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PET/CT for the Assessment of Pulmonary Nodules

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Early-stage Lung Cancer
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Abstract

As a noninvasive functional and anatomical imaging modality, PET/CT could provide additional information reflecting the biological features of lung cancer as well as anatomical information. In advanced lung cancers, PET/CT has showed unique values in diagnosis, staging, predictive analysis, and outcome assessment. With the development of lung cancer screening, the detection rate of small pulmonary nodules measuring less than 10 mm in diameter is increasing. The diagnosis and differential diagnosis of these subcentimeter pulmonary nodules are challenging. Numerous studies have conducted to evaluate the performance of PET/CT in small-sized early-stage NSCLC. In this chapter, we are going to elaborate on the advances of PET/CT clinical applications on small-sized pulmonary nodules, especially subcentimeter lung cancers.

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References

  1. Fletcher JW, Kymes SM, Gould M, Alazraki N, Coleman RE, Lowe VJ, Marn C, Segall G, Thet LA, Lee K. A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules. J Nucl Med. 2008;49(2):179–85. https://doi.org/10.2967/jnumed.107.044990.

    Article  PubMed  Google Scholar 

  2. Barger RL Jr, Nandalur KR. Diagnostic performance of dual-time 18F-FDG PET in the diagnosis of pulmonary nodules: a meta-analysis. Acad Radiol. 2012;19(2):153–8. https://doi.org/10.1016/j.acra.2011.10.009.

    Article  PubMed  Google Scholar 

  3. Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Bertelsen A, Ravn J, Clementsen P, Hogholm A, Larsen K, Rasmussen T, Keiding S, Dirksen A, Gerke O, Skov B, Steffensen I, Hansen H, Vilmann P, Jacobsen G, Backer V, Maltbaek N, Pedersen J, Madsen H, Nielsen H, Hojgaard L. Preoperative staging of lung cancer with combined PET-CT. N Engl J Med. 2009;361(1):32–9. https://doi.org/10.1056/NEJMoa0900043.

    Article  CAS  PubMed  Google Scholar 

  4. van Tinteren H, Hoekstra OS, Smit EF, van den Bergh JH, Schreurs AJ, Stallaert RA, van Velthoven PC, Comans EF, Diepenhorst FW, Verboom P, van Mourik JC, Postmus PE, Boers M, Teule GJ. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet. 2002;359(9315):1388–93.

    Article  PubMed  Google Scholar 

Suggested Readings

  1. Balogova S, Huchet V, Kerrou K, Nataf V, Gutman F, Antoine M, Ruppert AM, Prignon A, Lavolee A, Montravers F, Mayaud C, Cadranel J, Talbot JN. Detection of bronchioloalveolar cancer by means of PET/CT and 18F-fluorocholine, and comparison with 18F-fluorodeoxyglucose. Nucl Med Commun. 2010;31(5):389–97. https://doi.org/10.1097/MNM.0b013e3283369654.

  2. Buchbender C, Herbrik M, Treffert J, Forsting M, Bockisch A, Antoch G, Heusner TA. Virtual 18F-FDG PET/CT bronchoscopy for lymph node staging in non-small-cell lung cancer patients: present and future applications. Expert Rev Med Devices. 2012;9(3):241–7. https://doi.org/10.1586/erd.12.9.

    Article  CAS  PubMed  Google Scholar 

  3. Cha MJ, Lee KS, Kim HS, Lee SW, Jeong CJ, Kim EY, Lee HY. Improvement in imaging diagnosis technique and modalities for solitary pulmonary nodules: from ground-glass opacity nodules to part-solid and solid nodules. Expert Rev Respir Med. 2016;10(3):261–78. https://doi.org/10.1586/17476348.2016.1141053.

    Article  CAS  PubMed  Google Scholar 

  4. Chao F, Zhang H. PET/CT in the staging of the non-small-cell lung cancer. J Biomed Biotechnol. 2012;2012:783739. https://doi.org/10.1155/2012/783739.

    PubMed  PubMed Central  Google Scholar 

  5. Chiu CF, Lin YY, Hsu WH, Chen CY, Yeh JJ, Kao CH. Shorter-time dual-phase FDG PET/CT in characterizing solid or ground-glass nodules based on surgical results. Clin Imaging. 2012;36(5):509–14. https://doi.org/10.1016/j.clinimag.2011.11.032.

