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PET/CT for Staging and Diagnosis of Lung Cancer

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Advances in Radiation Oncology in Lung Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

Positron emission tomography (PET) is an imaging technique, which allows for accurate non-invasive measurements of metabolic pathways in tissues of man in vivo. The most frequently used tracer in PET oncology is the glucose analog 18F-fluoro-2-deoxy-glucose (FDG). The preferential accumulation of FDG in neoplastic cells permits differentiation between benign and malignant tissue. The ability to perform whole-body imaging within one examination without increasing the radiation burden makes it an ideal technique to “screen” patients for cancer deposits. Also in thoracic oncology, FDG-PET has proven its superiority over other imaging techniques in staging nodal and metastatic disease. However, the poor anatomic detail of PET can lead to errors in diagnosis and staging. Through the integration of computer tomography (CT) and PET into one machine, form and function are merged to create a better imaging tool. In this chapter, we will highlight the recent developments in hybrid machinery (time-of-flight PET, PET-MR) and review the role of integrated PET/CT in the diagnosis and staging of lung cancer.

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References

  • Alkhawaldeh K, Bural G, Kumar R, Alavi A (2008) Impact of dual-time-point (18)F-FDG PET imaging and partial volume correction in the assessment of solitary pulmonary nodules. Eur J Nucl Med Mol Imaging 35:246–252

    Article  PubMed  Google Scholar 

  • Antoch G, Stattaus J, Nemat AT et al (2003) Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology 229:526–533

    Article  PubMed  Google Scholar 

  • Ashraf H, Mortensend J, Dirksen A et al (2011) Combined use of PET and volume doubling time in lung cancer screening with low dose CT. Thorax 66:315–319

    Article  PubMed  CAS  Google Scholar 

  • Azad A, Chionh F, Scott AM et al (2010) High impact of 18F-FDGPET onmamagement and prognostic stratification of newly diagnosed small cell lung cancer. Mol Imaging Biol 12:433–451

    Article  Google Scholar 

  • Bastarrika G, Garcia-Velloso MJ, Lozano MD et al (2005) Early lung cancer detection using spiral computed tomography and positron emission tomography. Am J Respir Crit Care Med 171:1378–1383

    Article  PubMed  Google Scholar 

  • Belhocine T, Foidart J, Rigo P et al (2002) Fluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumours: correlations with the pathological indexes p53 and Ki-67. Nucl Med Commun 23:727–734

    Article  PubMed  CAS  Google Scholar 

  • Berger KL, Nicholson SA, Dehdashti F et al (2000) FDG PET evaluation of muci-nous neoplasms: correlation of FDG uptake with histopathologic features. Am J Roentgenol 174:1005–1008

    Article  CAS  Google Scholar 

  • Billè A, Pelosi E, Skanjeti A et al (2009) Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography. Eur J Cardiothorac Surg 36:440–445

    Article  PubMed  Google Scholar 

  • Bipat S, van Leeuwen MS, Comans EF et al (2005) Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology 237:123–131

    Article  PubMed  Google Scholar 

  • Boellaard R (2009) Standards for PET image acquisition and quantitative data analysis. J Nucl Med 50(Suppl 1):11S–20S

    Article  PubMed  CAS  Google Scholar 

  • Brady MJ, Thomas J, Wong TZ et al (2009) Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: a proposal for an efficient diagnostic algorithm. Radiology 250:523–530

    Article  PubMed  Google Scholar 

  • Bryant AS, Cerfolio RJ (2006) The maximum standardized uptake values on integrated FDG-PET/CT is useful in differentiating benign from malignant pulmonary nodules. Ann Thorac Surg 82:1016–1020

    Article  PubMed  Google Scholar 

  • Cerfolio RJ, Ojha B, Bryant AS et al (2004) The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with nonsmall cell lung cancer. Ann Thorac Surg 78:1017–1023

