The Role of PET/CT Imaging in Lung Cancer

David Ladrón de Guevara Hernández^*

Department of Radiology, Clinica Las Condes, Santiago, Chile.

DOI: 10.4236/jct.2015.68076                

Abstract

Lung cancer presents a high prevalence around the world and constitutes the leading cause of death due to cancer in men and women. Proper staging is essential in order to provide the correct treatment and estimate survival. PET/CT imaging is the method of choice for the staging of lung cancer patients with a better performance than the traditional imaging methods. It allows defining the primary tumor more clearly, separating it from the atelectasis and neighboring fibrotic changes, thus achieving an improved T evaluation while optimizing the target definition for radiotherapy. It presents greater sensibility and specificity than Computed Tomography (CT) when assessing the extra-thoracic and thoracic lymph nodes, modifying the N stage with regard to the traditional study in up to 25% of patients. PET/CT imaging is the method with the best performance for detecting extra-encephalic metastasis and for detecting unexpected lesions in up to 30% of patients. In order to achieve proper encephalic staging, a Magnetic Resonance Imaging scan must be performed or, a CT scan of the brain concomitant to the PET/CT. One to eight percent of lung cancer patients who are subjected to PET/CT imaging present a synchronous secondary extra pulmonary or pulmonary cancer when being diagnosed, with significant prognostic and therapeutic implications. PET/CT imaging has proven to be a valuable tool for survival prognosis with regard to the initial uptake of the tumor and the early response (interim) or final response to chemotherapy, although it is not routinely used for evaluating therapy. The PET/MRI is an emerging hybrid technique with certain advantages, such as less exposure to radiation in comparison to PET/CT and greater contrast resolution of the MRI images. However, its usefulness has not been validated yet for lung cancer patients.