    Article  PubMed  Google Scholar 

  6. Chun EJ, Lee HJ, Kang WJ, Kim KG, Goo JM, Park CM, Lee CH. Differentiation between malignancy and inflammation in pulmonary ground-glass nodules: the feasibility of integrated (18)F-FDG PET/CT. Lung Cancer. 2009;65(2):180–6. https://doi.org/10.1016/j.lungcan.2008.11.015.

    Article  PubMed  Google Scholar 

  7. Divisi D, Barone M, Zaccagna G, Crisci R. Fluorine-18 fluorodeoxyglucose positron emission tomography in the management of solitary pulmonary nodule: a review. Ann Med. 2017;49:626–35. https://doi.org/10.1080/07853890.2017.1339906.

    Article  PubMed  Google Scholar 

  8. Gomez-Caro A, Boada M, Cabanas M, Sanchez M, Arguis P, Lomena F, Ramirez J, Molins L. False-negative rate after positron emission tomography/computer tomography scan for mediastinal staging in cI stage non-small-cell lung cancer. Eur J Cardiothorac Surg. 2012;42(1):93–100; discussion 100. https://doi.org/10.1093/ejcts/ezr272.

    Article  PubMed  Google Scholar 

  9. Gould MK, Ananth L, Barnett PG. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest. 2007;131(2):383–8. https://doi.org/10.1378/chest.06-1261.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e93S–e120S. https://doi.org/10.1378/chest.12-2351.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Clinical significance of positron emission tomography in subcentimeter non-small cell lung cancer. Ann Thorac Surg. 2017;103(5):1614–20. https://doi.org/10.1016/j.athoracsur.2016.09.059.

    Article  PubMed  Google Scholar 

  12. Hattori A, Suzuki K, Matsunaga T, Fukui M, Tsushima Y, Takamochi K, Oh S. Tumour standardized uptake value on positron emission tomography is a novel predictor of adenocarcinoma in situ for c-stage IA lung cancer patients with a part-solid nodule on thin-section computed tomography scan. Interact Cardiovasc Thorac Surg. 2014;18(3):329–34. https://doi.org/10.1093/icvts/ivt500.

    Article  PubMed  Google Scholar 

  13. Kernstine KH, Grannis FW Jr, Rotter AJ. Is there a role for PET in the evaluation of subcentimeter pulmonary nodules? Semin Thorac Cardiovasc Surg. 2005;17(2):110–4. https://doi.org/10.1053/j.semtcvs.2005.04.004.

    Article  PubMed  Google Scholar 

  14. Kozower BD, Meyers BF, Reed CE, Jones DR, Decker PA, Putnam JB Jr. Does positron emission tomography prevent nontherapeutic pulmonary resections for clinical stage IA lung cancer? Ann Thorac Surg. 2008;85(4):1166–1169; discussion 1169-1170. https://doi.org/10.1016/j.athoracsur.2008.01.018.

    Article  PubMed  Google Scholar 

  15. Lasnon C, Hicks RJ, Beauregard JM, Milner A, Paciencia M, Guizard AV, Bardet S, Gervais R, Lemoel G, Zalcman G, Aide N. Impact of point spread function reconstruction on thoracic lymph node staging with 18F-FDG PET/CT in non-small cell lung cancer. Clin Nucl Med. 2012;37(10):971–6. https://doi.org/10.1097/RLU.0b013e318251e3d1.

    Article  PubMed  Google Scholar 

  16. Minamimoto R, Senda M, Jinnouchi S, Terauchi T, Yoshida T, Uno K, Iinuma T, Murano T, Nakashima R, Inoue T. Detection of lung cancer by FDG-PET cancer screening program: a nationwide Japanese survey. Anticancer Res. 2014;34(1):183–9.

    PubMed  Google Scholar 

  17. Murakami S, Saito H, Sakuma Y, Kondo T, Oshita F, Ito H, Tsuboi M, Hasegawa C, Yokose T, Kameda Y, Nakayama H, Yamada K. Prognostic value of preoperative FDG-PET in stage IA lung adenocarcinoma. Eur J Radiol. 2012;81(8):1891–5. https://doi.org/10.1016/j.ejrad.2011.04.007.

    Article  PubMed  Google Scholar 

  18. Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM, Macchiarini P, Crapo JD, Herold CJ, Austin JH, Travis WD. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner society. Radiology. 2013;266(1):304–17. https://doi.org/10.1148/radiol.12120628.

