Impact of 18F-FDG PET/CT in Staging Patients With Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Abstract

Background: Molecular imaging methods are currently used in the management of patients with lung cancer. Compared to non-small cell lung cancer, less data are available about the impact of molecular imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) in staging patients with small cell lung cancer (SCLC). Performing a systematic review and meta-analysis, we aimed to provide quantitative data about the impact of 18 F-FDG PET/CT in staging SCLC. Methods: A comprehensive literature search of studies on the use of 18 F-FDG PET/CT in patients with SCLC was performed. Three different databases were screened (PubMed/MEDLINE, EMBASE, and Cochrane library databases) until June 2019. Only articles describing the impact of 18 F-FDG PET/CT in staging patients with SCLC were selected. A pooled analysis evaluating the change of binary SCLC staging (limited-stage vs. extensive-stage disease) using 18 F-FDG PET/CT was carried out. Results: Nine articles including 721 patients with SCLC were included in the systematic review. Compared to conventional staging, a superior diagnostic accuracy of 18 F-FDG PET/CT was found. A change of binary SCLC staging using 18 F-FDG PET/CT was demonstrated in 15% (95% confidence interval, 9-21%) of patients with SCLC. Currently, it is not clearly demonstrated that the use of 18 F-FDG PET/CT for staging may improve the survival outcome of patients with SCLC. Conclusions: 18 F-FDG PET/CT is a useful molecular imaging method for staging patients with SCLC because it can change the management in a significant number of patients. More large prospective studies and cost-effectiveness analyses on the impact of 18 F-FDG PET/CT in staging patients with SCLC are needed.

Quantitative FDG PET Assessment for Oncology Therapy

“…Volumetric parameters (MTV and TLG) have been confirmed as relevant for identifying patients with a higher risk of postsurgical disease progression who could receive early therapeutic intervention to improve their prognosis [ 83 ]. Similar meta-analysis was reported and indicated prognostic value of quantitative FDG uptake parameters in non-small cell lung cancer [ 84 ] and uterine cervical cancer [ 85 ].…”

Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up☆

“…The use of FDGePET is still debated in SCLC; a review of small prospective series showed that 9% of patients were upstaged with FDGePET and 4% were downstaged. 13 In the majority of these series, pathological confirmation of metastatic sites was not obtained. As false-positive results have been reported using FDGePET, the presence of a metastasis should be pathologically confirmed if it alters the treatment plan [II, C].…”

Undesirable Status of Prostate Cancer Cells after Intensive Inhibition of AR Signaling: Post-AR Era of CRPC Treatment

“…Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is useful for SCLC staging because the detection rate of primary and metastatic lesions is very high due to the strong FDG accumulation [ 94 ]. Identifying NEPC, specifically by PET/CT, is difficult although PET/CT is also useful in detecting metastases in NEPC [ 95 ].…”