Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer.
Role of FDG-PET scans in staging, response assessment, and follow-up care for non-small cell lung cancer.
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DOI：
10.3389/fonc.2012.00208
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发表时间：
2012
影响因子：
4.7
通讯作者：
Rimner A
中科院分区：
文献类型：
--
作者：
Cuaron J;Dunphy M;Rimner A
使用葡萄糖类似物氟-18氟脱氧葡萄糖(FDG)的正电子发射断层扫描(PET)在非小细胞肺癌(NSCLC)分期中的重要作用已得到证实。有证据表明正电子发射计算机断层扫描在评估新辅助治疗、综合治疗和早期发现复发方面的作用。在这里，我们回顾了目前关于PET在非小细胞肺癌治疗中的这些方面的文献。FDG-PET，特别是集成的18F-FDG-PET/CT，已成为非小细胞肺癌局部肿瘤范围、纵隔淋巴结受累和远处转移疾病分期的标准检查。18F-FDG-PET敏感性一般优于单纯CT扫描。在某些情况下，FDG-PET可以更准确地确定局部肿瘤的范围和T分期，特别是在梗阻后肺不张或低CT密度变异的区域。FDG-PET对肿瘤的敏感度降低1厘米，至少部分是由于呼吸运动。假阴性结果可能发生在肿瘤负荷较低的区域，例如小淋巴结或磨玻璃样阴影。18F-FDG-PET-CT的结节分期比单独CT更准确，因为18F-FDG-PET扫描通常在不符合CT恶性受累标准的情况下首先发现肺门和纵隔受累。18F-FDG-PET扫描已经广泛取代了骨显像，用于评估远处转移，但大脑除外，这仍然需要专门的脑成像。18F-FDG摄取也被证明在不同的组织类型之间存在差异，腺癌通常比鳞癌对FDG的摄取不那么强烈。18F-FDG-PET扫描有助于发现复发，但目前不推荐用于常规随访。通常，患者每隔3-6个月进行一次胸部CT扫描，使用18F-FDG-PET来评估可疑的CT表现。由于18F-FDG高摄取可发生在感染性、炎症性和其他非肿瘤性条件下，18F-FDG-PET阳性发现在大多数情况下需要病理证实。人们对FDG-PET扫描的预后和预测作用越来越感兴趣。研究表明，缺乏对新辅助治疗的代谢反应与较差的病理反应有关，而良好的18F-FDG-PET反应似乎与改善存活率有关。进一步的工作正在进行中，以确定可能受益于基于FDG-PET的个性化治疗的患者亚群。
The integral role of positron-emission tomography (PET) using the glucose analog tracer fluorine-18 fluorodeoxyglucose (FDG) in the staging of non-small cell lung cancer (NSCLC) is well established. Evidence is emerging for the role of PET in response assessment to neoadjuvant therapy, combined-modality therapy, and early detection of recurrence. Here, we review the current literature on these aspects of PET in the management of NSCLC. FDG-PET, particularly integrated 18F-FDG-PET/CT, scans have become a standard test in the staging of local tumor extent, mediastinal lymph node involvement, and distant metastatic disease in NSCLC. 18F-FDG-PET sensitivity is generally superior to computed tomography (CT) scans alone. Local tumor extent and T stage can be more accurately determined with FDG-PET in certain cases, especially in areas of post-obstructive atelectasis or low CT density variation. FDG-PET sensitivity is decreased in tumors <1 cm, at least in part due to respiratory motion. False-negative results can occur in areas of low tumor burden, e.g., small lymph nodes or ground-glass opacities. 18F-FDG-PET-CT nodal staging is more accurate than CT alone, as hilar and mediastinal involvement is often detected first on 18F-FDG-PET scan when CT criteria for malignant involvement are not met. 18F-FDG-PET scans have widely replaced bone scintography for assessing distant metastases, except for the brain, which still warrants dedicated brain imaging. 18F-FDG uptake has also been shown to vary between histologies, with adenocarcinomas generally being less FDG avid than squamous cell carcinomas. 18F-FDG-PET scans are useful to detect recurrences, but are currently not recommended for routine follow-up. Typically, patients are followed with chest CT scans every 3–6 months, using 18F-FDG-PET to evaluate equivocal CT findings. As high 18F-FDG uptake can occur in infectious, inflammatory, and other non-neoplastic conditions, 18F-FDG-PET-positive findings require pathological confirmation in most cases. There is increased interest in the prognostic and predictive role of FDG-PET scans. Studies show that absence of metabolic response to neoadjuvant therapy correlates with poor pathologic response, and a favorable 18F-FDG-PET response appears to be associated with improved survival. Further work is underway to identify subsets of patients that might benefit individualized management based on FDG-PET.