Diagnostic Accuracy of [18F]FDG PET/CT versus CT for NSCLC Surveillance: Secondary Analysis of a Randomized Clinical Trial

Kasper Foged Guldbrandsen; Martin Bloch; Kristin Skougaard; Elisabeth Albrecht-Beste; Hanne Marie Nellemann; Martin Krakauer; Peter Michael Gørtz; Julie Marie Grüner; Joan Fledelius; Anne Lerberg Nielsen; Paw Christian Holdgaard; Søren Steen Nielsen; Karin Hjorthaug; Lise Barlebo Ahlborn; Erik Jakobsen; Anette Højsgaard; Rene Horsleben Petersen; Lars Borgbjerg Møller; Morten Dahl; Boe Sandahl Sorensen; Malene Støchkel Frank; Jeanette Haar Ehlers; Zaigham Saghir; Mette Pøhl; Svetlana Borissova; Lotte Holm Land; Charlotte Kristiansen; Tine McCulloch; Lise Saksø Mortensen; Malene Søby Christophersen; Ole Hilberg; Thor Lind Rasmussen; Signe Høyer Simonsen Schwaner; Christian B Laursen; Uffe Bodtger; Markus Nowak Lonsdale; Christian Niels Meyer; Oke Gerke; Jann Mortensen; Torben Riis Rasmussen; Barbara Malene Fischer; SUPE_R Study Group

doi:10.1016/j.cllc.2025.11.011

Diagnostic Accuracy of [18F]FDG PET/CT versus CT for NSCLC Surveillance: Secondary Analysis of a Randomized Clinical Trial

Kasper Foged Guldbrandsen, Martin Bloch, Kristin Skougaard, Elisabeth Albrecht-Beste, Hanne Marie Nellemann, Martin Krakauer, Peter Michael Gørtz, Julie Marie Grüner, Joan Fledelius, Anne Lerberg Nielsen, Paw Christian Holdgaard, Søren Steen Nielsen, Karin Hjorthaug, Lise Barlebo Ahlborn, Erik Jakobsen, Anette Højsgaard, Rene Horsleben Petersen, Lars Borgbjerg Møller, Morten Dahl, Boe Sandahl SorensenMalene Støchkel Frank, Jeanette Haar Ehlers, Zaigham Saghir, Mette Pøhl, Svetlana Borissova, Lotte Holm Land, Charlotte Kristiansen, Tine McCulloch, Lise Saksø Mortensen, Malene Søby Christophersen, Ole Hilberg, Thor Lind Rasmussen, Signe Høyer Simonsen Schwaner, Christian B Laursen, Uffe Bodtger, Markus Nowak Lonsdale, Christian Niels Meyer, Oke Gerke, Jann Mortensen, Torben Riis Rasmussen, Barbara Malene Fischer, SUPE_R Study Group

Abstract

BACKGROUND: Following curative treatment for non-small cell lung cancer (NSCLC), surveillance to detect recurrence is recommended. While computed tomography (CT) is the current standard for follow-up imaging, the optimal surveillance strategy remains debated. This study compares the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT; hereafter referred to as PET/CT) and CT for NSCLC surveillance.

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.

Originalsprog	Engelsk
Tidsskrift	Clinical Lung Cancer
ISSN	1525-7304
DOI	https://doi.org/10.1016/j.cllc.2025.11.011
Status	E-pub ahead of print - 19 nov. 2025

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10.1016/j.cllc.2025.11.011Licens: CC BY

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Guldbrandsen, K. F., Bloch, M., Skougaard, K., Albrecht-Beste, E., Nellemann, H. M., Krakauer, M., Gørtz, P. M., Grüner, J. M., Fledelius, J., Nielsen, A. L., Holdgaard, P. C., Nielsen, S. S., Hjorthaug, K., Ahlborn, L. B., Jakobsen, E., Højsgaard, A., Petersen, R. H., Møller, L. B., Dahl, M., ... SUPE_R Study Group (2025). Diagnostic Accuracy of [18F]FDG PET/CT versus CT for NSCLC Surveillance: Secondary Analysis of a Randomized Clinical Trial. Clinical Lung Cancer. Advance online publication. https://doi.org/10.1016/j.cllc.2025.11.011

Guldbrandsen, KF, Bloch, M, Skougaard, K, Albrecht-Beste, E, Nellemann, HM, Krakauer, M , Gørtz, PM, Grüner, JM, Fledelius, J, Nielsen, AL, Holdgaard, PC, Nielsen, SS, Hjorthaug, K, Ahlborn, LB, Jakobsen, E, Højsgaard, A, Petersen, RH, Møller, LB, Dahl, M, Sorensen, BS, Frank, MS, Ehlers, JH, Saghir, Z , Pøhl, M , Borissova, S, Land, LH, Kristiansen, C, McCulloch, T, Mortensen, LS, Christophersen, MS, Hilberg, O, Rasmussen, TL, Schwaner, SHS, Laursen, CB, Bodtger, U, Lonsdale, MN, Meyer, CN, Gerke, O, Mortensen, J, Rasmussen, TR, Fischer, BM & SUPE_R Study Group 2025, 'Diagnostic Accuracy of [18F]FDG PET/CT versus CT for NSCLC Surveillance: Secondary Analysis of a Randomized Clinical Trial', Clinical Lung Cancer. https://doi.org/10.1016/j.cllc.2025.11.011