    Article  PubMed  Google Scholar 

  19. Nair VS, Barnett PG, Ananth L, Gould MK. PET scan 18F-fluorodeoxyglucose uptake and prognosis in patients with resected clinical stage IA non-small cell lung cancer. Chest. 2010;137(5):1150–6. https://doi.org/10.1378/chest.09-2356.

    Article  PubMed  Google Scholar 

  20. Nitadori J, Bograd AJ, Morales EA, Rizk NP, Dunphy MP, Sima CS, Rusch VW, Adusumilli PS. Preoperative consolidation-to-tumor ratio and SUVmax stratify the risk of recurrence in patients undergoing limited resection for lung adenocarcinoma </=2 cm. Ann Surg Oncol. 2013;20(13):4282–8. https://doi.org/10.1245/s10434-013-3212-2.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med. 2003;348(25):2535–42. https://doi.org/10.1056/NEJMcp012290.

    Article  PubMed  Google Scholar 

  22. Park HK, Jeon K, Koh WJ, Suh GY, Kim H, Kwon OJ, Chung MP, Lee KS, Shim YM, Han J, Um SW. Occult nodal metastasis in patients with non-small cell lung cancer at clinical stage IA by PET/CT. Respirology. 2010;15(8):1179–84. https://doi.org/10.1111/j.1440-1843.2010.01793.x.

    Article  PubMed  Google Scholar 

  23. Park SY, Cho A, WS Y, Lee CY, Lee JG, Kim DJ, Chung KY. Prognostic value of total lesion glycolysis by 18F-FDG PET/CT in surgically resected stage IA non-small cell lung cancer. J Nucl Med. 2015;56(1):45–9. https://doi.org/10.2967/jnumed.114.147561.

    Article  CAS  PubMed  Google Scholar 

  24. Qiu ZX, Cheng Y, Liu D, Wang WY, Wu X, WL W, Li WM. Clinical, pathological, and radiological characteristics of solitary ground-glass opacity lung nodules on high-resolution computed tomography. Ther Clin Risk Manag. 2016;12:1445–53. https://doi.org/10.2147/tcrm.s110363.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Saisho S, Yasuda K, Maeda A, Yukawa T, Okita R, Hirami Y, Shimizu K, Nakata M. Role of 2-[18F]fluoro-2-deoxyglucose positron emission tomography in preoperative management of solid-type small-sized lung cancer. Ann Nucl Med. 2013;27(6):515–22. https://doi.org/10.1007/s12149-013-0715-7.

    Article  PubMed  Google Scholar 

  26. Sayyouh M, Vummidi DR, Kazerooni EA. Evaluation and management of pulmonary nodules: state-of-the-art and future perspectives. Expert Opin Med Diagn. 2013;7(6):629–44. https://doi.org/10.1517/17530059.2013.858117.

    Article  PubMed  Google Scholar 

  27. Shibata H, Nomori H, Uno K, Iyama K, Tomiyoshi K, Nakashima R, Sakaguchi K, Goya T, Takanami I, Koizumi K, Suzuki T, Kaji M, Horio H. 11C-acetate for positron emission tomography imaging of clinical stage IA lung adenocarcinoma: comparison with 18F-fluorodeoxyglucose for imaging and evaluation of tumor aggressiveness. Ann Nucl Med. 2009;23(7):609–16. https://doi.org/10.1007/s12149-009-0278-9.

    Article  PubMed  Google Scholar 

  28. Shiono S, Abiko M, Okazaki T, Chiba M, Yabuki H, Sato T. Positron emission tomography for predicting recurrence in stage I lung adenocarcinoma: standardized uptake value corrected by mean liver standardized uptake value. Eur J Cardiothorac Surg. 2011;40(5):1165–9. https://doi.org/10.1016/j.ejcts.2011.02.041.

    PubMed  Google Scholar 

  29. Shiono S, Abiko M, Sato T. Limited resection for clinical stage IA non-small-cell lung cancers based on a standardized-uptake value index. Eur J Cardiothorac Surg. 2013;43(1):e7–e12. https://doi.org/10.1093/ejcts/ezs573.

    Article  PubMed  Google Scholar 

  30. Shiono S, Yanagawa N, Abiko M, Sato T. Detection of non-aggressive stage IA lung cancer using chest computed tomography and positron emission tomography/computed tomography. Interact Cardiovasc Thorac Surg. 2014;19(4):637–43. https://doi.org/10.1093/icvts/ivu188.

