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Nuklearmedizin 2009; 48(02): 59-69
DOI: 10.3413/nukmed-0217
Nuclear medicine in the evaluation of lung cancer
Schattauer GmbH

FDG-PET, PET/CT and conventional nuclear medicine procedures in the evaluation of lung cancer

A systematic reviewFDG-PET, PET/CT und konventionelle nuklearmedizinische Untersuchungen zur Bewertung des LungenkrebsesEine systematische Übersicht
D. Hellwig
1   Department of Nuclear Medicine, Saarland University Medical Center, Homburg
,
R. P. Baum
2   Department of Nuclear Medicine / PET Center, Zentralklinik Bad Berka; Germany
,
C.-M. Kirsch
1   Department of Nuclear Medicine, Saarland University Medical Center, Homburg
› Author Affiliations
Further Information

Publication History

Received: 23 September 2008

accepted: 24 January 2008

Publication Date:
22 January 2018 (online)

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Summary

Aim: Currently, the German and Austrian S3 guidelines on the evaluation and treatment of lung cancer are about to be published whereas the American Colleague of Chest Physicians (ACCP) guidelines were already presented in 2007. An important part of the diagnostic workup of lung cancer will be the evaluation of indeterminate lung lesions and the mediastinal and extrathoracic staging using FDG-PET or PET/CT. The results from the literature on FDG-PET and PET/ CT as well as on conventional nuclear medicine staging procedures and the clinical implications are presented. Methods: The literature data was amassed in analogy to the metaanalyses drawn for the current ACCP guidelines. In addition, relevant more recent publications were also considered. To answer the important question for the extent of pathological confirmation needed, the residual risk of mediastinal metastases was calculated for certain constellations of FDG-PET and CT findings. Suggested recommendations were characterized with the level of evidence. Results: FDG-PET (PET/CT) allows the differentiation of indeterminate lung lesions with high accuracy. FDG-PET (PET/ CT) is the most accurate non-invasive procedure to assess the mediastinal nodal stage, for non-small cell as well as for small cell lung cancer. It is justified to omit invasive evaluation of enlarged but FDG-PET negative lymph nodes under certain circumstances. Unexpected extrathoracic metastases detected by FDG-PET imply important changes in therapeutic management. Conclusion: The upcoming S3 guideline on lung cancer will recommend FDG-PET in several indications due to its clinical efficacy well proven by data from literature (high level of evidence). The selected use of conventional nuclear medicine procedures remains beyond doubt. FDG-PET (PET/CT) belongs to the standard of care in lung cancer.

Zusammenfassung

Ziel: Momentan steht die Publikation der durch die deutschen und österreichischen Fachgesellschaften erstellten S3-Leitlinie zum Lungenkarzinom an, nachdem die ACCP bereits 2007 ihre Leitlinien aktualisiert hat. Wesentlicher Teil der Diagnostik bei Lungenkarzinomen werden die Dignitätsbeurteilung von unklaren Lungenherden sowie die mediastinale und extrathorakale Ausbreitungsdiagnostik mittels FDG-PET bzw. PET/CT sein. Hierzu und zu konventionellen nuklearmedizinischen Staging-Untersuchungen werden die zugrunde liegenden Literaturergebnisse und die resultierenden klinischen Konsequenzen dargestellt. Methodik: Die Zusammenstellung der Literaturdaten erfolgte analog zu den Metaanalysen, die für die aktuellen ACCPLeitlinien herangezogen wurden. Zusätzlich wurden relevante aktuelle Arbeiten berücksichtigt. Zur wichtigen Frage des Ausmaßes der pathologischen Sicherung erfolgte eine Berechnung des Restrisikos einer mediastinalen Lymphknoten- Metastasierung bei verschiedenen Befundkonstellationen von FDG-PET und CT. Den vorgeschlagenen Empfehlungen wurden durch die Datenlage der Literatur bestimmte Evidenzlevel zugeordnet. Ergebnisse: FDG-PET (PET/CT) erlaubt die Dignitätsbeurteilung von Lungenherden mit sehr hoher Treffsicherheit. FDG-PET (PET/CT) ist die genaueste nicht-invasive Methode zur Erfassung des mediastinalen Lymphknoten-Status, sowohl für das nichtkleinzellige als auch für das kleinzellige Lungenkarzinom. Unter bestimmten Voraussetzungen ist der Verzicht auf eine invasive Abklärung vergrößerter, FDG-PET negativer mediastinaler Lymphknoten möglich. Mit FDG-PET (PET/ CT) gefundene unerwartete Fernmetastasen bedingen wesentliche änderungen der geplanten Therapie. Schlussfolgerung: Die aktuellen Empfehlungen zum Einsatz der FDG-PET (PET/CT) beim Lungenkarzinom sind durch Literaturdaten sehr gut belegt (hoher Evidenzlevel). Der gezielte Einsatz konventioneller nuklearmedizinischer Untersuchungen bleibt unstrittig. FDG-PET (PET/CT) gehört zum Versorgungsstandard des Lungenkarzinoms.

Keywords

Lung cancer - systematic review - FDG-PET - PET/CT - skeletal scintigraphy - somatostatin receptor scintigraphy

Schlüsselwörter

Lungenkrebs - übersichtsarbeit - FDG-PET - PET/CT - Skelett szintigraphie - Somatostatinrezeptor-Szintigraphie
 

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