PET-CT in Clinical Adult Oncology: II. Primary Thoracic and Breast Malignancies

Abstract

Positron emission tomography combined with x-ray computed tomography (PET-CT) is an advanced imaging modality with oncologic applications that include staging, therapy assessment, restaging, and surveillance. This six-part series of review articles provides practical information to providers and imaging professionals regarding the best use of PET-CT for the more common adult malignancies. The second article of this series addresses primary thoracic malignancy and breast cancer. For primary thoracic malignancy, the focus will be on lung cancer, malignant pleural mesothelioma, thymoma, and thymic carcinoma, with an emphasis on the use of FDG PET-CT. For breast cancer, the various histologic subtypes will be addressed, and will include 18F fluorodeoxyglucose (FDG), recently Food and Drug Administration (FDA)-approved 18F-fluoroestradiol (FES), and 18F sodium fluoride (NaF). The pitfalls and nuances of PET-CT in breast and primary thoracic malignancies and the imaging features that distinguish between subcategories of these tumors are addressed. This review will serve as a resource for the appropriate roles and limitations of PET-CT in the clinical management of patients with breast and primary thoracic malignancies for healthcare professionals caring for adult patients with these cancers. It also serves as a practical guide for imaging providers, including radiologists, nuclear medicine physicians, and their trainees.

Mediastinal Rosai-Dorfman Disease with KRAS mutation case report and literature review

“…PET-CT may offer improved insights into RDD indications. In a study by Jia et al [ 11 ], a patient with anterior mediastinal RDD exhibited abnormally high FDG uptake (SUVmax 8.96) on PET/CT, surpassing the average metabolic activity of thymic hyperplasia (SUVmax 1.1), thymoma (SUVmax 2.3) and thymic carcinoma (SUVmax 7.0) [ 28 ]. Notably, two reports by Agarwal et al [ 6 ] and Furia et al [ 21 ] recorded even higher SUVmax values at 34.0 and 35.0, indicating a potential reference value for PET-CT in RDD diagnosis.…”

Diagnosis and management of patients with stage III non‑small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review)

“…According to international recommendations, a low-dose chest computerized tomography (CT) scan is the preferred tool for lung tumor detection (1,18). For lung nodules, a CT scan or PET/CT scan of the chest and abdomen using the glucose analogue 18 fluorodeoxyglucose ( 18 F-FDG) with intravenous contrast will confirm the diagnosis of a lung tumor, inform on the number of masses, the size of the primary tumor, the degree of invasion of the mediastinum and chest wall, as well as on the presence of abdominal lesions (19). The patient should then undergo pathological analyses to determine the exact type of lung cancer, followed by clinical staging.…”

Dosimetric comparison of nodal clinical target volume for locally advanced non‑small cell lung cancer: Options for geometric expansion vs. lymph node stations

“…NSCLC was a heterogeneous disease invading the lung and adjacent tissues, eventually progressing and spreading to distant sites (3). A computed tomographic (CT) scan and a positron emission tomographic scan using 18 F-fluorodeoxyglucose was used for the staging of NSCLC (3,4). Whilst chances for a complete remission or a cure were highest in early-stage cancers, survival rates decreased when the cancer was locally advanced (3,5).…”

“…Stations 2,3,4,5,6,7,10,and 11 were involved in 6, 4, 11, 4, 4, 7, 12, and 12 patients, respectively (TableII). The DVH parameters between the two options are listed in TableIII, and the target coverage of PTV…”