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Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer.

Cuaron J, Dunphy M, Rimner A - Front Oncol (2013)

Bottom Line: FDG-PET sensitivity is decreased in tumors <1 cm, at least in part due to respiratory motion.False-negative results can occur in areas of low tumor burden, e.g., small lymph nodes or ground-glass opacities. (18)F-FDG-PET-CT nodal staging is more accurate than CT alone, as hilar and mediastinal involvement is often detected first on (18)F-FDG-PET scan when CT criteria for malignant involvement are not met. (18)F-FDG-PET scans have widely replaced bone scintography for assessing distant metastases, except for the brain, which still warrants dedicated brain imaging. (18)F-FDG uptake has also been shown to vary between histologies, with adenocarcinomas generally being less FDG avid than squamous cell carcinomas. (18)F-FDG-PET scans are useful to detect recurrences, but are currently not recommended for routine follow-up.Further work is underway to identify subsets of patients that might benefit individualized management based on FDG-PET.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center New York, NY, USA.

ABSTRACT
The integral role of positron-emission tomography (PET) using the glucose analog tracer fluorine-18 fluorodeoxyglucose (FDG) in the staging of non-small cell lung cancer (NSCLC) is well established. Evidence is emerging for the role of PET in response assessment to neoadjuvant therapy, combined-modality therapy, and early detection of recurrence. Here, we review the current literature on these aspects of PET in the management of NSCLC. FDG-PET, particularly integrated (18)F-FDG-PET/CT, scans have become a standard test in the staging of local tumor extent, mediastinal lymph node involvement, and distant metastatic disease in NSCLC. (18)F-FDG-PET sensitivity is generally superior to computed tomography (CT) scans alone. Local tumor extent and T stage can be more accurately determined with FDG-PET in certain cases, especially in areas of post-obstructive atelectasis or low CT density variation. FDG-PET sensitivity is decreased in tumors <1 cm, at least in part due to respiratory motion. False-negative results can occur in areas of low tumor burden, e.g., small lymph nodes or ground-glass opacities. (18)F-FDG-PET-CT nodal staging is more accurate than CT alone, as hilar and mediastinal involvement is often detected first on (18)F-FDG-PET scan when CT criteria for malignant involvement are not met. (18)F-FDG-PET scans have widely replaced bone scintography for assessing distant metastases, except for the brain, which still warrants dedicated brain imaging. (18)F-FDG uptake has also been shown to vary between histologies, with adenocarcinomas generally being less FDG avid than squamous cell carcinomas. (18)F-FDG-PET scans are useful to detect recurrences, but are currently not recommended for routine follow-up. Typically, patients are followed with chest CT scans every 3-6 months, using (18)F-FDG-PET to evaluate equivocal CT findings. As high (18)F-FDG uptake can occur in infectious, inflammatory, and other non-neoplastic conditions, (18)F-FDG-PET-positive findings require pathological confirmation in most cases. There is increased interest in the prognostic and predictive role of FDG-PET scans. Studies show that absence of metabolic response to neoadjuvant therapy correlates with poor pathologic response, and a favorable (18)F-FDG-PET response appears to be associated with improved survival. Further work is underway to identify subsets of patients that might benefit individualized management based on FDG-PET.

No MeSH data available.


Related in: MedlinePlus

Eighty-two-year-old female with growing right lung nodule. Prior lung CT scans over a 1-year period had demonstrated increasing size of a spiculated-appearing right lung nodule (white arrow). FDG-PET/CT was performed for nodule characterization. Images show corresponding transaxial planes through the chest from the CT and FDG PET (upper right); and a 3D maximum intensity projection imaged centered on the chest region (center image). PET showed detectable, albeit minimal, activity in the right lung nodule (black arrows; SUVmax 2.1) and focal activity in the right pulmonary hilum (arrowhead) thought to represent lymph node FDG uptake. Wedge resection was performed; pathology found focal bronchopneumonia/granuloma.
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Figure 2: Eighty-two-year-old female with growing right lung nodule. Prior lung CT scans over a 1-year period had demonstrated increasing size of a spiculated-appearing right lung nodule (white arrow). FDG-PET/CT was performed for nodule characterization. Images show corresponding transaxial planes through the chest from the CT and FDG PET (upper right); and a 3D maximum intensity projection imaged centered on the chest region (center image). PET showed detectable, albeit minimal, activity in the right lung nodule (black arrows; SUVmax 2.1) and focal activity in the right pulmonary hilum (arrowhead) thought to represent lymph node FDG uptake. Wedge resection was performed; pathology found focal bronchopneumonia/granuloma.

Mentions: Toba et al. (2010) showed the positive predictive value (PPV) of FDG-PET to be significantly lower with lesions <1 cm in size compared with larger lesions (0.36 vs 0.90, p = 0.015). The lower PPV of smaller lesions reflects a higher rate of falsely positive FDG-PET scans. An example of a false-positive lung nodule is shown in Figure 2.


Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer.

Cuaron J, Dunphy M, Rimner A - Front Oncol (2013)

Eighty-two-year-old female with growing right lung nodule. Prior lung CT scans over a 1-year period had demonstrated increasing size of a spiculated-appearing right lung nodule (white arrow). FDG-PET/CT was performed for nodule characterization. Images show corresponding transaxial planes through the chest from the CT and FDG PET (upper right); and a 3D maximum intensity projection imaged centered on the chest region (center image). PET showed detectable, albeit minimal, activity in the right lung nodule (black arrows; SUVmax 2.1) and focal activity in the right pulmonary hilum (arrowhead) thought to represent lymph node FDG uptake. Wedge resection was performed; pathology found focal bronchopneumonia/granuloma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539654&req=5

Figure 2: Eighty-two-year-old female with growing right lung nodule. Prior lung CT scans over a 1-year period had demonstrated increasing size of a spiculated-appearing right lung nodule (white arrow). FDG-PET/CT was performed for nodule characterization. Images show corresponding transaxial planes through the chest from the CT and FDG PET (upper right); and a 3D maximum intensity projection imaged centered on the chest region (center image). PET showed detectable, albeit minimal, activity in the right lung nodule (black arrows; SUVmax 2.1) and focal activity in the right pulmonary hilum (arrowhead) thought to represent lymph node FDG uptake. Wedge resection was performed; pathology found focal bronchopneumonia/granuloma.
Mentions: Toba et al. (2010) showed the positive predictive value (PPV) of FDG-PET to be significantly lower with lesions <1 cm in size compared with larger lesions (0.36 vs 0.90, p = 0.015). The lower PPV of smaller lesions reflects a higher rate of falsely positive FDG-PET scans. An example of a false-positive lung nodule is shown in Figure 2.

Bottom Line: FDG-PET sensitivity is decreased in tumors <1 cm, at least in part due to respiratory motion.False-negative results can occur in areas of low tumor burden, e.g., small lymph nodes or ground-glass opacities. (18)F-FDG-PET-CT nodal staging is more accurate than CT alone, as hilar and mediastinal involvement is often detected first on (18)F-FDG-PET scan when CT criteria for malignant involvement are not met. (18)F-FDG-PET scans have widely replaced bone scintography for assessing distant metastases, except for the brain, which still warrants dedicated brain imaging. (18)F-FDG uptake has also been shown to vary between histologies, with adenocarcinomas generally being less FDG avid than squamous cell carcinomas. (18)F-FDG-PET scans are useful to detect recurrences, but are currently not recommended for routine follow-up.Further work is underway to identify subsets of patients that might benefit individualized management based on FDG-PET.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center New York, NY, USA.

ABSTRACT
The integral role of positron-emission tomography (PET) using the glucose analog tracer fluorine-18 fluorodeoxyglucose (FDG) in the staging of non-small cell lung cancer (NSCLC) is well established. Evidence is emerging for the role of PET in response assessment to neoadjuvant therapy, combined-modality therapy, and early detection of recurrence. Here, we review the current literature on these aspects of PET in the management of NSCLC. FDG-PET, particularly integrated (18)F-FDG-PET/CT, scans have become a standard test in the staging of local tumor extent, mediastinal lymph node involvement, and distant metastatic disease in NSCLC. (18)F-FDG-PET sensitivity is generally superior to computed tomography (CT) scans alone. Local tumor extent and T stage can be more accurately determined with FDG-PET in certain cases, especially in areas of post-obstructive atelectasis or low CT density variation. FDG-PET sensitivity is decreased in tumors <1 cm, at least in part due to respiratory motion. False-negative results can occur in areas of low tumor burden, e.g., small lymph nodes or ground-glass opacities. (18)F-FDG-PET-CT nodal staging is more accurate than CT alone, as hilar and mediastinal involvement is often detected first on (18)F-FDG-PET scan when CT criteria for malignant involvement are not met. (18)F-FDG-PET scans have widely replaced bone scintography for assessing distant metastases, except for the brain, which still warrants dedicated brain imaging. (18)F-FDG uptake has also been shown to vary between histologies, with adenocarcinomas generally being less FDG avid than squamous cell carcinomas. (18)F-FDG-PET scans are useful to detect recurrences, but are currently not recommended for routine follow-up. Typically, patients are followed with chest CT scans every 3-6 months, using (18)F-FDG-PET to evaluate equivocal CT findings. As high (18)F-FDG uptake can occur in infectious, inflammatory, and other non-neoplastic conditions, (18)F-FDG-PET-positive findings require pathological confirmation in most cases. There is increased interest in the prognostic and predictive role of FDG-PET scans. Studies show that absence of metabolic response to neoadjuvant therapy correlates with poor pathologic response, and a favorable (18)F-FDG-PET response appears to be associated with improved survival. Further work is underway to identify subsets of patients that might benefit individualized management based on FDG-PET.

No MeSH data available.


Related in: MedlinePlus