Positron emission tomography in nonsmall cell lung cancer

[(8)F]2-Fluoro-2-deoxy-glucose positron emission tomography is an important functional imaging technique for the diagnosis, staging and follow-up of patients with nonsmall cell lung cancer. We review recent developments with the emphasis on impact of positron emission tomography in early diagnosis, staging, restaging and prognosis of nonsmall cell lung cancer.

Data on the use and interpretation of positron emission tomography became available for small pulmonary nodules. We should abandon the 'magic' standardized uptake value threshold of 2.5 and rather make a visual assessment in this setting. The high negative predictive value of positron emission tomography in mediastinal staging was confirmed in a large prospective study. Tissue confirmation of all qualitative or quantitative suspicious mediastinal lymph nodes at positron emission tomography remains required. Minimally invasive techniques such as endobronchial ultrasound-guided transbronchial needle aspiration seem promising in this setting with sensitivities up to 90%. Recent data also point at integrated positron emission tomography/computed tomography as a tool for response assessment of mediastinal nodes and, more interestingly, of the primary tumor. Positron emission tomography has the potential to predict survival based on baseline positron emission tomography stage and standardized uptake value, visual [(18)F]2-fluoro-2-deoxy-glucose uptake at the time of suspected recurrence, and change in [(18)F]2-fluoro-2-deoxy-glucose uptake after neoadjuvant therapy.

Refinements in diagnosis and staging, as well as newer applications such as guidance of endoscopy and assessment of treatment, are described.