Keywords

Lung Cancer, Pulmonary Malignancy, PET/CT

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	GLOBOCAN (2012) Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr
[2]	Howlander, N., Noone, A. and Krapcho, M. (2012) SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Population) Based on November 2001 SEER Data Submission. National Cancer Institute, Bethesda. http://seer.cancer.gov/statfacts/html/lungb.html
[3]	(2015) National Comprehensive Cancer Network Guidelines. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site
[4]	Fischer, B., Lassen, U., Mortensen, J., Larsen, S., Loft, A., Bertelsen, A., et al. (2009) Preoperative Staging of Lung Cancer with Combined PET-CT. New England Journal of Medicine, 2, 32-29. http://dx.doi.org/10.1056/NEJMoa0900043
[5]	Schreyogg, J., Weller, J., Stargardt, T., et al. (2010) Cost-Effectiveness of Hybrid PET/CT for Staging of Non-Small Cell Lung Cancer. Journal of Nuclear Medicine, 51, 1668-1675. http://dx.doi.org/10.2967/jnumed.109.072090
[6]	Silvestri, G.A., Gould, M.K., Margolis, M.L., Tanoue, L.T., McCrory, D., Toloza, E., et al. (2007) Noninvasive Staging of Non-Small Cell Lung Cancer. ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition). Chest, 132, 178S-201S.
[7]	Ladron de Guevara, D., Furnaro, F., Yévenes, S., Clavero, J.M., Piottante, A., Lazo, D., Rodríguez, P., Undurraga, A., álvarez, M., Pefaur, R. and Pardo, C. (2015) Positron Emission Tomography/Computed Tomography for Lung Cancer Staging. Revista Médica de Chile, 143, 22-29.
[8]	UyBico, S.J., Wu, C.C., Suh, R.D., Le, H.N., Brown, K., Krishnam, M.S., et al. (2010) Lung Cancer Staging Essentials: The New TNM Staging System and Potential Imaging Pitfalls. RadioGraphics, 30, 1163-1181. http://dx.doi.org/10.1148/rg.305095166
[9]	Samson, D.J., Seidenfeld, J., Simon, G.R., Turrisi, A.T., Bonnell, C., Ziegler, K.M., et al. (2007) Evidence for Management of Small Cell Lung Cancer. ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest, 132, 314S-323S.
[10]	Lardinois, D., Weder, W., Hany, T.F., Kamel, E.M., Korom, S., Seifert, B., et al. (2003) Staging of Non-Small-Cell Lung Cancer with Integrated Positron-Emission Tomography and Computed Tomography. New England Journal of Medicine, 348, 2500-2507. http://dx.doi.org/10.1056/NEJMoa022136
[11]	Kim, D.H., Son, S.H., Kim, C.Y., Hong, C.M., Oh, J.R., Song, B.I., et al. (2014) Prediction for Recurrence Using F-18 FDG PET/CT in Pathologic N0 Lung Adenocarcinoma after Curative Surgery. Annals of Surgical Oncology, 21, 589-596. http://dx.doi.org/10.1245/s10434-013-3270-5
[12]	Gould, M.K., Kuschner, W.G., Rydzak, C.E., Maclean, C.C., Demas, A.N., Shigemitsu, H., 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. Annals of Internal Medicine, 139, 879-892. http://dx.doi.org/10.7326/0003-4819-139-11-200311180-00013
[13]	Enoch Lee, B., Redwine, J., Foster, C., Abella, E., Lown, T., Lau, D., et al. (2008) Mediastinoscopy Might Not Be Necessary in Patients with Non-Small Cell Lung Cancer with Mediastinal Lymph Nodes Having a Maximum Standardized Uptake Value of Less than 5.3. The Journal of Thoracic and Cardiovascular Surgery, 135, 615-619. http://dx.doi.org/10.1016/j.jtcvs.2007.09.029
[14]	Bryant, A.S., Cerfolio, R.J., Klemm, K.M. and Ojha, B. (2006) Maximum Standard Uptake Value of Mediastinal Lymph Nodes on Integrated FDG PET-CT Predicts Pathology in Patients with Non-Small Cell Lung Cancer. The Annals of Thoracic Surgery, 82, 417-423. http://dx.doi.org/10.1016/j.athoracsur.2005.12.047
[15]	Ambrosini, V., Nicolini, S., Caroli, P., Nanni, C., Massaro, A., Marzola, M.C., et al. (2012) PET/CT Imaging in Different Types of Lung Cancer: An Overview. European Journal of Radiology, 81, 988-1001. http://dx.doi.org/10.1016/j.ejrad.2011.03.020
[16]	Viney, R.C., Boyer, M.J., King, M.T., Kenny, P.M., Pollicino, C.A., McLean, J.M., et al. (2004) Randomized Controlled Trial of the Role of Positron Emission Tomography in the Management of Stage I and II Non-Small-Cell Lung Cancer. Journal of Clinical Oncology, 22, 2357-2362. http://dx.doi.org/10.1200/JCO.2004.04.126
