LUNG CANCER USING FDG PET/CT

Clinical FDG PET/CT Findings: Attached is a screen capture for a 65-year-old female with biopsy proven left upper lung adenocarcinoma. Our FDG PET images clearly show stage 2 disease, e.g, left upper lung primary cancer with ipsilateral hilar metastasis. FDG activity in the heard and both kidneys is physiological and normal.

STATISTICS  

Lung cancer is a significant global health issue. In the United States alone, there were an estimated 228,820 new cases of lung cancer diagnosed in 2020[4]. Non-small cell lung cancer (NSCLC) comprises approximately 84% of all lung cancer cases, while small cell lung cancer (SCLC) accounts for about 16%[4]. These statistics underscore the importance of effective lung cancer management strategies and the need for advanced diagnostic tools like PET to detect and stage lung cancer lesions. 

NCCN OVERVIEW:  PET/CT (FDG) APPLICATION TO LUNG CANCER  

According to the National Comprehensive Cancer Network (NCCN), positron emission tomography (PET) using fluorodeoxyglucose (FDG) plays a vital role in the clinical management of lung cancer at different stages.  

  • In stage 1 lung cancer, FDG PET is recommended for initial staging, assessing both nodal and distant metastases, and aiding in treatment decision-making[1] 
  • For stage 2 lung cancer, FDG PET is useful in detecting metastatic disease and evaluating the feasibility of surgical intervention[1] 
  • In stage 3 lung cancer, FDG PET is valuable for identifying distant metastases and guiding treatment selection[1] 
  • Finally, in stage 4 lung cancer, FDG PET is employed for whole-body evaluation to assess the presence of metastatic disease and to monitor treatment response[1]. 

SENSITIVITY AND SPECIFICITY OF PET/CT IN LUNG CANCER 

FDG PET imaging demonstrates higher sensitivity and specificity when compared to conventional imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of lung cancer[3]. FDG PET’s ability to detect metabolic activity in cancer cells allows for better identification of tumor location, size, and metabolic status, leading to improved diagnostic accuracy and staging[3]. The high standardized uptake value (SUV) on a FDG PET scan often correlates with increased metabolic activity, indicating a more aggressive disease[3]. PET imaging complements traditional imaging techniques, providing clinicians with more comprehensive information for accurate diagnosis, staging, and treatment planning[3]. 

Sources: 

  1. National Comprehensive Cancer Network (NCCN) – Non-Small Cell Lung Cancer Treatment (PDQ®) 
  1. NCBI – PET/CT imaging in lung cancer: indications and findings 
  1. American Lung Association – Lung Cancer Fact Sheet 
  1. Lung Cancer Fact Sheet | American Lung Association