Anne Arens MD, Presenter: Nothing to Disclose

Wendy Maria Jozephina Schreurs MD, Abstract Co-Author: Nothing to Disclose

Baudewijn Willem Hendrickx MD, Abstract Co-Author: Nothing to Disclose

Jan-Willem Postema MD, Abstract Co-Author: Nothing to Disclose

Albert Lafeber MD, Abstract Co-Author: Nothing to Disclose

Wouter Victor Vogel MD, PhD, Abstract Co-Author: Nothing to Disclose

FDG-PET/CT for initial evaluation of lung cancer is usually performed as a wholebody scan.This includes areas with a low pre-test likelihood for metastases, i.e. the head and neck (HN) and lower abdomen and pelvis (AP). Standard diagnostic CT-thorax does not include these areas.  We evaluated the feasibility of FDG-PET/CT limited to the thoracic range, for evaluation of lung cancer.  

In a multicenter trial 1059 FDG-PET/CT scans of patients with suspected or recently proven lung cancer were retrospectively evaluated. Excluded were patients with prior malignant disease or symptoms outside the thoracic region. Scan protocols varied slightly including low-dose or diagnostic wholebody CT, some including the brain. The occurrence of lesions suspect for malignancy in HN and AP was noted. The impact of  lesions in these areas on ordering additional investigations, staging, therapy and the detection of second primary malignancies was evaluated.  

HN revealed PET-positive lesions in 7.2%, of which 2.4% received additional investigations. Considered metastatic in HN were 3.2%, this upstaged only 0.5% and changed therapy in 0.4%, because most of these patients already showed distant metastases within the thorax or upper abdomen. AP showed PET-positive lesions in 15.8%, of which further investigated were 5.7%, considered metastatic 9.7%, upstaged 0.8%, and therapy changed in 0.8%. Six second primaries were confirmed in AP (0.6%), none in HN. Other reported lesions were either neglected, could not be confirmed, or were confirmed benign. In total, NOT scanning HN+AP would have (a) avoided reporting of (mostly irrelevant or neglected) PET lesions in 19,5% ,(b) avoided additional diagnostic procedures in 7.6%, and (c) reduced CT radiation burden, while understaging with therapeutic consequences in 1,2% and missing  proved second primaries in 0.6%.  

Thoracic FDG-PET/CT for initial staging of (suspected) lung cancer obviates wholebody low-dose or diagnostic CT, allows faster patient throughput on scarce PET resources, reduces additional diagnostic procedures thus therapy delay, while hardly affecting the added clinical value of FDG-PET.  

Limited range thoracic FDG-PET/CT is a feasible alternative strategy for initial staging of (suspected) lung cancer. 

Arens, A, Schreurs, W, Hendrickx, B, Postema, J, Lafeber, A, Vogel, W, Thoracic Range FDG-PET/CT for Staging and Management of Lung Cancer.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6010638.html