[17]	Cheran, S.K., Herndon, J.E. and Patz, E.F. (2004) Comparison of Whole-Body FDG-PET to Bone Scan for Detection of Bone Metastases in Patients with a New Diagnosis of Lung Cancer. Lung Cancer, 44, 317-325. http://dx.doi.org/10.1016/j.lungcan.2003.11.008
[18]	Seltzer, M.A., Yap, C.S., Silverman, D.H., Meta, J., Schiepers, C., Phelps, M.E., et al. (2002) The Impact of PET on the Management of Lung Cancer: The Referring Physician’s Perspective. Journal of Nuclear Medicine, 43, 752-756.
[19]	Hess, K.R., Varadhachary, G.R., Taylor, S.H., Wei, W., Raber, M.N., Lenzi, R., et al. (2006) Metastatic Patterns in Adenocarcinoma. Cancer, 106, 1624-1633. http://dx.doi.org/10.1002/cncr.21778
[20]	Boland, G.W.L., Dwamena, B.A., Sangwaiya, M.J., Goehler, A.G., Blake, M.A., Hahn, P.F., et al. (2011) Characterization of Adrenal Masses by Using FDG PET: A Systematic Review and Meta-Analysis of Diagnostic Test Performance. Radiology, 259, 117-126. http://dx.doi.org/10.1148/radiol.11100569
[21]	Brady, M.J., Thomas, J., Wong, T.Z., Franklin, K.M., Ho, L.M. and Paulson, E.K. (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. http://dx.doi.org/10.1148/radiol.2502080219
[22]	Ohno, Y., Koyama, H., Onishi, Y., Takenaka, D., Nogami, M., Yoshikawa, T., et al. (2008) Non-Small Cell Lung Cancer: Whole-Body MR Examination for M-Stage Assessment—Utility for Whole-Body Diffusion-weighted Imaging Compared with Integrated FDG PET/CT. Radiology, 248, 643-654. http://dx.doi.org/10.1148/radiol.2482072039
[23]	Hendriks, L.E.L., Bootsma, G.P., de Ruysscher, D.K.M., Scheppers, N.A.M., Hofman, P.A.M., Brans, B.T., et al. (2013) Screening for Brain Metastases in Patients with Stage III Non-Small Cell Lung Cancer: Is There Additive Value of Magnetic Resonance Imaging above a Contrast-Enhanced Computed Tomography of the Brain? Lung Cancer, 80, 293-297. http://dx.doi.org/10.1016/j.lungcan.2013.02.006
[24]	Lardinois, D., Weder, W., Roudas, M., von Schulthess, G.K., Tutic, M., Moch, H., et al. (2005) Etiology of Solitary Extrapulmonary Positron Emission Tomography and Computed Tomography Findings in Patients with Lung Cancer. Journal of Clinical Oncology, 23, 6846-6853. http://dx.doi.org/10.1200/JCO.2005.10.116
[25]	Choi, J.Y., Lee, K.S., Kwon, O.J., Shim, Y.M., Baek, C.-H., Park, K., et al. (2005) Improved Detection of Second Primary Cancer Using Integrated [18F] Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography for Initial Tumor Staging. Journal of Clinical Oncology, 23, 7654-7659. http://dx.doi.org/10.1200/JCO.2005.01.4340
[26]	Xue, X., Xue, Q., Wang, N., Zhang, L., Guo, L., Li, X., et al. (2012) Early Clinical Diagnosis of Synchronous Multiple Primary Lung Cancer. Oncology Letters, 3, 234-237.
[27]	Chi, A. and Nguyen, N.P. (2014) The Utility of Positron Emission Tomography in the Treatment Planning of Image-Guided Radiotherapy for Non-Small Cell Lung Cancer. Frontiers in Oncology, 4, Article No. 273. http://dx.doi.org/10.3389/fonc.2014.00273
[28]	Bradley, J., Thorstad, W.L., Mutic, S., Miller, T.R., Dehdashti, F., Siegel, B.A., et al. (2004) Impact of FDG-PET on Radiation Therapy Volume Delineation in Non-Small-Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics, 59, 78-86. http://dx.doi.org/10.1016/j.ijrobp.2003.10.044
[29]	Black, Q.C., Grills, I.S., Kestin, L.L., Wong, C.Y., Wong, J.W., Martinez, A.A., et al. (2004) Defining a Radiotherapy Target with Positron Emission Tomography. International Journal of Radiation Oncology, Biology, Physics, 60, 1272-1282. http://dx.doi.org/10.1016/j.ijrobp.2004.06.254
[30]	Berghmans, T., Dusart, M., Paesmans, M., Hossein-Foucher, C., Buvat, I., Castaigne, C., et al. (2008) Primary Tumor Standardized Uptake Value (SUVmax) Measured on Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) Is of Prognostic Value for Survival in Non-Small Cell Lung Cancer (NSCLC): A Systematic Review and Meta-Analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. Journal of Thoracic Oncology, 3, 6-12. http://dx.doi.org/10.1097/JTO.0b013e31815e6d6b