    Article  PubMed  Google Scholar 

  31. Sun JS, Park KJ, Sheen SS, Yoon JK, Yoon SN, Lee KB, Hwang SC. Clinical usefulness of the fluorodeoxyglucose (FDG)-PET maximal standardized uptake value (SUV) in combination with CT features for the differentiation of adenocarcinoma with a bronchioloalveolar carcinoma from other subtypes of non-small cell lung cancers. Lung Cancer. 2009;66(2):205–10. https://doi.org/10.1016/j.lungcan.2009.01.009.

    Article  PubMed  Google Scholar 

  32. Swensen SJ, Silverstein MD, Ilstrup DM, Schleck CD, Edell ES. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med. 1997;157(8):849–55.

    Article  CAS  PubMed  Google Scholar 

  33. Takenaka T, Yano T, Morodomi Y, Ito K, Miura N, Kawano D, Shoji F, Baba S, Abe K, Honda H, Maehara Y. Prediction of true-negative lymph node metastasis in clinical IA non-small cell lung cancer by measuring standardized uptake values on positron emission tomography. Surg Today. 2012;42(10):934–9. https://doi.org/10.1007/s00595-012-0277-7.

    Article  PubMed  Google Scholar 

  34. Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, Okada M. Solid tumor size on high-resolution computed tomography and maximum standardized uptake on positron emission tomography for new clinical T descriptors with T1 lung adenocarcinoma. Ann Oncol. 2013;24(9):2376–81. https://doi.org/10.1093/annonc/mdt230.

    Article  CAS  PubMed  Google Scholar 

  35. Uehara H, Tsutani Y, Okumura S, Nakayama H, Adachi S, Yoshimura M, Miyata Y, Okada M. Prognostic role of positron emission tomography and high-resolution computed tomography in clinical stage IA lung adenocarcinoma. Ann Thorac Surg. 2013;96(6):1958–65. https://doi.org/10.1016/j.athoracsur.2013.06.086.

    Article  PubMed  Google Scholar 

  36. Waki A, Fujibayashi Y, Yokoyama A. Recent advances in the analyses of the characteristics of tumors on FDG uptake. Nucl Med Biol. 1998;25(7):589–92.

    Article  CAS  PubMed  Google Scholar 

  37. Wang YC, Tseng HL, Lin YH, Kao CH, Huang WC, Huang TC. Improvement of internal tumor volumes of non-small cell lung cancer patients for radiation treatment planning using interpolated average CT in PET/CT. PLoS One. 2013;8(5):e64665. https://doi.org/10.1371/journal.pone.0064665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Yi CA, Lee KS, Kim BT, Choi JY, Kwon OJ, Kim H, Shim YM, Chung MJ. Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT. J Nucl Med. 2006;47(3):443–50.

    PubMed  Google Scholar 

  39. Yonemori K, Tateishi U, Uno H, Yonemori Y, Tsuta K, Takeuchi M, Matsuno Y, Fujiwara Y, Asamura H, Kusumoto M. Development and validation of diagnostic prediction model for solitary pulmonary nodules. Respirology. 2007;12(6):856–62. https://doi.org/10.1111/j.1440-1843.2007.01158.x.

    Article  PubMed  Google Scholar 

  40. Yoshioka M, Ichiguchi O. Selection of sublobar resection for c-stage IA non-small cell lung cancer based on a combination of structural imaging by CT and functional imaging by FDG PET. Ann Thorac Cardiovasc Surg. 2009;15(2):82–8.

    PubMed  Google Scholar 

  41. Zhang WD, Guan YB, Li CX, Huang XB, Zhang FJ. Pulmonary mucosa-associated lymphoid tissue lymphoma: computed tomography and (1)(8)F fluorodeoxyglucose-positron emission tomography/computed tomography imaging findings and follow-up. J Comput Assist Tomogr. 2011;35(5):608–13. https://doi.org/10.1097/RCT.0b013e318227a661.

    Article  CAS  PubMed  Google Scholar 

  42. Zhou J, Li Y, Zhang Y, Liu G, Tan H, Hu Y, Xiao J, Shi H. Solitary ground-glass opacity nodules of stage IA pulmonary adenocarcinoma: combination of 18F-FDG PET/CT and high-resolution computed tomography features to predict invasive adenocarcinoma. Oncotarget. 2017;8(14):23312–21. https://doi.org/10.18632/oncotarget.15577.

    Article  PubMed  PubMed Central  Google Scholar 

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Guan, Y. (2018). PET/CT for the Assessment of Pulmonary Nodules. In: Zheng, X., Li, M., Zhang, G. (eds) Early-stage Lung Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-7596-4_4

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