Seeking a Home for a PET, Part 2

Detterbeck, Frank C.; Falen, Steven; Rivera, M. Patricia; Halle, Jan; Socinski, Mark A.

doi:10.1378/chest.125.6.2300

Cited by 64 publications

(6 citation statements)

References 36 publications

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“…The sensitivity of 18 F-FDG PET/CT in lymph nodes greater than 1 cm is high, although the accuracy and specificity rates are low ( 19 ). In a study by Detterbeck et al ( 20 ), the false positive rate of PET in mediastinal lymph nodes was reported to be 13-22%, and the false negative rate as 5-8%. In our study, histopathologic lymph node evaluation was carried out in 21 of the 50 patients, and 52% of the 21 patients were correctly staged by 18 F-FDG PET/CT whereas the rate of patients incorrectly down-staged or up-staged by 18 F-FDG PET/CT were detected as 19% and 28%, respectively.…”

Section: Discussionmentioning

confidence: 98%

The Contribution of Fluorine 18F-FDG PET/CT to Lung Cancer Diagnosis, Staging and Treatment Planning

Budak

Çok

Akgün

2018

Mirt

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Objective:Lung cancer is the most common cause of cancer-related death throughout the world, and the correct choice of treatment based on early diagnosis and staging increases the chance of survival. The present study aims to investigate the contribution of fluorine 18-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) to the management of lung cancer.Methods:In this study, 50 patients who underwent 18F-FDG PET/CT for lung cancer diagnosis and staging between February 2012 and February 2014 were included. The maximum standardized uptake value (SUVmax) of the primary lung lesion along with other findings of 18F-FDG PET/CT and the results of histopathologic and conventional examinations were evaluated retrospectively. The mean survival time of patients was determined, and the findings were compared by using statistical methods.Results:Histopathologic examinations revealed 51 lung cancers in 50 patients. The sensitivity, accuracy and positive predictive value of 18F-FDG PET/CT in detecting primary malignancy were 94%, 94%, 100%, respectively. Adenocarcinoma (n=23, 16.8±13.5) and squamous cell carcinoma (n=15, 17.9±5.6) did not differ significantly regarding their mean SUVmax values (p=0.2). A statistically significant positive correlation (r=0.4) was identified between tumor size and SUVmax value for 51 tumors (p=0.002). The 18F-FDG PET/CT result was true negative in nine, false positive in six, true positive in two, and false negative in four patients who underwent histopathologic evaluation of their lymph nodes. The 18F-FDG PET/CT changed treatment planning in 34% of the patients. No significant relationship was identified between SUVmax value of the tumor and patient survival in patients (p=0.118).Conclusion:The present study concluded that PET/CT was an efficient method in the diagnosis and staging of lung cancer since it provided useful information in addition to conventional methods. It was also observed that PET/CT scanning resulted in a change in therapeutic plans in the majority of patients. However, there was no statistically significant relationship between survival and the SUVmax of the primary mass.

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Section: Discussionmentioning

confidence: 98%

The Contribution of Fluorine 18F-FDG PET/CT to Lung Cancer Diagnosis, Staging and Treatment Planning

Budak

Çok

Akgün

2018

Mirt

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“…Consequently, preoperative assessment of lymph node status is strategical to assess the proper treatment; N2 status may require neoadjuvant therapy or exclude surgery, while N1 status should guide the decision of upfront surgical resection, to be performed either with as VATS or open surgery. However, preoperative staging is still affected by high rates of false-positives or negatives due to the relatively low sensitivity and specificity of Chest Computed Tomography (CT) and 18-fluorodeoxyglucose-positron emission tomography (18-FDG-PET), and to the reduced use of preoperative invasive staging procedures such as mediastinoscopy and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) [42][43][44]. Cerfolio et al [45] reported that, when analyzing all clinical stage patients, 14% of them had unsuspected pN2 metastases.…”

Section: Unexpected N2mentioning

confidence: 99%

Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment

Brascia

Iaco

Schiavone

et al. 2020

Cancers

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Locally advanced non-small cell lung cancer accounts for one third of non-small cell lung cancer (NSCLC) at the time of initial diagnosis and presents with a wide range of clinical and pathological heterogeneity. To date, the combined multimodality approach involving both local and systemic control is the gold standard for these patients, since occult distant micrometastatic disease should always be suspected. With the rapid increase in treatment options, the need for an interdisciplinary discussion involving oncologists, surgeons, radiation oncologists and radiologists has become essential. Surgery should be recommended to patients with non-bulky, discrete, or single-level N2 involvement and be included in the multimodality treatment. Resectable stage IIIA patients have been the subject of a number of clinical trials and retrospective analysis, discussing the efficiency and survival benefits on patients treated with the available therapeutic approaches. However, most of them have some limitations due to their retrospective nature, lack of exact pretreatment staging, and the involvement of heterogeneous populations leading to the awareness that each patient should undergo a tailored therapy in light of the nature of his tumor, its extension and his performance status.

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“…While a full discussion of this debate is beyond the scope of this review, we believe that use of PET is reasonable in selected high-risk patients, including patients with primary tumors that are large, centrally-located or adenocarcinoma by histology, as well as patients with hilar nodal enlargement [26, 27]. However, because these are situations in which the likelihood of malignant mediastinal lymph node involvement is actually increased, many would argue that tissue sampling is mandatory in these patients, and that PET is therefore superfluous except for the potential to more specifically direct mediastinal biopsies or evaluate for distant metastasis.…”

Section: Initial Stagingmentioning

confidence: 99%

The Use and Misuse of Positron Emission Tomography in Lung Cancer Evaluation

Chang

Rashtian

Gould

2011

Clinics in Chest Medicine

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Synopsis Positron emission tomography (PET) has been studied for a variety of indications in patients with known or suspected non-small cell lung cancer (NSCLC). In this review, we discuss the potential benefits and limitations of PET for characterizing lung nodules, staging the mediastinum, identifying occult distant metastasis, determining prognosis and treatment response, guiding plans for radiation therapy, restaging during and after treatment, and selecting targets for tissue sampling. (Table 1) Evidence from randomized, controlled trials supports the use of PET for initial staging in NSCLC, while lower quality evidence from studies of diagnostic accuracy and modeling studies supports the use of PET for characterizing lung nodules. For most other indications in NSCLC, additional studies are required to clarify the role of PET and determine who is most likely to benefit.

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Seeking a Home for a PET, Part 2

Cited by 64 publications

References 36 publications

The Contribution of Fluorine 18F-FDG PET/CT to Lung Cancer Diagnosis, Staging and Treatment Planning

The Contribution of Fluorine 18F-FDG PET/CT to Lung Cancer Diagnosis, Staging and Treatment Planning

Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment

The Use and Misuse of Positron Emission Tomography in Lung Cancer Evaluation

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