NUCLEAR MEDICINE AND ONCOLOGY 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2004 June;48(2):119-42

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Position of nuclear medicine modalities in the diagnostic workup of cancer patients: lung cancer

Baum R. P. ¹, Hellwig D. ², Mezzetti M. ³

¹ Department of Nuclear Medicine Center for PET, Bad Berka, Germany 2 Department of Nuclear Medicine Saarland University Medical Center, Homburg/Saar, Germany 3 Division of Thoracic Surgery San Paolo Hospital, Milan, Italy

This ­review sum­mariz­es the cur­rent lit­er­a­ture and ­tries to ­define the stat­us of nucle­ar med­i­cine in the clin­i­cal work­up of ­lung can­cer ­patients. Nuclear med­i­cine pro­ce­dures and posi­tron emis­sion tomog­ra­phy (PET) ­with the ­EMEA-­approved radio­phar­ma­ceu­ti­cal flu­o­rod­e­o-
x­y­glu­cose (FDG) are indi­cat­ed for the char­ac­ter­iza­tion of ­lung ­lesions; the ­nodal stag­ing of non-­small ­cell ­lung can­cer (­NSCLC); the detec­tion of dis­tant metas­ta­ses; and for the diag­no­sis of recur­rent dis­ease. Recent stud­ies ­have ­shown the clin­i­cal effi­ca­cy of nucle­ar med­i­cine and espe­cial­ly of FDG-PET in the work­up of ­lung can­cer ­patients and its sig­nif­i­cant ­impact on ­patients’ man­age­ment. Conventional nucle­ar med­i­cine pro­ce­dures are estab­lished for the pre-ther­a­peu­tic assess­ment of pul­mo­nary per­fu­sion and func­tion (­lung per­fu­sion and ven­ti­la­tion scin­tig­ra­phy) and for the detec­tion of ­bone metas­ta­ses (skel­e­tal scin­tig­ra­phy). In stud­ies in thou­sands of ­patients, FDG-PET has ­been ­proved to be the ­most accu­rate non-inva­sive diag­nos­tic ­test for the char­ac­ter­iza­tion of ­lung nod­ules and mass­es. It can be rec­om­mend­ed at ­least for ­patients ­with ­increased ­risk at sur­gery. FDG-PET ­should be ­applied in can­di­dates for sur­gery of ­lung can­cer, as med­i­as­ti­nos­co­py may be omit­ted if PET ­shows no metas­ta­ses in the med­i­as­ti­num, and ­because FDG-PET ­avoids ­futile sur­gery by a ­more accu­rate selec­tion of ­patients, espe­cial­ly by the detec­tion of unex­pect­ed dis­tant metas­ta­ses. In can­di­dates for tho­rac­ic radio­ther­a­py, FDG-PET can ­help to ­exclude extrath­o­rac­ic di-s­ease ­which ­needs system­ic treat­ment and to bet­ter ­define the tar­get vol­ume for radi­a­tion ther­a­py. The ­time has ­come for FDG-PET to ­find its ­place in new guide­lines for the work­up of ­lung can­cer ­patients.