Imaging in lung cancer: positron emission tomography scan

Abstract

In the past 5 yrs, positron emission tomography (PET), usually used with 18 F-fluoro-2-deoxy-glucose (FDG), has become an important imaging modality in lung cancer patients.Currently, the use of FDG-PET in respiratory oncology is mainly for diagnosis and staging. Standard indications are the evaluation of an indeterminate solitary pulmonary nodule or mass, where FDG-PET has proven to be significantly more accurate than computed tomography (CT) in the distinction between benign and malignant lesions. Several studies have also convincingly demonstrated that locoregional lymph node staging by FDG-PET (in correlation with CT images) is significantly superior to CT, with a negative predictive value equal or even superior to mediastinoscopy. FDG-PET also improves extrathoracic staging, through the detection of lesions missed at conventional imaging or characterization of lesions that remain equivocal on conventional imaging. Many European countries now have or plan reimbursement in these indications. Large-scale randomized studies should now focus on the impact this accurate tumour imaging technique has on treatment outcome and cost-efficacy.Ongoing studies in specialized centres focus on the use of FDG-PET in more advanced clinical applications, such as planning radiotherapy, response evaluation after radiotherapy or (induction) chemotherapy, follow-up and early detection of recurrence, and prognostic information in this in vivo measurement of tumour glucose metabolism.After a short note on the technique used and a summary of the current common indications of diagnosis and staging, this paper will deal mainly with two of the more advanced clinical applications of FDG-PET in locally advanced nonsmall cell lung cancer: radiation treatment planning and assessment of induction chemotherapy.Finally, it should be mentioned that a whole new field of applications of positron emission tomography in molecular biology, using new radiopharmaceutical probes, is under extensive investigation. These techniques are promising for future use in very early response monitoring during chemo-or radiotherapy, in evaluation of novel molecular-targeted lung cancer therapies, or even gene therapy.

Integrated imaging of non-small cell lung cancer recurrence: CT and PET-CT findings, possible pitfalls and risk of recurrence criteria

“…Extrathoracic metastases are reported to be better demonstrated by PET-CT than by either CT or PET alone [67,68]. However, a review of the role of PET in lung cancer imaging [69] stated that indications for PET-CT in NSCLC recurrences needed further prospective investigations. Two studies published in 2010 enrolled 92 and 121 patients who underwent NSCLC resection [70,71] and stated that PET-CT accuracy in assessing intra-and extra-thoracic recurrences was equivalent to or better than standard radiological examinations.…”

“…As discussed earlier, it is difficult to determine whether a pulmonary lesion presenting in an already treated NSCLC patient represents a recurrence or a second primary tumour [10,20,69] and any new nodule should be properly investigated. Previous studies demonstrated that CT findings of multiple pulmonary nodules with the feeding vessel sign and welldefined and smooth margins in the lower lobes, especially when they were not present on previous images must be suspected of being metastases [69,70,73]. Solitary pulmonary nodules in already treated lung cancer patients may be either recurrent disease or a second primary.…”

Diagnostik des Bronchialkarzinoms

“…Ukena · D. HellwigDiagnostik des Bronchialkarzinoms. PositronenEmissions-Tomographie (PET) ZusammenfassungDie Positronen-Emissions-Tomographie mit18 F-Desoxyglukose (FDG-PET) ist ein nichtinvasives Verfahren zum sog. metabolischen "Imaging" des Bronchialkarzinoms.…”

Bone single photon emission computed tomography (SPECT) in a patient with Pancoast tumor: a case report

“…13,14 Furthermore, it has been shown that Tc-99m methoxy isobutyl isonitrile (MIBI) SPECT faithfully identifies not only the mediastinal lymph node metastases in patients with NSCLCs, 15 but also the chemotherapy response in both small-cell lung carcinoma (SCLC) 16 and NSCLCs. 17 The functional imaging mode of SPECT has a capability to visualize and measure molecular processes in vivo.…”