Role of FDG-PET in the diagnosis and management of lung cancer

Positron emission tomography (PET) using (18)F]-2-deoxy-2-fluoro-d-glucose (FDG) has emerged as a valuable diagnostic modality in patients with non-small cell lung cancer (NSCLC). Data in the literature show that the addition of FDG-PET definitely alters clinical management in patients with potentially resectable NSCLC by adequately staging the mediastinum and detecting previously unknown distant metastases. Thus, the number of noncurative thoracotomies and unnecessary mediastinoscopies is reduced. Furthermore, there is increasing evidence that FDG-PET will change radiation treatment planning by defining a biologic treatment volume, incorporating unsuspected additional locoregional disease, and avoiding overtreatment by identifying computerized tomography abnormalities as benign. For follow-up during systemic therapy, early FDG-PET appears to be predictive for the response to therapy. However, before FDG-PET-induced changes in patient management can be incorporated into clinical practice both for radiation treatment planning and chemotherapy, technical issues must be resolved, validation studies should be performed and, most importantly, randomized trials are necessary to evaluate the effect of FDG-PET on patient outcome parameters.