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Abstract
Lung cancer is the leading cause of cancer-related deaths around the world, the most common type of which is non-small-cell lung cancer (NSCLC). Computed tomography (CT) is required for patients with NSCLC, but often involves diagnostic issues and large intra- and interobserver variability. The anatomic data obtained using CT can be supplemented by the metabolic data obtained using fluorodeoxyglucose F 18 (FDG) positron emission tomography (PET); therefore, the use of FDG-PET/CT for staging NSCLC is recommended, as it provides more accuracy than either modality alone. Furthermore, FDG-PET/magnetic resonance imaging (MRI) provides useful information on metabolic activity and tumor cellularity, and has become increasingly popular. A number of studies have described FDG-PET/MRI as having a high diagnostic performance in NSCLC staging. Therefore, multidimensional functional imaging using FDG-PET/MRI is promising for evaluating the activity of the intratumoral environment. Radiomics is the quantitative extraction of imaging features from medical scans. The chief advantages of FDG-PET/CT radiomics are the ability to capture information beyond the capabilities of the human eye, non-invasiveness, the (virtually) real-time response, and full-field analysis of the lesion. This review summarizes the recent advances in FDG-PET imaging within the field of clinical oncology in NSCLC, with a focus on surgery and prognostication, and investigates the site-specific strengths and limitations of FDG-PET/CT. Overall, the goal of treatment for NSCLC is to provide the best opportunity for long-term survival; therefore, FDG-PET/CT is expected to play an increasingly important role in deciding the appropriate treatment for such patients.
Highlights
Lung cancer is the leading cause of cancer-related deaths worldwide [1]
This review focuses on recent advances in FDG-positron emission tomography (PET) imaging within the field of clinical oncology in Non-small-cell lung cancer (NSCLC), with a particular emphasis on surgery and prognostication, and investigates the site-specific strengths and limitations of FDG-PET/Computed tomography (CT)
Even if tumors are diagnosed as clinical N0, based on preoperative radiological findings, microscopic lymph node metastasis is sometimes detected by pathological evaluation after surgery [41,42,43,44,45,46,47,48,49,50,51,52,53,54]
Summary
Lung cancer is the leading cause of cancer-related deaths worldwide [1]. Non-small-cell lung cancer (NSCLC) is the most common type of lung cancer, with subtypes including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma [2]. Feng et al reported finding a 7% false positive FDG-PET/CT rate in patients with lung cancer, the causes for which included inflammatory pseudotumor (43%), tuberculoma (37%), and organizing pneumonia (6%). 3. Predictive Value of FDG-PET/CT for the Detection of Lymph Node Metastasis in Patients with NSCLC. Even if tumors are diagnosed as clinical N0 (no nodal involvement), based on preoperative radiological findings, microscopic lymph node metastasis is sometimes detected by pathological evaluation after surgery [41,42,43,44,45,46,47,48,49,50,51,52,53,54]. FDG-PET/CT has been shown to have a sensitivity of 58–94% and a specificity of 76–96% for the detection of mediastinal lymph node metastasis [58].
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