Download PDF
Nuklearmedizin 2025; 64(02): 150-155
DOI: 10.1055/a-2438-7278
Original Article

Comparison of whole-body 18F-FDG-PET/CT with 18F-FDG-PET/CT limited to skull base to upper abdomen for primary staging of lung cancer – a retrospective explorative analysis

Vergleich der Ganzkörper-FDG-PET/CT-Methode mit einer auf Schädelbasis bis Oberbauch beschränkten FDG-PET/CT zum Primärstaging von Lungenkarzinomen – eine retrospektive explorative Analyse
Lukas Schulz
1   2. Medizinische Abteilung mit Pneumologie und Karl-Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Wiener Gesundheitsverbund Klinik Ottakring, Wien, Austria (Ringgold ID: RIN643471)
,
Georg-Christian Funk
1   2. Medizinische Abteilung mit Pneumologie und Karl-Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Wiener Gesundheitsverbund Klinik Ottakring, Wien, Austria (Ringgold ID: RIN643471)
,
Klaus Kirchbacher
1   2. Medizinische Abteilung mit Pneumologie und Karl-Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Wiener Gesundheitsverbund Klinik Ottakring, Wien, Austria (Ringgold ID: RIN643471)
,
Elena Egger
1   2. Medizinische Abteilung mit Pneumologie und Karl-Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Wiener Gesundheitsverbund Klinik Ottakring, Wien, Austria (Ringgold ID: RIN643471)
,
Nino Müser
1   2. Medizinische Abteilung mit Pneumologie und Karl-Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Wiener Gesundheitsverbund Klinik Ottakring, Wien, Austria (Ringgold ID: RIN643471)
,
Siroos Mirzaei
2   Institut für Nuklearmedizin mit PET-Zentrum, Wiener Gesundheitsverbund Klinik Ottakring, Wien, Austria (Ringgold ID: RIN643471)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Aim

The gold standard for ruling out distant metastases as part of primary staging in lung cancer is whole-body 18F-FDG-PET/CT, but this method is resource-intensive. Recent evidence suggests that examining only the thorax and upper abdomen may be sufficient [1] [2] [3]. If a limited 18F-FDG-PET/CT approach proves effective for proper staging, it could lead to quicker examinations and reduced radiation exposure. This study aimed to determine whether limited 18F-FDG-PET/CT is adequate for the primary staging of lung cancer.

Methods

In this study, a retrospective analysis of 161 patients (87 men, 74 women; age range 31–88 y) with recent or suspected lung cancer who had undergone a whole-body 18F-FDG-PET/CT examination for primary staging at our clinic between 2018 and 2022 was conducted. None of these patients showed evidence of extrathoracic metastases before the 18F-FDG-PET/CT examination. The images were divided into three regions: “head-neck” (HN), “thorax-upper abdomen” (TUA), and “lower abdomen-hip” (LAH). TNM staging based on the HN plus TUA region was compared with TNM staging based on the whole body.

Results

Among the 161 subjects, 7 (4%) showed malignancy-suspect lesions in HN, 110 (68%) in TUA and 7 (4%) had suspected distant metastases in LAH. The TNM staging based on HN plus TUA corresponded to TNM staging based on the whole body in 161 (100%) examinations. This finding aligns with similar results in previous literature.

Conclusion

18F-FDG-PET/CT limited to HN and TUA yielded accurate staging in all cases. Adopting this method could facilitate the examination and correct staging of more individuals, reducing exam waiting times and physician reporting time and minimising radiation exposure.

Keywords

lung cancer - primary staging - limited field of view


Publication History

Received: 21 May 2024

Accepted after revision: 09 October 2024

Article published online:
11 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Literature

  • 1 Arens AI, Postema JW, Schreurs WM. et al. FDG-PET/CT Limited to the Thorax and Upper Abdomen for Staging and Management of Lung Cancer. PLoS One 2016; 11: e0160539
    Search in Google Scholar
  • 2 Aquino SL, Fischman AJ. Does whole-body 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography have an advantage over thoracic positron emission tomography for staging patients with lung cancer?. Chest 2004; 126: 755-760
    Search in Google Scholar
  • 3 Sebro R, Mari-Aparici C, Hernandez-Pampaloni M. Value of true whole-body FDG-PET/CT scanning protocol in oncology: optimization of its use based on primary diagnosis. Acta Radiol 2013; 54: 534-539
    Search in Google Scholar
  • 4 Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP), Deutsche Krebsgesellschaft e.V. S3-Leitlinie Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms. Kapitel 6.3 Bildgebung und Diagnosesicherung. Version 2.1 2022:. In: . 87-98
  • 5 Delgado Bolton RC, Calapaquí-Terán AK, Giammarile F. et al. Role of (18)F-FDG PET/CT in establishing new clinical and therapeutic modalities in lung cancer. A short review. Rev Esp Med Nucl Imagen Mol (Engl Ed) 2019; 38: 229-233
    Search in Google Scholar
  • 6 Farsad M. FDG PET/CT in the Staging of Lung Cancer. Curr Radiopharm 2020; 13: 195-203
    Search in Google Scholar
  • 7 National Center for Biotechnology Information. PubChem Compound Summary for CID 68614, Fludeoxyglucose F-18. 2024 Accessed April 15, 2024 at: https://pubchem.ncbi.nlm.nih.gov/compound/Fludeoxyglucose-F-18
    Search in Google Scholar
  • 8 Viney RC, Boyer MJ, King MT. et al. Randomized controlled trial of the role of positron emission tomography in the management of stage I and II non-small-cell lung cancer. J Clin Oncol 2004; 22: 2357-2362
    Search in Google Scholar
  • 9 Verschakelen JA, Bogaert J, De Wever W. Computed tomography in staging for lung cancer. Eur Respir J Suppl 2002; 35: 40s-48s
    Search in Google Scholar
  • 10 Martí-Climent JM, Prieto E, Morán V. et al. Effective dose estimation for oncological and neurological PET/CT procedures. EJNMMI research 2017; 7: 37
    Search in Google Scholar
  • 11 Schuirmann DJ. A comparison of the two one-sided tests procedure and the power approach for assessing the equivalence of average bioavailability. J Pharmacokinet Biopharm 1987; 15: 657-680
    Search in Google Scholar
  • 12 Newcombe RG. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med 1998; 17: 873-890
    Search in Google Scholar