    Article  PubMed  Google Scholar 

  • Cook GJ, Houston S, Rubens R, Maisey MN et al (1998) Detection of bone metastases in breast cancer by 18FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol 16:3375–3379

    PubMed  CAS  Google Scholar 

  • De Wever W, Ceyssens S, Mortelmans L et al (2007a) Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT. Eur Radiol 17:23–32

    Article  PubMed  CAS  Google Scholar 

  • De Wever W, Vankan Y, Stroobants S et al (2007b) Detection of extrapulmonary lesions with integrated PET/CT in the staging of lung cancer. Eur Respir J 29:995–1002

    Article  PubMed  CAS  Google Scholar 

  • De Wever W, Stroobants S, Coolen J et al (2009) Integrated PET/CT in the staging of non small cell lung cancer: technical aspects and clinical integration. Eur Respir J 33:201–212

    Article  PubMed  CAS  Google Scholar 

  • Dillemans B, Deneffe G, Verschakelen J et al (1994) Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small cell lung cancer. A study of 569 patients. Eur J Cardiothorac Surg 8:37–42

    Article  PubMed  CAS  Google Scholar 

  • Fischer BM, Mortensen J, Hojgaard L (2001) Positron emission tomography in the diagnosis and staging of lung cancer: a systematic, quantitative review. Lancet Oncol 2:659–666

    Article  PubMed  CAS  Google Scholar 

  • Fischer BM, Mortensen J, Langer SW et al (2007) A prospective study of PET/CT in initial staging of small-cell lung cancer: comparison with CT, bone scintigraphy and bone marrow analysis. Ann Oncol 18:338–345

    Article  PubMed  CAS  Google Scholar 

  • Goldstraw P (2009) The 7th edition of TNM in lung cancer: what now? J Thorac Oncol 4:671–673

    Article  PubMed  Google Scholar 

  • Goldstraw P, Crowley J, Chansky K et al (2007) The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forth-coming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol 2:706–714

    Article  PubMed  Google Scholar 

  • Gould MK (2011) Evaluation of screening-detected lung nodules: minimising the risk of unnecessary biopsy and surgery. Thorax 66:277–279

    Article  PubMed  Google Scholar 

  • Gould MK, Maclean CC, Kuschner WG et al (2001) Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 285:914–924

    Article  PubMed  CAS  Google Scholar 

  • Gould MK, Kuschner WG, Rydzak CE et al (2003) Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small cell lung cancer: a meta-analysis. Ann Intern Med 139:879–892

    Article  PubMed  Google Scholar 

  • Gurney JW, Lyddon DM, McKay JA (1993) Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part II. Application. Radiology 186:415–422

    PubMed  CAS  Google Scholar 

  • Heyneman LE, Patz EF (2002) PET imaging in patients with bronchioloalveolar cell carcinoma. Lung Cancer 38:261–266

    Article  PubMed  Google Scholar 

  • Hicks RJ, Lau EWF (2009) PET/MRI: a different spin from under the rim. Eur J Nucl Med Mol Imaging 36(Suppl 1):S10–S14

    Article  PubMed  Google Scholar 

  • Hsia TC, Shen YY, Yen RF et al (2002) Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diophosphate bone scan to detect bone metastases in patients with non-small cell lung cancer. Neoplasma 49:267–271

    PubMed  CAS  Google Scholar 

  • Ikeda K, Nomori H, Mori T et al (2006) Size of metastatic and nonmetastatic mediastinal lymph nodes in non-small cell lung cancer. J Thorac Oncol 1:949–952

    Article  PubMed  Google Scholar 

  • Kadrmas DJ, Casey ME, Conti M et al (2009) Impact of time-of-flight on PET tumor detection. J Nucl Med 50:1315–1323

    Article  PubMed  Google Scholar 

  • Langen AJ, Raijmakers P, Riphagen I et al (2006) The size of mediastinal lymph nodes and its relation with metastatic involvement: a meta-analysis. Eur J Cardiothor Surg 29:26–29

