Economic Evaluation of Positron Emission Tomography (PET) in Non Small Cell Lung Cancer (NSCLC), CHERE Working Paper 2007/6

with a ‘high prognostic value.’⁸ Although practice varies from centre to centre patients with
stage IIIB and above are usually considered inappropriate for surgery. Some patients with IIIA
may be treated with chemotherapy with a view of down staging the tumour before radiotherapy
or surgery. Meanwhile, stage I and II patients are treated with either a lobectomy or
pneumonectomy with some receiving adjuvant chemotherapy.⁹ In this study, all surgery will be
classed under the more general heading of a thoractomy.

Figure 1: The Stage grouping (TNM subsets).

Currently, the investigation of patients suspected of having lung cancer is based on a set
of ‘conventional’ diagnostic techniques. A chest x-ray is usually the initial first step for
detecting the presence of a pulmonary lesion, which always warrants further examination as it
raises the suspicion of lung cancer. Then a brochoscopy or a transthoracic needle biopsy are
usually used to determine the exact nature of the pulmonary lesion as these procedures produce
a sample of the lesion that can be analysed. ¹⁰ Once lung cancer is detected it is then staged to
ascertain the spread of the disease and to see if the cancer is treatable or palliative care is
needed.

Traditionally, computer tomography (CT) has been the mainstay of non-invasive
staging. There is, however, undoubtedly a variation in the performance of CT in its ability to
accurately evaluate the individual TNM components. CT has a role in the basic T staging of
NSCLC with respect to the size and the location of the tumour and the extent of invasion of
chest wall because of its excellent anatomical description. However, given CT relies on
morphological detail rather than histological characteristics its use in the N staging of NSCLC

⁸ Chiti, A., F. A. Schreiner, et al. (1999). "Nuclear medicine procedures in lung cancer." Eur J Nucl Med 26(5), p.
536.

⁹ Devaraj, A., G. J. Cook, et al. (2007). "PET/CT in non-small cell lung cancer staging-promises and problems."
Clinical Radiology 62(2), p.99.

¹⁰ Nguyen, V. H., S. Peloquin, et al. (2005). "Cost-effectiveness of positron emission tomography for the
management of potentially operable non-small cell lung cancer in Quebec" Canadian Respiratory Journal 12(1),
pp.19-20.

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