- •
PET is essential to accurately stage patients with potentially curable lung cancer.
- •
PET plays a central role in precision medicine by helping to noninvasively assess molecular pathobiology and genetic make-up of disease so that appropriate therapy is selected and started.
- •
PET is key for subsequent treatment strategy of patients with lung cancer, including monitoring of therapy response, detection of recurrence, and prediction of patient outcomes.
Molecular Imaging and Precision Medicine in Lung Cancer
Section snippets
Key points
Precision medicine and lung cancer
Lung cancer is the second most commonly diagnosed malignancy in men and women, estimated to account for approximately 224,390 new cases and 158,080 deaths in 2016 according to the American Cancer Society.1 Although localized disease may be curable, metastatic lung cancer is the leading cause of cancer-related death. Indeed, it is estimated that one out of four cancer-related deaths are related to manifestations of metastatic lung cancer.1
Lung cancer is heterogeneous morphologically and
PET/CT Imaging in initial staging of the patient with lung cancer
FDG-PET/CT is helpful to (1) characterize a morphologically indeterminate solitary pulmonary nodule (SPN); (2) guide biopsy to the site of most aggressive, intensely FDG-avid, disease; and (3) evaluate disease extent including primary disease, lymph nodes, and distant metastases.
An SPN is a common incidental finding on anatomic imaging done as a part of clinical practice.6 The differential diagnoses are numerous and include benign and malignant causes, such as infection, inflammation, and lung
PET-based molecular imaging and precision medicine in the subsequent treatment strategy of the patient with lung cancer
Precision medicine aims to classify patients into subgroups by integrating molecular pathobiology and genetic make-up of disease with clinical manifestations to diagnose, stage, predict treatment response, and suggest patient outcome.32 Once those who will benefit are identified, tailored “preventive or therapeutic interventions” can be used to avoid the expense and toxicity of futile treatment given to those who will not respond. The ultimate goal is to offer the right treatment, to the right
PET as a predictive biomarker of response to lung cancer therapy
Limitations and pitfalls of morphologic imaging criteria (ie, World Health Organization, Response Evaluation Criteria in Solid Tumours [RECIST]) to assess tumor response or progression after therapy have become evident over the years. Some of these shortcomings are related to issues of reproducibility and that results do not correlate with patient outcomes in certain tumor types. Other limitations are therapy specific, because morphologic response criteria were designed to monitor the cytolytic
PET as a biomarker of prognosis in lung cancer
Several studies have been conducted to determine the prognostic value of FDG-PET in lung cancer. Understanding the prognostic value of FDG metabolism in these lesions facilitates the identification of patients at high risk of early disease progression irrespective of their clinical stage at diagnosis. This information can then be used early during the clinical management of the patient with lung cancer to personalize postsurgical therapy in those with early stage disease, but highly
Summary
PET/CT is a sensitive molecular imaging technique with a major role in the precision medicine algorithm of the patient with lung cancer. On one hand, it provides anatomofunctional insight during diagnosis, staging, and restaging. On the other hand, it is a biomarker of tumoral heterogeneity that directs the selection of the most appropriate treatment, and predicts response early and accurately during the course of cytotoxic and cytostatic therapies. Last but not least, it is a biomarker of
References (76)
- et al.
The current and evolving role of PET in personalized management of lung Cancer
PET Clin
(2016) - et al.
Assessment of indeterminate pulmonary nodules detected in lung cancer screening: diagnostic accuracy of FDG PET/CT
Lung Cancer
(2016) - et al.
Oncologic outcomes of segmentectomy versus lobectomy for clinical T1a N0 M0 non-small cell lung cancer
Ann Thorac Surg
(2016) - et al.
Impact of tumor size on outcomes after anatomic lung resection for stage 1A non-small cell lung cancer based on the current staging system
J Thorac Cardiovasc Surg
(2012) - et al.
Anatomo-metabolic characteristics of atelectasis in F-18 FDG-PET/CT imaging
Eur J Radiol
(2007) - et al.
Noninvasive staging of non-small cell lung cancer: a review of the current evidence
Chest
(2003) - et al.
American College of Surgeons Oncology Group Z0050 trial. results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer
J Thorac Cardiovasc Surg
(2003) FDG-PET for lymph node staging in NSCLC: a major step forward, but beware of the pitfalls
Lung Cancer
(2005)- et al.
High rate of detection of unsuspected distant metastases by PET in apparent stage III non-small-cell lung cancer: implications for radical radiation therapy
Int J Radiat Oncol Biol Phys
(2001) - et al.