    Article  Google Scholar 

  • Lardinois D, Weder W, Hany TF et al (2003) Staging of non-small-cell lung cancernwith integrated positron-emission tomography and computed tomography. N Engl J Med 348:2500–2507

    Article  PubMed  Google Scholar 

  • Lee BE, von Haag D, Lown T et al (2007) Advances in positron emission tomography technology have increased the need for surgical staging in non-small cell lung cancer. J Thorac Cardiovasc Surg 133:746–752

    Article  PubMed  Google Scholar 

  • Lowe VJ, Hoffman JM, DeLong DM et al (1994) Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities. J Nucl Med 35:1771–1776

    PubMed  CAS  Google Scholar 

  • Mawlawi O, Pan T, Macapinlac HA (2006) PET/CT imaging techniques, considerations, and artifacts. Thorac Imaging 21:99–110

    Article  Google Scholar 

  • Mountain CF (1997) Revisions in the international system for staging lung cancer. Chest 111:1710–1717

    Article  PubMed  CAS  Google Scholar 

  • Niho S, Fujii H, Murakami K et al (2007) Detection of unsuspected distant metastases and/or regional nodes by FDG-PET in LD-SCLC scan in apparent limited-disease small-cell lung cancer. Lung Cancer 57:328–333

    Article  PubMed  Google Scholar 

  • Nomori H, Watanabe K, Ohtsuka T et al (2004) Valuation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. Lung Cancer 45:19–27

    Article  PubMed  Google Scholar 

  • Pantel K, Izbicki J, Passlick B et al (1996) Frequency and prognostic significance of isolated tumour cells in bone marrow of patients with non-small cell lung cancer without overt metastases. Lancet 347:649–653

    Article  PubMed  CAS  Google Scholar 

  • Pastorino U, Bellomi M, Landoni C et al (2003) Early lung cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. Lancet 362:593–597

    Article  PubMed  Google Scholar 

  • Pauwels EK, McCready VR, Stoot JH, van Deurzen DF (1998) The mechanism of accumulation of tumour-localising radiopharmaceuticals. Eur J Nucl Med 25:277–305

    Article  PubMed  CAS  Google Scholar 

  • Pfannenberg AC, Aschoff P, Brechtel K et al (2007) Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer. Eur J Nucl Med Mol Imaging 34:36–44

    Article  PubMed  Google Scholar 

  • Quint LE, Tummala S, Brisson LJ et al (1996) Distribution of distant metastases from newly diagnosed non- small cell lung cancer. Ann Thorac Surg 62:246–250

    Article  PubMed  CAS  Google Scholar 

  • Rodriguez E, Lilenbaum RC (2010) Small cell lung cancer: past, present and future. Curr Oncol Rep 12:327–334

    Article  PubMed  Google Scholar 

  • Sathekge MM, Maes A, Pottel H et al (2010) Dual time-point FDG PET-CT for differentiating benign from malignant solitary pulmonary nodules in a TB endemic area. S Afr Med J 100:598–601

    PubMed  Google Scholar 

  • Schaffler GJ, Wolf G, Schoellnast H et al (2004) Non-small cell lung cancer: evaluation of pleural abnormalities on CT scans with 18F FDG PET. Radiology 231:858–865

    Article  PubMed  Google Scholar 

  • Schirrmeister H, Arslandemir C, Glatting G et al (2004) Omission of bone scanning according to staging guidelines leads to futile therapy in non-small cell lung cancer. Eur J Nucl Med Mol Imaging 31:964–968

    Article  PubMed  Google Scholar 

  • Schlemmer HP, Pichler BJ, Krieg R et al (2009) An integrated MR/PET system: prospective applications. Abdom Imaging 34:668–674

