Diagnostic value of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography for the detection of metastases in non–small‐cell lung cancer patients

Abstract

In the recent years, fluorine 18 fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) has emerged as a new modality for staging non-small-cell lung cancer (NSCLC) patients. The aim of this meta-analysis was to assess the diagnostic value of 18 F-FDG PET/CT in detecting metastatic lesions in NSCLC patients. Meta-analysis methods were used to pool sensitivity, specificity, positive and negative likehood ratios, diagnostic odd ratios and to construct a summary receiver-operating characteristic curve. Data from included studies were pooled to compare the diagnostic accuracy between PET/CT and PET or CT alone in nodal staging. Totally, 56 studies involving 8,699 patients met the inclusion criteria. Lung cancer is the leading cause of tumor-related deaths worldwide, and non-small-cell lung cancer (NSCLC) accounts for about 80% of all lung cancers. 1 The current criteria for staging NSCLC is based on the TNM system, 2 which determines treatment options and predicts survival. 3 So, staging NSCLC is important, and accurate clinical methods are in great need. Various diagnostic methods have been used for staging NSCLC. [4][5][6][7] Computed tomography (CT) has been widely used to evaluate the nodal status of lung cancer based on the size or shape of the lymph nodes. 8 However, the sensitivity and the specificity were relatively low, because the lymph node size may not correlate with the presence of metastatic disease. 9 Based on the fact that malignant cells show higher rates of glycolysis than most surrounding normal structures, 10 fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has been introduced and developed as an effective modality for tumor staging in a variety of cancers. 11 However, PET has relatively poor spatial resolution, thus limits its anatomical localization of lesions. 12 Mediastinoscopy, endobronchial and endoscopic ultrasound, and other surgical procedures are frequently used for thoracic nodal evaluation in lung cancer, but these techniques are invasive and cumbersome. 7,13 In the past recent years, 18 F-FDG PET/CT has emerged as a new modality for staging NSCLC patients. 4,14 The aim of this study was to evaluate the diagnostic accuracy of 18 F-FDG PET/CT in detecting metastases in NSCLC patients. Material and Methods Selection criteriaSelection criteria were given as follows: (1) 18 F-FDG PET/CT was used for the evaluation of lymph node (LN) metastases or extrapulmonary metastases in NSCLC; (2) histologic assessment should be applied as reference standard for LN metastases; for studies evaluated extrathoracic metastases, other reference standards such as imaging modality, radiological and clinical follow-up were also applied; (3) absolute numbers of true-positive (TP), false-positive (FP), true-

Diagnostic Value of18F-FDG PET/CT in Comparison to Bone Scintigraphy, CT and18F-FDG PET for the Detection of Bone Metastasis

“…With tracer accumulation 18 F-FDG PET visualizes regions of enhanced metabolic activity and complements other imaging modalities based on structural anatomic changes (Wu et al, 2013). 18 F-FDG PET had a better performance in esophagus, thyroid, nasopharyngeal and lung carcinoma (Kato et al, 2005;Shinji et al, 2007;Liu et al, 2010;Chang et al, 2013) when compared with the isotope BS.…”

Second-Line Chemotherapy in Advanced Non-Small Cell Lung Cancer (NSCLC): Single Institution Experience

“…Some studies showed no difference in time to progression and OS between younger and elder patients (>70years) 12,13 . Others obtained a higher risk of death in patients aged 65 and older ones 14,15 .…”

Whole body PET-CT: M staging in non small- cell lung cancer

“…In a recent meta-analysis including 13 studies and 2873 patients, sensitivity and specificity of PET-CT in the detection of extrathoracic metastases were estimated respectively to 77 and 95% (18). These numbers include the detection of brain metastases, were there is a known lack of sensitivity du to the high physiological uptake of FDG in the cerebral cortex.…”

“…PET imaging is based on positron-emitters such as 18 F, 15 O or 82 Rb, among others. The annihilation of the positron emitted leads to the emission of two 180°-sided 511 kev photons, detected by a full crystal ring (5).…”

“…Radiochemistry and radiopharmacy both represents an important prerequisite to molecular imaging, as they allow the incorporation of the positron emitter in a chemical structure suitable for injection and further, to the analysis of a precise physiological pathway. Integrated in glucose (as 18 F-fluorodeoxyglucose, FDG), fluorine-18 allows the metabolic imaging of increased glucose metabolism (6) -or its reduction or absence (in therapy monitoring, in cysts or in particular epilepsy indications).…”