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J Thorac Cardiovasc Surg 2007;133:1425-1427
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Discussion

Dr Carolyn R. Reed (Charleston, SC). When PET came on the scene, all of us hoped that it would remarkably improve the accuracy of clinical staging. Although PET, especially integrated PET/CT, has increased staging accuracy, the multi-institutional studies have somewhat dampened our initial enthusiasm. As we have seen in other papers today, we must look at subsets of patients to refine the utility of PET.

Recently, there has been a new focus on the intensity of FDG uptake in an individual tumor as a surrogate marker of the biologic behavior of that tumor. This is particularly attractive because assessment of such things as cell proliferation markers and gene expression profiling require tissue samples. Dr Downey’s paper gives us insight into the true usefulness of PET and also, I believe, its limitations.

Dr Downey, I think your study corroborates several known things: the size cut-off point between T1 and T2 tumors should be lower than 3 cm; small adenocarcinomas have better prognosis, perhaps because histologies such as BAC and other GGOs are included; and most importantly, postoperative pathologic stage is still the key.

I do have one problem with the preoperative use of SUV_MAX because although at your institution an SUV_MAX of less than 4.3 might be predictive of good prognosis, that might not be the case at other institutions. SUV is a continuous variable, and a binary cut-off point might not be appropriate. There are many factors, as we all know, that affect the SUV determination. Therefore my first question is this: How do we use your finding of an SUV_MAX of 4.3 as a prognostic cut-off point? Should we establish our own institutional cut-off point?

Dr Downey. This is a problem that has been addressed before, and it is a very important point. The standardized uptake value . . . [Full Text of this Article]

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J. Thorac. Cardiovasc. Surg. 2007 133: 1419-1427. [Abstract] [Full Text] [PDF]