The Role of Positron Emission Tomography–Computed Tomography in the Workup of Non–Small Cell Lung Cancer

Abstract

Non-small cell lung cancer (NSCLC) remains a significant global health burden and is a leading cause of cancer-related death. The correct staging of patients with NSCLC is a key step in selecting an adequate treatment regimen, and combined positron emission tomography-computed tomography (PET-CT) with fluorine 18-labeled fluorodeoxyglucose (FDG) is increasingly used for staging and treatment monitoring of patients with NSCLC. The principal strengths of PET-CT with FDG in staging NSCLC include the assessment of intrathoracic lymph nodes and the detection of unanticipated stage IV disease. However, data on the effects of PET-CT with FDG on cancer-related mortality in NSCLC remain sparse.The article by Vella et al 1 aims to provide such data on cancer-related mortality. The authors examined the association of the use of PET-CT with NSCLC mortality in 64 103 patients treated in the US Department of Veterans Affairs from 2000 to 2013. They found that PET-CT use increased over this 13-year period, while mortality decreased. 1 Vella et al 1 concluded that PET-CT was associated with both a higher level of care and decreased mortality for veterans with NSCLC.To appreciate the contribution of this study in the context of the existing body of literature, it is worthwhile to summarize its main strengths and limitations. Strengths of the study by Vella et al 1 include a highly relevant research question, ie, the association of PET-CT with survival in one of the most frequent cancers today; a large patient number; and the choice of survival as the main clinical end point, which is arguably the most relevant clinical outcome in oncology.As does every study, the study by Vella et al 1 has limitations, which are openly discussed in the article. An association such as that shown in the study does not prove or even indicate a causal Open Access. This is an open access article distributed under the terms of the CC-BY License.