Seeking a Home for a PET, Part 1

Detterbeck, Frank C.; Falen, Steven; Rivera, M. Patricia; Halle, Jan; Socinski, Mark A.

doi:10.1378/chest.125.6.2294

Cited by 58 publications

(5 citation statements)

References 22 publications

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“…PET/CT not only has potential for uncovering the malignancy, but also has other roles in patient management, such as staging, evaluation of a response to therapy and detection of recurrence. The results of PET scanning also often determine further approach to the management to SPN [5,47]. PET imaging appears to be the best evaluation method for patients with low or intermediate pretest probability for malignancy and the nodule with diameter of 10 mm or more.…”

Section: Pet/ct Scanningmentioning

confidence: 99%

Evaluation of Solitary Pulmonary Nodule Detected During Computed Tomography Examination

Choromańska

Macura

2012

Pol J Radiol

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SummaryThe solitary pulmonary nodule (SPN) has always been a diagnostic challenge for the radiologists. Currently, with increased utilization of computed tomography (CT) greater number of nodules is being discovered, with numerous indeterminate lesions, which frequently cannot be immediately classified into benign or malignant category.In this article we review the imaging features of benign and malignant round opacities; we demonstrate currently used standards and also more advanced techniques that are helpful in evaluating SPNs such as contrast-enhanced CT, PET/CT imaging and also pathologic sampling with biopsy or surgical resection.We also summarize the methods of evaluating and managing SPNs based on the latest guidelines from the Fleischner Society and American College of Chest Physicians.

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Section: Pet/ct Scanningmentioning

confidence: 99%

Evaluation of Solitary Pulmonary Nodule Detected During Computed Tomography Examination

Choromańska

Macura

2012

Pol J Radiol

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“…This result stresses the importance of a careful selection of patients when offering PET for diagnosis of pulmonary nodules; the usefulness of a PET scan in patients with very small nodules, GGO or ongoing infection can be limited. Furthermore, the pre-test possibility of cancer, depending on patient history (e.g., smoking, age, sex, previous malignancy), determines the possible diagnostic gain of using PET [40]. This diagnostic gain can be calculated by means of the positive and negative likelihood ratio (LR+ and LR–); a diagnostic test with a large LR+ or a small LR– is important, since such a test results in large changes in our belief in the diagnosis from before to after the test [41].…”

Section: Diagnosismentioning

confidence: 99%

The Future in Diagnosis and Staging of Lung Cancer: Positron Emission Tomography

Fischer

Mortensen²

2006

Respiration

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Since its introduction in 1974, positron emission tomography (PET) has gained widespread use, especially in diagnosis and staging of lung cancer. In this respect, ¹⁸F-fluorodeoxyglucose (FDG) is by far the most used PET tracer exploiting the increased glucose uptake and metabolism in malignant cells. A large number of studies have suggested that addition of FDG-PET to conventional workup can improve diagnosis and staging in patients with non-small cell lung cancer (NSCLC). In meta-analysis, the sensitivity and specificity of PET in diagnosing single pulmonary nodules and masses is found to be 96 and 78%, respectively. In mediastinal staging, the sensitivity and specificity of PET is estimated to be 83 and 92%. In order to achieve high diagnostic values from PET, it is necessary to pay attention to a number of pitfalls, e.g., the uptake of FDG by inflammatory cells causing false-positive results, as well as size and histology of the tumour in order to avoid false-negative results. In 2001, the first integrated PET/computed tomography (CT) was installed, and since then, the use of this modality has expanded steadily, thereby decreasing examination time and overcoming the lack of anatomical details on PET. Recently, PET and PET/CT have become increasingly integrated in therapy planning and evaluation: response evaluation during and after chemotherapy, restaging after neoadjuvant therapy, planning of radiotherapy and detection of recurrent disease are all examples of emerging indications for PET and PET/CT in managing patients with lung cancer.

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“…Inflammatory nodes, granulomas, and tuberculosis account for the false-positive cases, particularly in endemic countries like India, where the false-positive rate can go up to 65%. 10 Low-grade tumors like adenocarcinoma in situ are responsible for the false-negative results on PET-CT. 11 12 Thus, after the initial staging PET-CT, findings need to be confirmed with cytological or histological proof of the mediastinal nodes. Some authors believe PET-CT is sufficient and can obviate the need for biopsy.…”

Section: Noninvasive Mediastinal Stagingmentioning

confidence: 99%

Controversies in Mediastinal Staging for Nonsmall Cell Lung Cancer

Ashok

Jiwnani

Karimundackal

et al. 2021

Indian J Med Paediatr Oncol

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Mediastinal lymph nodal involvement in nonsmall cell lung cancer plays a crucial role in deciding treatment strategy. Survival falls markedly with increasing involvement of mediastinal nodal stations. Hence, accurate staging of the mediastinum with lowest morbidity is of utmost importance. A wide array of invasive and noninvasive modalities that complement each other in assessing the nodes are available at our disposal. Guidelines recommend noninvasive imaging as the initial step in the staging algorithm for all tumors, followed by invasive staging. No single modality has proven to be the ideal method to stage the mediastinum when used alone. In the present decade, minimally invasive endobronchial ultrasound (EBUS) has challenged the position of surgical mediastinoscopy, which has been the gold standard, historically. However, a negative EBUS needs to be confirmed by surgical mediastinoscopy. Video-assisted mediastinoscopic lymphadenectomy has also come to the forefront in last two decades and has shown exceptional results, when performed in experienced centers. This review details the various modalities of mediastinal staging and the controversies surrounding the optimal method of staging, restaging after neoadjuvant therapy, and the most cost-effective strategy.

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Seeking a Home for a PET, Part 1

Cited by 58 publications

References 22 publications

Evaluation of Solitary Pulmonary Nodule Detected During Computed Tomography Examination

Evaluation of Solitary Pulmonary Nodule Detected During Computed Tomography Examination

The Future in Diagnosis and Staging of Lung Cancer: Positron Emission Tomography

Controversies in Mediastinal Staging for Nonsmall Cell Lung Cancer

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