Integrated PET/CT in the staging of nonsmall cell lung cancer: technical aspects and clinical integration

Abstract

Lung cancer is a common disease and is a leading cause of death in many countries. The management of lung cancer is directed by an optimal staging of the tumour. Integrated positron emission tomography (PET)/computed tomography (CT) is an anatomo-metabolic imaging modality that has recently been introduced to clinical practice and combines two different techniques: CT, which provides very detailed anatomic information; and PET, which provides metabolic information. One of the advantages of PET/CT is the improved image interpretation. This improvement can result in the detection of lesions initially not seen on CT or PET, a more precise location of lesions, a better characterisation of the lesion as benign or malignant and a better differentiation between tumour and surrounding structures. Initial studies demonstrate better results for PET/CT in the staging of lung cancer in comparison with PET alone, CT alone or visual correlation of PET and CT. The purpose of the present article is to discuss technical aspects of integrated PET/CT and to attempt to outline how to introduce integrated PET/ CT in clinical and daily practice.

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

“…5 When one considers that more than 200,000 new cases of non-small cell lung cancer (NSCLC) alone are diagnosed in the United States annually and up to 20% of these patients have adrenal gland lesions, minimally invasive urologists will increasingly be called on to evaluate and potentially operate on patients with suspicious PET/CT adrenal findings. [2][3][4] This review examines two cases of NSCLC with positive adrenal PET/CT, summarizes the existing literature, explains the possible causes for false-positive PET findings, and provides a treatment algorithm that may be helpful in PET/CT interpretation and in decision making.…”

“…[1][2][3][4] These recommendations have evolved because of FDG-PET/CT's ability to integrate both anatomic and functional assessments of potential metastasis, improving not only staging accuracy but also surveillance and restaging accuracy for a variety of cancer types. 5 When one considers that more than 200,000 new cases of non-small cell lung cancer (NSCLC) alone are diagnosed in the United States annually and up to 20% of these patients have adrenal gland lesions, minimally invasive urologists will increasingly be called on to evaluate and potentially operate on patients with suspicious PET/CT adrenal findings.…”

Integrated positron emission tomography/computed tomography for evaluation of mediastinal lymph node staging of non-small-cell lung cancer in a tuberculosis-endemic area: A 5-year prospective observational study

“…[8] Developing regions, particularly high tuberculosis (TB)-endemic areas, face the potential challenge of interpreting PET-CT images as false positive in TB-involved lymph nodes. [2,5,9,10] The effect of TB on PET-CT staging of NSCLC has previously been investigated in areas with an incidence of TB of approximately 73/100 000 population. [5,11,12] Two studies from Korea showed that the sensitivity (75% and 46%, respectively) and PPV (27% and 72%) of PET-CT were adversely affected, but that a high specificity (85% and 98%) and NPV (98% in both studies) were maintained, especially when calcification and attenuation of nodes on CT was taken into account.…”

“…[1] Non-small-cell lung cancer (NSCLC) comprises 75 -80% of lung cancer cases. [2] Determining mediastinal lymph node involvement is fundamental in the staging of NSCLC and has been shown to have prognostic significance. [3] The node (N) stage determines the treatment strategy, as patients with N2 lymph node metastasis are considered inoperable and only selected patients with this stage are eligible for chemotherapy and/or radiotherapy with curative intent.…”

“…[4,5] At present, integrated positron emission tomography/computed tomography (PET-CT) is recognised as being superior to PET alone, CT alone, or visual comparison of PET and CT images for the assessment of mediastinal lymph node involvement in NSCLC, [6] with an average sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 73%, 80%, 78% and 91%, respectively. [2] This imaging modality has been available in the Western world since the 1990s, forming an integral part of mediastinal lymph node staging in those regions, [7] but has only recently become standard practice in South Africa (SA). It has been suggested that negative PET-CT for mediastinal lymph node involvement requires no further invasive staging and surgical resection may proceed.…”