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

Abstract

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.

Solitary pulmonary nodule evaluation with99mTc-methoxy isobutyl isonitrile in a tuberculosis-endemic area

“…Increased MIBI uptake in aspergilloma and granuloma due to silicosis has not yet been described. These false-positive results show similar limitations for MIBI as are known for PET [4,6,17].…”

“…Fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) has become the method of choice to evaluate such SPN but availability and cost still limit its widespread use [3,4]. There are also several reports indicating false-positive results of FDG-PET in patients with active TB [4][5][6].…”

“…There are also several reports indicating false-positive results of FDG-PET in patients with active TB [4][5][6]. Radiopharmaceuticals containing either technetium-99m ( 99m Tc) or thallium-201 ( 201 Tl) are more affordable than FDG since they can be produced on site and do not need a cyclotron facility.…”

Eosinophilic Pneumonia and Thoracic Metastases as an Initial Manifestation of Prostatic Carcinoma

“…As for pulmonary metastases from the prostate, the reported incidence found during autopsy ranges from 23 to 74% (4 …”

Positron emission tomography imaging approaches for external beam radiation therapies: current status and future developments

“…This is because of its capability in identifying distant metastases or regional nodal involvement that was not previously appreciated [13,14] and the impact of this information on treatment management decisions relating to suitability for surgery. Meta-analysis studies of 18 F-FDG-PET have determined the sensitivity and specificity of PET in diagnosing single pulmonary nodules or masses to be 96% and 78%, respectively; the sensitivity and specificity of PET in mediastinal staging is estimated to be 83% and 92%, respectively ( [13] and references therein). As a result, 18 F-FDG-PET is now widely used in the routine diagnosis of lung cancer and has been approved by official bodies in the USA, Germany and the UK.…”