Elsevier

PET Clinics

Volume 10, Issue 2, April 2015, Pages 147-158
PET Clinics

Lung Cancer

https://doi.org/10.1016/j.cpet.2014.12.002Get rights and content

Section snippets

Key points

  • Undiagnosed 18F-fluorodeoxyglucose–avid pulmonary nodules generally require further evaluation.

  • PET-assisted staging of the mediastinum is much more accurate than computed tomography–based evaluation.

  • PET imaging before planned surgery for apparently resectable lung cancer reduces the futile thoracotomy rate.

  • Almost one-third of patients with apparent stage III non–small cell lung cancer will be found to have disease too advanced for curative radiation therapy after PET staging.

  • PET-assisted

Positron emission tomography/computed tomography imaging in the management of lung cancer

Rational decision-making in oncology is dependent on high-quality data regarding the biological characteristics, location, and extent of malignancy. Although pathologic sampling of the presumed primary or suspected metastatic disease provides critical diagnostic information about tumor type and grade, economic and physical (morbidity) factors mandate noninvasive evaluation of the extent of disease. Medical imaging is pivotal in providing this information. Although computed tomography (CT) or

Lung nodule characterization

As CT scans are increasingly performed for investigation of a range of diseases and, in some patients, as a screening procedure, the incidental detection of pulmonary nodules is becoming more common. FDG-PET can play a key role in characterizing many of these nodules. The Fleischner Society does not currently recommend FDG-PET/CT scanning of patients with nodules smaller than 8 mm.1 These recommendations recognize that lesions smaller than twice the theoretic spatial resolution of the scanner

Staging of known non–small cell lung cancer

The most powerful adverse prognostic parameter in patients with NSCLC is the presence of metastatic disease (M status). Stage IV disease is defined by the presence of distant metastases (M1) and is independent of N-stage and T-stage because these cease to have independent prognostic significance in this setting. In the absence of distant metastases (M0), nodal (N) status (a surrogate for the later development of distant metastatic disease) becomes relevant to both treatment choices and

Impact of positron emission tomography on management and prognostic stratification in surgical candidates

In 2001, a study (using PET rather than PET-CT data) in a group of patients referred for surgical resection found that PET data predicted survival, whereas CT did not, but 10% of patients were overstaged with PET.25 Accordingly, although this was less than the 32% overstaged by CT, the investigators recommended the need for biopsy confirmation of suspected disease sites that would otherwise make the patient unsuitable for resection with curative intent. Invasive biopsy procedures can be

Impact of positron emission tomography on management and prognostic stratification in candidates for curative-intent radiotherapy

If resection of all known disease can be safely accomplished, radical surgery is generally the preferred treatment strategy for early-stage NSCLC, but in patients unfit for surgery or who refuse it, radiotherapy is a valid option. PET/CT is of particular value for such patients, as they will not have comprehensive evaluation of their mediastinal nodes at thoracotomy and hence will tend to be understaged by conventional imaging. PET/CT not only helps noninvasively to decide the need for

Defining the target for radiotherapy with curative intent

The radiotherapy lexicon includes a number of technical terms that describe the lesion to be targeted and its surrounds. The planning target volume (PTV) describes the volume within the patient that is to be irradiated. There is an element of clinical judgment as to how large the PTV needs to be to achieve optimal tumor control. Ideally, the PTV will include all of the tumor, its microscopic extensions, and a safety margin for factors such as variations in daily set-up on the treatment machine.

The roles of 18F-fluorodeoxyglucose–positron emission tomography/computed tomography in the posttreatment evaluation of non–small cell lung cancer

The role of imaging after an attempt at cure in NSCLC remains controversial. Based on a lack of published evidence of benefit, most clinical guidelines do not recommend PET/CT, or even in some cases CT, for the routine follow-up of patients who have had therapy of lung cancer with curative intent.46 The main justification for surveillance has been screening for complications of the previous therapy. In general terms, no test should be performed if the patient or the referring clinician is not

The role of 18F-fluorodeoxyglucose–positron emission tomography/computed tomography in treatment response evaluation

Conventional response assessment of cancer after therapy using CT relies on unidimensional or bidimensional measures of tumor before and after treatment. This can be particularly problematic in lung cancer because of the presence of tumor-related atelectasis before treatment and the effects of treatment after its delivery. Posttherapy effects include radiation pneumonitis, infection, and postsurgical scarring, all of which can obscure tumor boundaries. Furthermore, because of the use of nodal

Summary

The role of PET is continually evolving in lung cancer, but it is already firmly established as the primary noninvasive imaging modality for the staging of patients with lung cancer who are candidates for curative therapies. In the developed world, it is now routine to have an FDG-PET/CT scan before surgery is contemplated for apparently localized NSCLC. The impact of PET in patients with more advanced disease, especially for those being considered for definitive chemoradiation, is even

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    The authors have nothing to disclose.

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