PET in lung cancer.

Accurate tumor staging is essential for choosing the appropriate treatment strategy in patients with lung cancer. It has already been shown that FDG-PET is highly accurate in classifying lung nodules as benign or malignant. Integrated PET-CT enables the exact matching of focal abnormalities on PET to anatomic structures on CT. PET-CT is superior in diagnostic accuracy for T staging and differentiation between tumor and peritumoral atelectasis. PET has also proved to be a very effective staging modality for mediastinal nodal staging. It has been demonstrated to assist mediastinoscopy to reveal additional mediastinal disease in 6% of patients. PET detects unexpected extrathoracic metastases in 10-20% of patients and changes therapeutic management in about 20% of patients. A very high accuracy of FDG-PET in distinguishing recurrent disease from benign treatment effects has been shown. Patients should be evaluated after a minimum of 2 months after completion of therapy. FDG-PET can be clinically used for selecting biopsy sites. At our institution PET-CT has become the standard imaging modality for staging patients with lung cancer. Although not all tumors take up FDG, other radiotracers are being studied to expand the utility of PET-CT. PET-CT offers many opportunities for the patients, the clinicians, and the researchers. PET-CT has the potential to become the most efficient oncologic examination in the near future.