspected recurrence and unexpected second primary cancers in patients with NSCLC after curative resection. However, its incremental value over guideline-recommended CT surveillance, clinical impact, cost-effectiveness, and optimal surveillance interval require prospective evaluation.