The Use and Misuse of Positron Emission Tomography in Lung Cancer Evaluation

Abstract

Synopsis Positron emission tomography (PET) has been studied for a variety of indications in patients with known or suspected non-small cell lung cancer (NSCLC). In this review, we discuss the potential benefits and limitations of PET for characterizing lung nodules, staging the mediastinum, identifying occult distant metastasis, determining prognosis and treatment response, guiding plans for radiation therapy, restaging during and after treatment, and selecting targets for tissue sampling. (Table 1) Evidence from randomized, controlled trials supports the use of PET for initial staging in NSCLC, while lower quality evidence from studies of diagnostic accuracy and modeling studies supports the use of PET for characterizing lung nodules. For most other indications in NSCLC, additional studies are required to clarify the role of PET and determine who is most likely to benefit.

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“…25 PET imaging, like SPECT, is commonly used with CT and is widely used in oncology for perioperative evaluation. 26,27 PET is valued not only for its sensitivity and depth of detection but also its ability to yield quantitative information. Despite the frequent use of PET-CT in pre-operative assessment of solid tumors like NSCLC, true intra-operative PET scanning has not been possible due to the size and geometric constraints of scanners.…”

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