Fludeoxyglucose F 18 in Detecting Lymph Node Metastasis in Patients With Stage I or Stage II Non-Small Cell Lung Cancer That Can Be Removed by Surgery

• Survival rate at 2 years [ Time Frame: 2 years ] [ Designated as safety issue: No ]
• Recurrence rate at 2 years [ Time Frame: 2 years ] [ Designated as safety issue: No ]

• Survival rate at 2 years [ Designated as safety issue: No ]
• Recurrence rate at 2 years [ Designated as safety issue: No ]

• Positive threshold of lymph node radioactivity [ Time Frame: within 90 days ] [ Designated as safety issue: No ]
• Comparison of the accuracy of detecting thoracic lymph node metastases using PET-CT scans versus intra-operative hand-held gamma probe [ Time Frame: Within 90 days ] [ Designated as safety issue: No ]
• Ability of the gamma probe to detect lymph node micrometastases, resulting in upstaging [ Time Frame: Within 90 days ] [ Designated as safety issue: No ]
• Quality of life [ Time Frame: At 3 years ] [ Designated as safety issue: No ]

• Positive threshold of lymph node radioactivity [ Designated as safety issue: No ]
• Comparison of the accuracy of detecting thoracic lymph node metastases using PET-CT scans versus intra-operative hand-held gamma probe [ Designated as safety issue: No ]
• Ability of the gamma probe to detect lymph node micrometastases, resulting in upstaging [ Designated as safety issue: No ]
• Quality of life [ Designated as safety issue: No ]
• Cost [ Designated as safety issue: No ]

RATIONALE: Diagnostic procedures using fludeoxyglucose F 18 and a surgical probe may help find lymph node metastases in patients with early-stage non-small cell lung cancer.

PURPOSE: This clinical trial is studying how well fludeoxyglucose F 18 works in detecting lymph node metastasis in patients with stage I or stage II non-small cell lung cancer that can be removed by surgery.

OBJECTIVES:

Primary

• Determine the positive threshold of lymph node radioactivity after fludeoxyglucose F 18, utilizing the gamma probe, in patients with resectable stage I or II non-small cell lung cancer.
• Compare the accuracy of detecting thoracic lymph node metastases using positron emission tomography-computed tomography (PET-CT) versus the intra-operative hand-held gamma probe in these patients.
• Determine the ability of the gamma probe to detect lymph node micrometastases, resulting in upstaging in these patients.
• Assess the clinical relevance of the gamma probe-detected lymph node metastases by measuring patient survival, tumor recurrence, impact on patient quality of life, and cost.

OUTLINE: Patients undergo a positron emission tomography-computed tomography (PET-CT) scan within 90 days before surgery. Beginning 1-4 hours before surgery on day 1, patients receive an injection of fludeoxyglucose F 18 (FDG) and a mediastinoscopy is performed. FDG-avid lymph nodes are obtained and may undergo immunohistochemical analysis or standard analysis. Patients with mediastinal lymph node micrometastasis do not undergo primary tumor resection. Patients with ipsilateral mediastinal micrometastases undergo neoadjuvant chemotherapy prior to surgical resection. Patients with contralateral mediastinal micrometastases undergo definitive chemoradiotherapy. In the absence of mediastinal lymph node metastases (micro or macro), complete surgical resection is performed after the mediastinoscopy, including complete thoracic lymphadenectomy. The tumor and lymph nodes (both from mediastinoscopy and thoracotomy) undergo radioactivity measurements with the hand-held gamma probe. Fresh tumor and lymph node samples are stored for future studies.

Patients complete the Short Form 36 Health Survey (SF-36) before surgery and at 1, 3, and 6 months after surgery to assess the potential impact of the gamma probe on patient quality of life.

After completion of study, patients are followed every 6 months for 2 years, and then annually for 3 years.

• Drug: chemotherapy
  Given IV and Orally
• Procedure: lymphadenectomy
  Removal of lymph nodes
• Procedure: neoadjuvant therapy
  Tumor reduction
• Procedure: quality-of-life assessment
  Correlative Study
• Procedure: therapeutic conventional surgery
  Treatment for cancer
• Procedure: thoracic surgical procedure
  removal of tissue
• Radiation: fludeoxyglucose F 18
  given IV
• Radiation: radiation therapy
  undergoing radiotherapy

DISEASE CHARACTERISTICS:

• Diagnosis of non-small cell lung cancer

  • Stage I-II disease
  • Resectable disease
• Planning to undergo surgical resection
• No tumors that are not fludeoxyglucose F 18 (FDG)-avid on PET scan

PATIENT CHARACTERISTICS:

• Not pregnant
• Negative pregnancy test
• Fertile patients must use effective contraception
• No previous allergic reaction to fludeoxyglucose F 18
• No contraindication to a pulmonary lobectomy and lymphadenectomy

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics