Spiro Stephen G, Buscombe John, Cook Gary, Eisen Tim, Gleeson Fergus, O'Brien Mary, Peake Michael D, Rowell Nicholas P, Seymour Richard
Department of Respiratory Medicine, University College Hospital, UCLH NHS Foundation Trust, London WC1E 6AU, United Kingdom.
Lung Cancer. 2008 Jan;59(1):48-56. doi: 10.1016/j.lungcan.2007.07.026. Epub 2007 Sep 12.
Guidelines issued by the National Institute for Clinical Excellence (NICE) in the England and Wales recommend that rapid access to (18)F-deoxyglucose positron emission tomography (FDG-PET) is made available to all appropriate patients with non-small-cell lung cancer (NSCLC). The clinical evidence for the benefits of PET scanning in NSCLC is substantial, showing that PET has high accuracy, sensitivity and specificity for disease staging, as well as pre-therapeutic assessment in candidates for surgery and radical radiotherapy. Moreover, PET scanning can provide important information to assist in radiotherapy treatment planning, and has also been shown to correlate with responses to treatment and overall outcomes. If the government cancer waiting time targets are to be met, rapid referral from primary to secondary healthcare is essential, as is early diagnostic referral within secondary and tertiary care for techniques such as PET. Studies are also required to explore new areas in which PET may be of benefit, such as surveillance studies in high-risk patients to allow early diagnosis and optimal treatment, while PET scanning to identify treatment non-responders may help optimise therapy, with benefits both for patients and healthcare resource use. Further studies are needed into other forms of lung cancer, including small-cell lung cancer and mesothelioma. In conclusion, PET scanning has the potential to improve the diagnosis and management of lung cancer for many patients. Further studies and refinement of guidelines and procedures will maximise the benefit of this important technique.
英国国家临床优化研究所（NICE）发布的指南建议，应让所有适合的非小细胞肺癌（NSCLC）患者能够快速接受（18）F-脱氧葡萄糖正电子发射断层扫描（FDG-PET）。PET扫描在NSCLC中具有益处的临床证据充分，表明PET对疾病分期以及手术和根治性放疗候选者的治疗前评估具有高准确性、敏感性和特异性。此外，PET扫描可为放疗治疗计划提供重要信息，并且也已证明与治疗反应和总体结果相关。若要实现政府设定的癌症等待时间目标，从初级医疗迅速转诊至二级医疗至关重要，在二级和三级医疗中对PET等技术进行早期诊断转诊也同样重要。还需要开展研究以探索PET可能有益的新领域，例如对高危患者进行监测研究以便早期诊断和优化治疗，而通过PET扫描识别治疗无反应者可能有助于优化治疗，这对患者和医疗资源利用都有益处。还需要对其他形式的肺癌，包括小细胞肺癌和间皮瘤进行进一步研究。总之，PET扫描有可能改善许多患者肺癌的诊断和管理。进一步的研究以及对指南和程序的完善将使这项重要技术的益处最大化。
