Conducted by the Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-Based Care, the review evaluated the accuracy and utility of 18-fluorodeoxyglucose PET (18FDG-PET) in the diagnosis and staging of lung cancer.
"Lung cancer remains the leading cause of cancer-related death and early diagnosis provides the best chance for long term survival. It is our hope this systematic review contributes to clinical guideline discussions exploring the potential of PET as part of standard preoperative work-up - along with computed tomography (CT) - to further enhance assessment of early-stage lung cancer." said Dr. Yee Ung, lead author of the review, Lung Cancer Site Group, Odette Cancer Centre, Sunnybrook.
Standard imaging technologies, such as magnetic resonance imaging or computed tomography imaging, provide structural information and defines disease states based on anatomical changes, but PET provides complementary information on biochemical processes that may precede gross anatomical changes.
The findings of the review revealed that PET imaging is accurate in differentiating between benign and malignant lung tumours as small as 1 centimetre. PET was also shown to be more effective for mediastinal (lymph nodes in the centre of the chest) staging in non-small cell lung cancer.
Nonetheless, confirmation of PET findings by surgical biopsy remains important. With best available data, the researchers also identified good accuracy in staging extensive versus limited stage small cell lung cancer.
The Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-Based Care reviewed recent relevant health technology assessments, randomized trials and meta-analyses and also took into consideration studies evaluating the utility of PET.
"Future research is needed to determine not only if PET should be integrated into the standard staging and diagnostic processes of lung cancer but also how PET would be incorporated into the staging algorithm," Ung said.
The review is published online in Journal of National Cancer Institute.