Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer Journal Article

Authors: Cuaron, J.; Dunphy, M.; Rimner, A.
Article Title: Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer
Abstract: The integral role of positron-emission tomography (PET) using the glucose analog tracer fluorine-18 fluorodeoxyglucose (FDG) in the staging of non-small cell lung cancer (NSCLC) is well established. Evidence is emerging for the role of PET in response assessment to neoadjuvant therapy, combined-modality therapy, and early detection of recurrence. Here, we review the current literature on these aspects of PET in the management of NSCLC. FDG-PET, particularly integrated 18F-FDG-PET/CT, scans have become a standard test in the staging of local tumor extent, mediastinal lymph node involvement, and distant metastatic disease in NSCLC. 18F-FDG-PET sensitivity is generally superior to computed tomography (CT) scans alone. Local tumor extent and T stage can be more accurately determined with FDG-PET in certain cases, especially in areas of post-obstructive atelectasis or low CT density variation. FDG-PET sensitivity is decreased in tumors <1 cm, at least in part due to respiratory motion. False-negative results can occur in areas of low tumor burden, e.g., small lymph nodes or ground-glass opacities. 18F-FDG-PET-CT nodal staging is more accurate than CT alone, as hilar and mediastinal involvement is often detected first on 18F-FDG-PET scan when CT criteria for malignant involvement are not met. 18F-FDG-PET scans have widely replaced bone scintography for assessing distant metastases, except for the brain, which still warrants dedicated brain imaging. 18F-FDG uptake has also been shown to vary between histologies, with adenocarcinomas generally being less FDG avid than squamous cell carcinomas. 118F-FDG-PET scans are useful to detect recurrences, but are currently not recommended for routine follow-up. Typically, patients are followed with chest CT scans every 3-6 months, using 18F-FDG-PET to evaluate equivocal CT findings. As high 18F-FDG uptake can occur in infectious, inflammatory, and other non-neoplastic conditions, 18F-FDG-PET-positive findings require pathological confirmation in most cases. There is increased interest in the prognostic and predictive role of FDG-PET scans. Studies show that absence of metabolic response to neoadjuvant therapy correlates with poor pathologic response, and a favorable 18F-FDG-PET response appears to be associated with improved survival. Further work is underway to identify subsets of patients that might benefit individualized management based on FDG-PET. © 2013 Cuaron, Dunphy and Rimner.
Keywords: cancer staging; positron emission tomography; staging; diagnostic accuracy; sensitivity and specificity; computer assisted tomography; lung non small cell cancer; clinical assessment; inflammation; prediction; distant metastasis; fibrosis; fluorodeoxyglucose f 18; medronate technetium tc 99m; clinical evaluation; atelectasis; stereotactic body radiation therapy; fluorine 18; pet; non-small cell lung cancer; predictive value; induction chemotherapy; bone scintiscanning; follow-up; lung lesion; lung nodule; response assessment; meta analysis (topic); diagnostic test accuracy study; multicenter study (topic); evaluation and follow up; mediastinum disease; human; article
Journal Title: Frontiers in Oncology
Volume: 2
ISSN: 2234-943X
Publisher: Frontiers Media S.A.  
Date Published: 2013-01-03
Start Page: 208
Language: English
DOI: 10.3389/fonc.2012.00208
PROVIDER: scopus
PMCID: PMC3539654
PUBMED: 23316478
Notes: Article -- Export Date: 5 June 2017 -- Source: Scopus
Citation Impact
MSK Authors
  1. Mark Phillip Dunphy
    63 Dunphy
  2. Andreas Rimner
    320 Rimner
  3. John Jacob Cuaron
    47 Cuaron
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