[31]	Goodgame, B., Pillot, G.A., Yang, Z., Shriki, J., Meyers, B.F., Zoole, J., Gao, F., Dehdashti, F., Patterson, A., Siegel, B.A., et al. (2008) Prognostic Value of Preoperative Positron Emission Tomography in Resected Stage I Non-Small Cell Lung Cancer. Journal of Thoracic Oncology, 3, 130-134. http://dx.doi.org/10.1097/JTO.0b013e318160c122
[32]	Erasmus, J.J., Rohren, E. and Swisher, S.G. (2009) Prognosis and Reevaluation of Lung Cancer by Positron Emission Tomography Imaging. Proceedings of the American Thoracic Society, 6, 171-179. http://dx.doi.org/10.1513/pats.200806-059LC
[33]	Downey, R.J., Akhurst, T., Gonen, M., Vincent, A., Bains, M.S. and Larson, S. (2004) Preoperative F-18 Fluorodeoxyglucose-Positron Emission Tomography Maximal Standardized Uptake Value Predicts Survival after Lung Cancer Resection. Journal of Clinical Oncology, 22, 3255-3260. http://dx.doi.org/10.1200/JCO.2004.11.109
[34]	Ladrón de Guevara, D., Fuentes, A., Farina, C., Corral, C. and Pefaur, R. (2013) Prognostic Value of PET/CT in Lung Cancer. Retrospective Analysis of 47 Patients. Revista Méica de Chile, 141, 41-48. http://dx.doi.org/10.4067/S0034-98872013000100006
[35]	Hoekstra, C.J., Stroobants, S.G., Smit, E.F., Vansteenkiste, J., van Tinteren, H., Postmus, P.E., et al. (2005) Prognostic Relevance of Response Evaluation Using [18F]-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography in Patients With Locally Advanced Non-Small-Cell Lung Cancer. Journal of Clinical Oncology, 23, 8362-8370. http://dx.doi.org/10.1200/JCO.2005.01.1189
[36]	Tu-Quynh, H.E., Yong-Fang, K. and Gulshan, S. (2013) Surveillance Following Lung Cancer Resection. Clinical Research in Pulmonology, 1, 1001-1008.
[37]	Sudarski, S., Henzler, T. and Schoenberg, S.O. (2013) Post-Therapeutic Positron Emission Tomography/Computed Tomography for Early Detection of Non-Small Cell Lung Cancer Recurrence. Translational Lung Cancer Research, 2, 295-303.
[38]	Hellwig, D., Groschel, A., Graeter, T.P., Hellwig, A.P., Nestle, U., Schafers, H.J., et al. (2006) Diagnostic Performance and Prognostic Impact of FDG-PET in Suspected Recurrence of Surgically Treated Non-Small Cell Lung Cancer. European Journal of Nuclear Medicine and Molecular Imaging, 33, 13-21. http://dx.doi.org/10.1007/s00259-005-1919-4
[39]	Marcus, C., Paidpally, V., Antoniou, A., Zaheer, A., Wahl, R. and Subramaniam, R.M. (2015) 18F-FDG PET/CT and Lung Cancer: Value of Fourth and Subsequent Posttherapy Follow-Up Scans for Patient Management. Journal of Nuclear Medicine, 56, 204-208. http://dx.doi.org/10.2967/jnumed.114.147884
[40]	van Loon, J., Grutters, J.P., Wanders, R., Boersma, L., Dingemans, A.M., Bootsma, G., et al. (2010) 18FDG-PET-CT in the Follow-Up of Non-Small Cell Lung Cancer Patients after Radical Radiotherapy with or without Chemotherapy: An Economic Evaluation. European Journal of Cancer, 46, 110-119. http://dx.doi.org/10.1016/j.ejca.2009.10.028
[41]	Goerres, G.W., von Schulthess, G.K. and Steinert, H.C. (2004) Why Most PET of Lung and Head-and-Neck Cancer Will Be PET/CT. Journal of Nuclear Medicine, 45, 66S-71S.
[42]	Brink, I., Schumacher, T., Mix, M., Ruhland, S., Stoelben, E., Digel, W., et al. (2004) Impact of [18F]FDG-PET on the Primary Staging of Small-Cell Lung Cancer. European Journal of Nuclear Medicine and Molecular Imaging, 31, 1614-1620. http://dx.doi.org/10.1007/s00259-004-1606-x
[43]	Lee, Y.J., Cho, A., Cho, B.C., Yun, M., Kim, S.K., Chang, J., et al. (2009) High Tumor Metabolic Activity as Measured by Fluorodeoxyglucose Positron Emission Tomography Is Associated with Poor Prognosis in Limited and Extensive Stage Small-Cell Lung Cancer. Clinical Cancer Research, 15, 2426-2432. http://dx.doi.org/10.1158/1078-0432.CCR-08-2258
[44]	Yoon, S.H., Goo, J.M., Lee, S.M., Park, C.M., Seo, H.J. and Cheon, G.J. (2014) Positron Emission Tomography/ Magnetic Resonance Imaging Evaluation of Lung Cancer Current Status and Future Prospects. Journal of Thoracic Imaging, 29, 4-16. http://dx.doi.org/10.1097/RTI.0000000000000062
[45]	Yankeelov, T.E., Peterson, T.E., Abramson, R.G., Garcia-Izquierdo, D., Arlinghaus, L.R., Li, X., Atuegwu, N.C., et al. (2012) Simultaneous PET-MRI in Oncology: A Solution Looking for a Problem? Magnetic Resonance Imaging, 30, 1342-1356. http://dx.doi.org/10.1016/j.mri.2012.06.001