PET scan in small cell lung cancer – pro

PET with 2-[fluorine 18]-fluoro-2-deoxy-D-glucose (FDG) has recently received attention, and growing evidence suggests its superiority in the staging of lung cancer. However, PET is more frequently used in evaluating patients with NSCLC to identify surgical candidates. It is less commonly used in patients with SCLC because most of these patients are not candidates for surgery. PET may be useful for evaluating cases in which recurrent disease but this is questionable.Generally, the resolution of PET is not considered good for lesions smaller than 1 cm. The PET results can also overlap with the standard uptake values (SUVs) in some benign lesions and malignant lesions.Unfortunately, specificity, sensitivity and accuracy compared to CT are not securely known. The utility of positron emission tomography (PET) scanning in patients with SCLC has been recently reported in two small prospective studies. In a study reported by Hauber et al, PET scans detected all primary lesions, lymph node metastases, and distant metastases that had been detected by other standard staging procedures. In a second study, 30 patients with SCLC were evaluated with 36 PET scan examinations, and the results were compared with the sum of the other staging procedures. The results of 23 of the 36 PET scan examinations were concordant with those of the other staging procedures. In seven cases, the PET scan examination resulted in upward staging of the patient, and in one instance the PET scan revealed the presence of a viable tumor when conventional staging procedures had revealed no residual disease. PET scan identified all areas of tumor involvement detected by other staging procedures. A third study looked at the accuracy of PET scanning in detecting bony metastases in patients with SCLC and NSCLC, comparing the PET scans to bone scans and single-photon emission CT scans. In this study, PET scans were found to be the most accurate whole-body imaging modality for the screening of bone metastases. These and similar studies suggested that PET scanning is likely to be a useful staging tool in patients with SCLC. However, all the studies were small, and the experience with PET scan as a staging tool remains largely limited.

NCCN 2015, SCL – 1 says that PET should be used only if limited disease is suspected. On p. SCL-6 it mentions “other imaging studies” as clinically indicated.

PET scan has not been sufficiently studied for small celll lung cancer to be considered standard and it is not Medicare approved. NCCN mentions PET for initial staging but not for restaging.

P. Chirrmeister, H, Glatting, G, Hetzel, J, et al Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 2001;42,1800-1804

Hauber, HP, Bohuslavizki, KH, Lund, CH, et al Positron emission tomography in the staging of small-cell lung cancer: a preliminary study. Chest 2001;119,950-954

Schumacher, T, Brink, I, Mix, M, et al FDG-PET imaging for the staging and follow-up of small cell lung cancer. Eur J Nucl Med 2001;28,483-48

Seute T, Leffers P, ten Velde GP, Twijnstra A. Detection of brain metastases from small cell lung cancer: consequences of changing imaging techniques (CT versus MRI). Cancer. Apr 15 2008;112(8):1827-34.

Lee HY, Chung JK, Jeong JM, Lee DS, Kim DG, Jung HW, et al. Comparison of FDG-PET findings of brain metastasis from non-small-cell lung cancer and small-cell lung cancer. Ann Nucl Med. May 2008;22(4):281-6.

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