Value of whole-body FDG PET in management of lung cancer

Abstract

18F-fluorodeoxyglucose (FDG) PET imaging provides physiologic and metabolic information that characterizes lesions that are indeterminate by CT. FDG PET imaging is sensitive to the detection of lung cancer in patients who have indeterminate lesions on CT, whereas low grade malignancy such as bronchioloalveolar carcinoma and carcinoid may be negative on FDG PET. The specificity of PET imaging is less than its sensitivity because some inflammatory processes, such as active granulomatous infections, avidly accumulate FDG. This possibility should be kept in mind in the analysis of PET studies of glucose metabolism aimed at differentiating malignant from benign solitary pulmonary nodules. FDG uptake is considered to be a good marker of cell differentiation, proliferative potential, aggressiveness, and the grade of malignancy in patients with lung cancer. FDG PET accurately stages the distribution of lung cancer. Several studies have documented the increased accuracy of PET compared with CT in the evaluation of the hilar and mediastinal lymphnode status in patients with lung cancer. Whole-body PET studies detect metastatic disease that is unsuspected by conventional imaging. Management changes have been reported in up to 41% of patients on the basis of the results of whole-body studies. Whole-body FDG PET is also useful for the detection of recurrence. Several studies have indicated that the degree of FDG uptake in primary lung cancer can be used as an independent prognostic factor. Thus, whole-body FDG PET is clinically very useful in the management of lung cancer.

High incidence of thyroid cancer in focal thyroid incidentaloma detected by 18F-fluorodexyglucose positron emission tomography in relatively young healthy subjects: results of 3-year follow-up

“…Although SUVmax is used as a semiquantitative indicator of FDG uptake, it is known to be influenced by various factors. For example, SUVmax correlates positively with the proliferation ability of malignant tumors as well as the GLUT expression that relates critically to FDG uptake [19,20]. Increased blood flow and inflammation increase FDG uptake and therefore SUVmax [15].…”

Quantitative Accuracy and Lesion Detectability of Low-Dose 18F-FDG PET for Lung Cancer Screening

“…Hence, recent work has focused on potential screening applications of the combined modality PET/CT in high-risk groups (8). Currently, PET/CT is used clinically for staging (9,10), monitoring treatment response (11)(12)(13), and long-surveillance (14,15). The application of this hybrid modality as a screening tool, whereby subjects are scanned annually, would need low-dose alternatives to current scanning protocols (16)(17)(18)(19).…”

Evaluation of Dual–Time-Point 18F-FDG PET for Staging in Patients with Lung Cancer

“…Precise diagnosis of the patient's stage of lung cancer is important for determining prognosis and treatment options. 18 F-FDG PET, which is increasingly used for diagnosing, staging, and determining the type of lung cancer (1)(2)(3), can obtain images that reflect physiologic and biochemical function and is therefore useful in the differential diagnosis of benign and malignant lesions (4)(5)(6). However, there are numerous causes of 18 F-FDG uptake in benign processes (7,8), and this nonspecific uptake is a potential source of false-positive results in 18 F-FDG PET (3,9,10) even when PET/CT is also used (11)(12)(13).…”