Clinical evaluation of whole-body 18F-fluorodeoxyglucose positron emission tomography in the detection of liver metastases
Ann Oncol
(1998)
Positron-emission tomography in prognostic and therapeutic assessment of lung cancer: systematic review
Lancet Oncol
Repeat 18F-FDG-PET after neoadjuvant therapy is a predictor of pathologic response in patients with non-small cell lung cancer
Ann Thorac Surg
Early FDG-PET imaging after radical radiotherapy for non-small-cell lung cancer: inflammatory changes in normal tissues correlate with tumor response and do not confound therapeutic response evaluation
Int J Radiat Oncol Biol Phys
Usefulness of FDG-PET for early prediction of the response to gefitinib in non-small cell lung cancer
Lung Cancer
Primary tumor standardized uptake value measured on fluorodeoxyglucose positron emission tomography is of prognostic value for survival in non-small cell lung cancer: update of a systematic review and meta-analysis by the European Lung Cancer Working Party for the International Association for the Study of Lung Cancer Staging Project
J Thorac Oncol
NF-κB protein expression associates with (18)F-FDG PET tumor uptake in non-small cell lung cancer: a radiogenomics validation study to understand tumor metabolism
Lung Cancer
Prognostic value of preoperative positron emission tomography in resected stage I nonsmall cell lung cancer
J Thorac Oncol
The maximum standardized uptake values on positron emission tomography of a non-small cell lung cancer predict stage, recurrence, and survival
J Thorac Cardiovasc Surg
Complete metabolic tumour response, assessed by 18-fluorodeoxyglucose positron emission tomography (18FDG-PET), after induction chemotherapy predicts a favourable outcome in patients with locally advanced non-small cell lung cancer (NSCLC)
Lung Cancer
Multimodality imaging review of malignant pleural mesothelioma diagnosis and staging
PET Clin
Tumor treatment response based on visual and quantitative changes in global tumor glycolysis using PET-FDG imaging. the visual response score and the change in total lesion glycolysis
Clin Positron Imaging
Metabolic tumor burden predicts for disease progression and death in lung cancer
Int J Radiat Oncol Biol Phys
Tumor volume combined with number of positive lymph node stations is a more important prognostic factor than TNM stage for survival of non-small-cell lung cancer patients treated with (chemo)radiotherapy
Int J Radiat Oncol Biol Phys
Prognostic value of the quantitative metabolic volumetric measurement on 18F-FDG PET/CT in stage IV nonsurgical small-cell lung cancer
Acad Radiol
Prognostic value of metabolic tumor burden from (18)F-FDG PET in surgical patients with non-small-cell lung cancer
Acad Radiol
The metabolism of tumours in the body
J Gen Physiol
On respiratory impairment in cancer cells
Science
PET/CT of lung cancer
Recent trends in the identification of incidental pulmonary nodules
Am J Respir Crit Care Med
Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis
JAMA
A tabulated summary of the FDG PET literature
J Nucl Med
Solitary pulmonary nodules: meta-analytic comparison of cross-sectional imaging modalities for diagnosis of malignancy
Radiology
Recommendations on the use of 18F-FDG PET in oncology
J Nucl Med
Staging of non–small-cell lung cancer with integrated positron emission tomography and computed tomography
N Engl J Med
Non-small cell lung cancer: dual-modality PET/CT in preoperative staging
Radiology
Impact of whole-body 18F-FDG PET on staging and managing patients for radiation therapy
J Nucl Med
Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis
Ann Intern Med
Cited by (11)
A novel stereotactic frame for real PET-guided biopsies: A preclinical proof-of-concept
2017, Physica MedicaCitation Excerpt :The use of positron emission tomography (PET) has become increasingly widespread over the past few years as this functional imaging technique can distinguish between tissues with specific metabolic characteristics. In particular, it has had a significant impact in the field of oncology by facilitating the early detection of malignancy [1], the initial staging of tumours [2–3], or the evaluation of the treatment response and the follow-up of patients [4–5]. 18F Fluorodeoxyglucose (FDG) is the most commonly used radiopharmaceutical for PET imaging due to its high sensitivity in the detection of malignancy.
Specialty Imaging: PET
2017, Specialty Imaging: PETCharacteristics of fibrotic-foci-like lung adenocarcinoma on <sup>18</sup>F-FDG PET/computed tomography and HRCT
2023, Nuclear Medicine CommunicationsSP70-Targeted Imaging for the Early Detection of Lung Adenocarcinoma
2020, Scientific ReportsDetection and Independent Validation of Model-Based Quantitative Transcriptional Regulation Relationships Altered in Lung Cancers
2020, Frontiers in Bioengineering and BiotechnologyDriverDBv3: A multi-omics database for cancer driver gene research
2020, Nucleic Acids Research
The authors have nothing to disclose.