The role of positron emission tomography in the diagnosis, staging and response assessment of non-small cell lung cancer

Abstract

Lung cancer is a common disease and the leading cause of cancer-related mortality, with non-small cell lung cancer (NSCLC) accounting for the majority of cases. Following diagnosis of lung cancer, accurate staging is essential to guide clinical management and inform prognosis. Positron emission tomography (PET) in conjunction with computed tomography (CT)-as PET-CT has developed as an important tool in the multi-disciplinary management of lung cancer. This article will review the current evidence for the role of F-fluorodeoxyglucose (FDG) PET-CT in NSCLC diagnosis, staging, response assessment and follow up.

PET/CT implication on bronchogenic carcinoma TNM staging and follow-up using RECIST/PERCIST criteria: a comparative study with CT

“…Four cases of our study showed changing in their TNM staging due to the difference in diagnosis of the nature of pulmonary nodules. The ability of PET/CT to differentiate the benign from the malignant nodules affects both T and M staging, and this is consistent with Volpi et al who discussed the accuracy of PET/CT in differentiating the benign nodules from a malignant one [6].…”

“…PET/CT is a known modality to detect the malignant activity in the mediastinal lymph nodes more accurately compared to the CT which depends only on the nodal size with the accuracy reaching to about 90% in the diagnosis of malignant mediastinal lymphadenopathy [6,11,27].…”

“…Valopi et al stated that patients with negative mediastinal lymph nodes on PET/ CT can proceed to their management, according to the rest of T and M staging while the patients with positive nodal lesions may need further assessment via biopsy using mediastinoscopy for accurate histopathological verification avoiding false-positive results [7]. PET/CT is a known modality to detect the hidden bone marrow infiltrates being more accurate than CT and even bone scan to detect bony metastases, which are a common site for metastases in cases with bronchogenic carcinoma [6,11,27,30]. Ten percent of patients with bronchogenic carcinoma found to have positive distant metastases by PET/CT not detected by CT alone [27].…”

“…Patients with stage I are suitable for lobectomy or pneumonectomy while stage II patients are treated surgically followed by adjuvant chemotherapy. Patients with stage IIIA receive chemotherapy and radiotherapy followed by surgery if downstaging occurred while for patients with stage IIIB or IV, the surgery has no role in their treatment [6].…”

Functional consequence of PSAT1 association on PKM2's inherent enzymatic activity.

“…However, the fluorine inhibits the cell from metabolizing phosphorylated FDG past this step [3][4][5]. PET imaging is then able to detect the radioisotopic fluorine accumulating in tissues [2,6]. As one of the hallmarks of cancer is increased glucose metabolism, this procedure allows for diagnostic imaging in cancer patients [7,8].…”