@article{ed72078009234ea499c052c456fbf847,

title = "Diagnostic Accuracy of [18F]FDG PET/CT versus CT for NSCLC Surveillance: Secondary Analysis of a Randomized Clinical Trial",

abstract = "BACKGROUND: Following curative treatment for non-small cell lung cancer (NSCLC), surveillance to detect recurrence is recommended. While computed tomography (CT) is the current standard for follow-up imaging, the optimal surveillance strategy remains debated. This study compares the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT; hereafter referred to as PET/CT) and CT for NSCLC surveillance.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.",

author = "Guldbrandsen, {Kasper Foged} and Martin Bloch and Kristin Skougaard and Elisabeth Albrecht-Beste and Nellemann, {Hanne Marie} and Martin Krakauer and G{\o}rtz, {Peter Michael} and Gr{\"u}ner, {Julie Marie} and Joan Fledelius and Nielsen, {Anne Lerberg} and Holdgaard, {Paw Christian} and Nielsen, {S{\o}ren Steen} and Karin Hjorthaug and Ahlborn, {Lise Barlebo} and Erik Jakobsen and Anette H{\o}jsgaard and Petersen, {Rene Horsleben} and M{\o}ller, {Lars Borgbjerg} and Morten Dahl and Sorensen, {Boe Sandahl} and Frank, {Malene St{\o}chkel} and Ehlers, {Jeanette Haar} and Zaigham Saghir and Mette P{\o}hl and Svetlana Borissova and Land, {Lotte Holm} and Charlotte Kristiansen and Tine McCulloch and Mortensen, {Lise Saks{\o}} and Christophersen, {Malene S{\o}by} and Ole Hilberg and Rasmussen, {Thor Lind} and Schwaner, {Signe H{\o}yer Simonsen} and Laursen, {Christian B} and Uffe Bodtger and Lonsdale, {Markus Nowak} and Meyer, {Christian Niels} and Oke Gerke and Jann Mortensen and Rasmussen, {Torben Riis} and Fischer, {Barbara Malene} and {SUPE_R Study Group}",

year = "2025",

month = nov,

day = "19",

doi = "10.1016/j.cllc.2025.11.011",

language = "English",

journal = "Clinical Lung Cancer",

issn = "1525-7304",

publisher = "Elsevier Inc",

}

TY - JOUR

T1 - Diagnostic Accuracy of [18F]FDG PET/CT versus CT for NSCLC Surveillance

T2 - Secondary Analysis of a Randomized Clinical Trial

AU - Guldbrandsen, Kasper Foged

AU - Bloch, Martin

AU - Skougaard, Kristin

AU - Albrecht-Beste, Elisabeth

AU - Nellemann, Hanne Marie

AU - Krakauer, Martin

AU - Gørtz, Peter Michael

AU - Grüner, Julie Marie

AU - Fledelius, Joan

AU - Nielsen, Anne Lerberg

AU - Holdgaard, Paw Christian

AU - Nielsen, Søren Steen

AU - Hjorthaug, Karin

AU - Ahlborn, Lise Barlebo

AU - Jakobsen, Erik

AU - Højsgaard, Anette

AU - Petersen, Rene Horsleben

AU - Møller, Lars Borgbjerg

AU - Dahl, Morten

AU - Sorensen, Boe Sandahl

AU - Frank, Malene Støchkel

AU - Ehlers, Jeanette Haar

AU - Saghir, Zaigham

AU - Pøhl, Mette

AU - Borissova, Svetlana

AU - Land, Lotte Holm

AU - Kristiansen, Charlotte

AU - McCulloch, Tine

AU - Mortensen, Lise Saksø

AU - Christophersen, Malene Søby

AU - Hilberg, Ole

AU - Rasmussen, Thor Lind

AU - Schwaner, Signe Høyer Simonsen

AU - Laursen, Christian B

AU - Bodtger, Uffe

AU - Lonsdale, Markus Nowak

AU - Meyer, Christian Niels

AU - Gerke, Oke

AU - Mortensen, Jann

AU - Rasmussen, Torben Riis

AU - Fischer, Barbara Malene

AU - SUPE_R Study Group

PY - 2025/11/19

Y1 - 2025/11/19

N2 - BACKGROUND: Following curative treatment for non-small cell lung cancer (NSCLC), surveillance to detect recurrence is recommended. While computed tomography (CT) is the current standard for follow-up imaging, the optimal surveillance strategy remains debated. This study compares the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT; hereafter referred to as PET/CT) and CT for NSCLC surveillance.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.

AB - BACKGROUND: Following curative treatment for non-small cell lung cancer (NSCLC), surveillance to detect recurrence is recommended. While computed tomography (CT) is the current standard for follow-up imaging, the optimal surveillance strategy remains debated. This study compares the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT; hereafter referred to as PET/CT) and CT for NSCLC surveillance.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.

U2 - 10.1016/j.cllc.2025.11.011

DO - 10.1016/j.cllc.2025.11.011

M3 - Journal article

C2 - 41387040

SN - 1525-7304

JO - Clinical Lung Cancer

JF - Clinical Lung Cancer

ER -

Diagnostic Accuracy of [18F]FDG PET/CT versus CT for NSCLC Surveillance: Secondary Analysis of a Randomized Clinical Trial

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