    Article  PubMed  Google Scholar 

  • Schrevens L, Lorent N, Dooms C et al (2004) The role of PET scan in diagnosis, staging, and management of non-small cell lung cancer. Oncologist 9:633–643

    Article  PubMed  Google Scholar 

  • Shields AF, Grierson JR, Dohmen BM et al (1998) Imaging proliferation in vivo with [F-18]FLT and positron emission tomography. Nat Med 4:1334–1336

    Article  PubMed  CAS  Google Scholar 

  • Shim SS, Lee KS, Kim BT et al (2005) Non-small cell lung cancer: prospective comparison of integrated FDG PET-CT and CT alone for preoperative staging. Radiology 236:1011–1019

    Article  PubMed  Google Scholar 

  • Shim SS, Lee KS, Kim BT et al (2006a) Focal parenchymal lung lesions showing a potential of false-positive and false-negative interpretations on integrated PET/CT. AJR Am J Roentgenol 186(2):639–648

    Article  PubMed  Google Scholar 

  • Shim SS, Lee KS, Kim BT et al (2006b) Integrated PET/CT and the dry pleural dissemination of peripheral adenocarcinoma of the lung: diagnostic implications. J Comput Assist Tomogr 30:70–76

    Article  PubMed  Google Scholar 

  • Siegelman SS, Khouri N, Leo FP, Fishman EK et al (1986) Solitary pulmonary nodules: CT assessment. Radiology 160:307–312

    PubMed  CAS  Google Scholar 

  • Silvestri GA, Gould MK, Margolis ML et al (2007) Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines 132(Suppl 3):178S–201S (2nd ed)

    Google Scholar 

  • Swensen SJ, Viggiano RW, Midthum DE et al (2000) Lung nodule enhancement at CT: multicenter study. Radiology 214:73–80

    PubMed  CAS  Google Scholar 

  • Swensen SJ, Jett JR, Hartman TE et al (2003) Lung cancer screening with CT: Mayo clinic experience. Radiology 226:756–761

    Article  PubMed  Google Scholar 

  • Tan BB, Flaherty KR, Kazerooni EA et al (2003) The solitary pulmonary nodule. Chest 123(Suppl 1):89S–96S

    Article  PubMed  Google Scholar 

  • Ung YC, Maziak DE, Vanderveen JA et al (2007) 18F-fluorodeoxyglucose positron emission tomography in the diagnosis and staging of lung cancer: a systematic review. J Natl Cancer Inst 99:1753–1767

    Article  PubMed  Google Scholar 

  • Verschakelen JA, De Wever W, Bogaert J (2004) Role of computed tomography in lung cancer staging. Curr Opin Pulm Med 10:248–255

    Article  PubMed  Google Scholar 

  • Vinjamuri M, Craig M, Campbell-Fontaine A et al (2008) Can positron emission tomography be used as a staging tool for small-cell lung cancer? Clin Lung Cancer 9:30–34

    Article  PubMed  Google Scholar 

  • Yang W, Zhang Y, Fu Z et al (2010) Imaging of proliferation with 18F-FLT PET/CT versus 18F-FDG PET/CT in non-small-cell lung cancer. Eur J Nucl Med Mol Imaging 37:1291–1299

    Article  PubMed  Google Scholar 

  • Yankelevitz DF, Henschke CI (1997) Does 2-year stability imply that pulmonary nodules are benign? Am J Roentgenol 168:325–328

    Article  CAS  Google Scholar 

  • Yap CS, Czernin J, Fishbein MC et al (2006) Evaluation of thoracic tumors with 18F-fluorothymidine and 18F-fluorodeoxyglucose-positron emission tomography. Chest 129:393–401

    Article  PubMed  Google Scholar 

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Correspondence to Sigrid Stroobants .

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Stroobants, S. (2011). PET/CT for Staging and Diagnosis of Lung Cancer. In: Jeremic, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_323

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  • DOI: https://doi.org/10.1007/174_2011_323

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