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 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 5 June 2017 -- Source: Scopus |
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