Contrast CT versus PET/CT in Assessment of Bronchogenic Carcinoma 

In the past decades, diagnostic imaging modalities of bronchogenic carcinoma were; chest X-ray and Computed Tomography (CT) to determine tumor size and mediastinal lymph nodes involved, as well as liver and adrenal metastases. Now positron emission tomography (PET/CT) has been become a routine procedure for the primary assessment (Initial staging) for detection functional tumor activity (viable cells). Objectives: Comparison between contrast CT and PET/CT in the assessment of bronchogenic carcinoma (initial staging) and impact of weight and BMI on it.

Methods: This was a cross-sectional study involved 100 patients for initial staging of newly diagnosed bronchogenic carcinoma examined by contrast CT and PET/CT as well anthropometry measures were taken; weight, height and calculate BMI. Results: The Initial staging of bronchogenic carcinoma showed significant differences between PET/CT versus contrast CT (P=0.001).

There is upstaged by PET/CT in 6 patients (stages I and II), as well as an agreement between PET/CT &CT in (Stage III & IV) was detected.

The Evaluation showed a sensitivity of 84% for CT, 98% for PET/CT. There is a positive significant correlation between tumor size and its metabolic activity measured by SUVmax. Conclusion: PET/CT is a powerful imaging modality for assessment of functional behavior of tumor cells, to avoid false results depending on morphology only as contrast CT, which leading to change decision taken for management of bronchogenic carcinoma. Keywords Contrast CT, PET/CT and bronchogenic carcinoma. Introduction: Cancer is a major public health problem in the world (Ibrahim, et al, 2014). Lung cancer or bronchogenic carcinoma incidence and mortality are rapidly increased to become the most commonly diagnosed cancer worldwide represent 11.

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6% of the total cases and 18.4% of the total cancer deaths (2018).

Egyptian Statistics revealed that the lung cancer in males represent (8.2%) according to the Egyptian National Cancer Program in 2014. In the past decades, diagnostic imaging modalities of bronchogenic carcinoma were; chest X-ray and Computed Tomography (CT), which has been employed in the past decades as the gold standard imaging modality for bronchogenic carcinoma staging (Hochhegger, et al, 2015). In fact, CT can accurately determine tumor size, mediastinal and vascular invasion and suggest lymph node involvement, when the nodal axial diameter is greater than 1cm (Fernando, et al, 2017). The employment of contrast-enhanced chest CT including the upper abdomen is recommended to evaluate the potential presence of liver and adrenal metastases (Kim, et al, 2015).

Now PET/CT has been become a routine procedure for the primary assessment (Initial staging) to detect functional tumor activity (viable cells) (Fledelius, et al, 2010), in order to select the most appropriate therapeutic option and to derive prognostic information (De Guevara 2015). In particular, it is extremely relevant to correctly differentiate patients with potentially curable disease (early stage), that may benefit from radical surgery, from those who are judged as un-resectable for cure and are therefore addressed to chemotherapy, radiotherapy or both (Antoniou, et al, 2014). The aim of this study were; Comparison between contrast CT and PET/CT in the assessment of bronchogenic carcinoma (initial staging) and impact of weight and BMI on it.

Cross section data were collected and reported in this manuscript. Results: The present study includes one hundred patients; 72 males and 28 females, their ages (45-75 years, mean 60.1 years ± 1.0 SD), weight (52 -117 Kg, mean 77.9± 1.6 SD), height (140-181 cm, mean 163.0± 0.01 SD), BMI (20.1- 39.7, mean 28.5± 0.5 SD) and fasting blood sugar (79- 132 mg/dL, mean 102.2 ± 1.6 SD), The Initial staging of bronchogenic carcinoma showed significant differences between PET/CT versus contrast CT (P=0.001) according to TNM staging as the following; (T) staging, The upper lung lobe was the most frequent site of location (64%), followed by lower lung lobe (32%) then right middle lobe (4%).

The lung lesion mass size by contrast CT (1.5 cm-14.5 cm), while The SUVmax values by PET/CT (3.5 – 55.7, mean 25.5 ± 1.4 SD), There was down-staging by PET/CT comparing to contrast CT by 4% (four patients), which was larger by CT due to distal lung consolidation. (N) staging, there were 92 patients with positive nodal affection, with upstaging by PET/CT from N1 to N2 in 20 patients and down-staging from N3 to N2 in 15 patients. (M) staging, PET/CT detected more metastasis at the following sites; the osseous (54 patients) which were the most frequent site after nodal affection, followed by hepatic (39 patients), then the pleural (37 patients), adrenal glands (33 patients), the brain (11 patients) and contralateral lung (7 patients), the SUVmax values of the metastatic deposits were showed at (Table 1). Finally 6 patients were diagnosed at stage (I), 10 were stage (II), 20 were stage (III) and 64 were stage (IV). There is upstaged by PET/CT in 6 patients (stages I and II), as well as an agreement between PET/CT & CT in (Stage III & IV) was detected. The Evaluation showed a sensitivity of 84% for CT, 98% for PET/CT (Table 2). The Correlation between size of the primary lung mass measured by contrast (CT) and its metabolic activity measured by PET/CT showed, a positive highly significant correlation between tumor size and its metabolic activity measured by SUVmax (Fig 1).