FDG PET Imaging for Lung Cancer

Solitary Pulmonary Nodule: Medicare has approved the use of PET/CT in the assessment of SPN’s. Because of the low background uptake of FDG in the lung, the sensitivity of PET/CT for SPN’s is very high. In a meta analysis of over 1400 nodules, Gould et al (2001) found that PET had a sensitivity of 97% and an specificity of 78%.

1.Gould et al. Accuracy of PET for the diagnosis of pulmonary nodules and mass lesions: A Meta Analysis. JAMA 2001;2856:914-924.

Non-Small Cell Lung Cancer: Medicare has approved the use of PET/CT for staging, restaging and detecting recurrence in non-small cell lung cancer.

Lung Cancer & FDG PET Imaging Statistics**

Table 1: Utility of PET Imaging in Lung Cancer Diagnosis (N=1108)

  PET CT
Sensitivity 96% 67%
Specificity 73% N/A
PPV 91% N/A
NPV 90% N/A
Accuracy 90% N/A

Table 2: Utility of PET Imaging in Lung Cancer Staging (N=4005)

  PET CT
Sensitivity 83% 64%
Specificity 91% 74%
PPV 86% 67%
NPV 93% 86%
Accuracy 82% 68%

For this patient population there was a 37% change in the way the physician managed these patients based upon the PET scan.

Table 3: Utility of PET Imaging in Lung Cancer Recurrence (N=337)

  PET CT
Sensitivity 98% 72%
Specificity 92% 95%
PPV 93% 93%
NPV 97% 79%
Accuracy 96% 64%

Table 4: Utility ofPET Imaging in Monitoring Lung Cancer (N=270 )

  PET CT
Sensitivity 94% 72%
Specificity 90% 95%
PPV 92% 93%
NPV 100% 79%
Accuracy 96% 84%

** Reprinted by permission of the Society of Nuclear Medicine from: Gambhir, Sanjiv S., Czernin, Johannes, Schwimmer, Judy, Silverman, Daniel H.S., Coleman, R. Edward, Phelps, Michael E. “A Tabulated Summary of the FDG PET Literature” J Nucl Med 2001 42: 1-93.

Case Study
Patient: 61yo male remote smoker. The patient presented with CP and abnormal CXR. He was treated for pneumonia without resolution. CT documented right lower lobe mass. He was scheduled for mediastinoscopy. Bone scan showed a cracked rib from a recent fall, but otherwise was called normal. PET/CT was ordered prior to surgery.

Results: Detected more disease than bone scan. Upstaged the patient to stage IV. Risk stratified the patient away from a futile invasive procedure.